Intangible Assets, Goodwill and Other Assets

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Intangible Assets, Goodwill and Other Assets

Intangible Assets, Goodwill and Other Assets(a)Intangible Assets

Intangible assets consisted of the following (amounts in thousands):

	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Weighted Average Amortization Period in Years
December 31, 2019
Customer relationships	$	135,290	$	(21,637)	$	113,653	12.1
Trade names	1,536		(147)		1,389		3.0
Intellectual property	27,700		(10,893)		16,807		3.7
Total	$	164,526	$	(32,677)	$	131,849

	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Weighted Average Amortization Period in Years
December 31, 2018
Customer relationships	$	156,790	$	(104,740)	$	52,050	12.8
Trade names	16,246		(16,215)		31		0.7
Intellectual property	21,700		(6,670)		15,030		4.1
Restrictive covenants	263		(234)		29		0.7
Total	$	194,999	$	(127,859)	$	67,140

Amortization expense of intangible assets is expected to approximate the following (in thousands):

Year ending December 31,	Amortization
2020	$	14,914
2021	14,447
2022	14,439
2023	11,605
2024	10,180
Thereafter	66,264
Total	$	131,849

For the years ended December 31, 2019, 2018 and 2017, amortization expense related to intangible assets was $9.7 million, $24.3 million, and $22.6 million, respectively. In addition, during the year ended December 31, 2019, some of the intangible assets became fully amortized.

(b)Goodwill

As a result of the Accent and VitreosHealth acquisitions, the changes in the carrying amount of goodwill were as follows (in thousands):

Balance at December 31, 2018	$	487,617
Vitreos acquisition	30,189
Accent acquisition	81,545
Balance at December 31, 2019	$	599,351

(c)Other Assets

In the third quarter of 2019, a third party acquired one hundred percent of the outstanding stock of InstaMed Holdings, Inc. ("InstaMed") including the Company's cost based investment in InstaMed of $2.1 million. As a result, the Company received proceeds of $9.8 million from the sale of the investment and recognized a $7.7 million gain in other income for the year ended December 31, 2019.

In 2019, the Company made a investment of $7.4 million in ordinary shares of MedAdvisor Limited ("MedAdvisor")(ASX: MDR), a digital medication management company based in Australia. The equity securities are categorized as Level 1 within the fair value hierarchy as the ordinary shares are actively traded on the Australian Stock Exchange. For the year ended December 31, 2019, the fair value measurement in relation to this equity instrument was $7.9 million. There were no sales, settlements issuances or transfers related to this level 1 instrument in 2019 or 2018.

The Company recorded net unrealized gains of $0.5 million for the year ended December 31, 2019. There were no realized or unrealized gains in 2018. These gains are reflected as a component of other income, in the accompanying Consolidated Statements of Income.