GOODWILL AND OTHER INTANGIBLE ASSETS

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill is not amortized, but is evaluated for impairment annually in the fourth quarter of the fiscal year, or more frequently if an event occurs or circumstances change that would more likely than not reduce the fair value of a reporting unit below its carrying value.

Circumstances that could trigger an interim impairment test include: a significant adverse change in the business climate or legal factors; an adverse action or assessment by a regulator; unanticipated competition; the loss of key personnel; a change in reporting units; the likelihood that a reporting unit or significant portion of a reporting unit will be sold or otherwise disposed of; and the results of testing for recoverability of a significant asset group within a reporting unit.

A qualitative impairment analysis was performed in the fourth quarter of 2023, 2022 and 2021, to assess whether it is more likely than not that the fair value of the Company’s reporting unit is less than its carrying value. The Company assessed relevant events and circumstances including macroeconomic conditions, industry and market considerations, overall financial performance, entity-specific events, and changes in the Company’s stock price. The Company determined that there was no goodwill impairment in 2023, 2022 or 2021.

The determination of fair value for acquisitions and the allocation of that value requires the Company to make significant estimates and assumptions. These estimates and assumptions primarily include, but are not limited to, the selection of appropriate peer group companies; control premiums appropriate for acquisitions in the industries in which the Company competes; the discount rate; terminal growth rates; and forecasts of revenue, operating income, depreciation and amortization, and capital expenditures. Actual financial results could differ from those estimates due to the inherent uncertainty involved in making such estimates. Changes in assumptions concerning future financial results or other underlying assumptions could have a significant impact on either the fair value of the reporting unit, the amount of the goodwill impairment charge, or both. The Company did not recognize any accumulated impairment losses at the beginning of the period.

Changes in the carrying amount of goodwill consist of the following activity for the years ended December 31, 2023, 2022 and 2021 (in thousands):


Balance at December 31, 2020	$	1,428,610
Acquisitions	48,954
Balance at December 31, 2021	$	1,477,564
Acquisitions	54,543
Purchase accounting adjustments	1,317
Balance at December 31, 2022	$	1,533,424
Acquisitions	6,998
Purchase accounting adjustments	(176)
Balance at December 31, 2023	$	1,540,246

The carrying amount and accumulated amortization of intangible assets consist of the following as of December 31, 2023 and 2022 (in thousands):


	December 31, 2023		December 31, 2022
Gross intangible assets:
Referral sources	$	514,388	$	509,646
Trademarks/names	39,136		38,508
Other amortizable intangible assets	995		912
Total gross intangible assets	554,519		549,066

Accumulated amortization:
Referral sources	(199,084)		(167,902)
Trademarks/names	(19,698)		(16,901)
Other amortizable intangible assets	(341)		(148)
Total accumulated amortization	(219,123)		(184,951)
Total intangible assets, net	$	335,396	$	364,115

Amortization expense for intangible assets was $34.2 million, $32.9 million and $32.9 million for the years ended December 31, 2023, 2022 and 2021, respectively.

Expected future amortization expense for intangible assets recorded at December 31, 2023, is as follows (in thousands):


	Amount
2024	$	34,386
2025	34,176
2026	34,071
2027	33,931
2028	33,881
2029 and beyond	164,951
Total	$	335,396