In June 2022, we initiated a restructuring plan with the objective of reducing costs and optimizing our global footprint. In addition, the national volume-based procurement ("VBP") program for spine products in China took place in late September 2022, and we were not successful in our bid. After evaluating our alternatives, in the fourth quarter of 2022, we approved a plan to exit our spine products activities in China. During the three months ended March 31, 2023, we recorded pre-tax charges of $3.3 million related to these actions, and we have incurred pre-tax charges of $12.3 million from inception to date. We anticipate total charges related to these actions of approximately $14-15 million, including projects in process or under final evaluation. The restructuring charges incurred in the three months ended March 31, 2023 under this plan were primarily related to accelerated depreciation and impairment of assets. We anticipate incurring the remaining charges throughout 2023.

In December 2019 and December 2021, Zimmer Biomet initiated restructuring plans (the "ZB Restructuring Plans") with an objective of reducing costs to allow further investment in higher priority growth opportunities. We incurred pre-tax charges related to the ZB Restructuring Plans of $0.7 million in the three months ended March 31, 2022. The restructuring charges incurred under these plans primarily related to employee termination benefits, contract terminations and retention period compensation and benefits. We do not expect to incur material expenses from the ZB Restructuring Plans after June 30, 2022.

The following table summarizes the liabilities directly attributable to us that were recognized under the plans discussed above and excludes non-cash charges (in thousands):


	Employee Termination Benefits			Other			Total
Balance, December 31, 2022	$	1,893		$	2,173		$	4,066
Additions		827			2,092			2,919
Cash payments		(1,762	)		(1,113	)		(2,875	)
Balance, March 31, 2023	$	958		$	3,152		$	4,110

Balance, December 31, 2021	$	1,099		$	1,150		$	2,249
Additions		—			742			742
Cash payments		(36	)		(742	)		(778	)
Balance, March 31, 2022	$	1,063		$	1,150		$	2,213

In April 2023, we initiated additional restructuring activities to better position our organization for future success based on the current business environment. These initiatives have the objective of reducing our global cost structure and streamlining our organizational infrastructure across all regions, functions and levels. We accrued charges of $1.6 million in March 2023 related to professional fees incurred to assess our global cost structure, and we anticipate total charges related to the program of approximately $15-16 million, to be incurred in 2023 and 2024.

We do not include charges for restructuring and other cost reduction initiatives in the operating profit of our reportable segments.