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Goodwill and Intangible Assets
3 Months Ended
Mar. 31, 2016
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Intangible Assets
Goodwill and Intangible Assets. The changes in the carrying amount of goodwill for the three months ended March 31, 2016 were as follows (in thousands):

 
2016
Goodwill balance at January 1
$
184,472

Effect of foreign exchange
20

Additions as the result of acquisitions
2,555

Goodwill balance at March 31
$
187,047



As of March 31, 2016, we had recorded $8.3 million of accumulated goodwill impairment charges. All of the goodwill balance as of March 31, 2016 and December 31, 2015 related to our cardiovascular segment.

Other intangible assets at March 31, 2016 and December 31, 2015, consisted of the following (in thousands):

 
March 31, 2016
 
Gross Carrying
Amount
 
Accumulated
Amortization
 
Net Carrying
Amount
Patents
$
12,496

 
$
(2,691
)
 
$
9,805

Distribution agreements
5,626

 
(3,000
)
 
2,626

License agreements
19,639

 
(2,616
)
 
17,023

Trademarks
7,974

 
(2,702
)
 
5,272

Covenants not to compete
1,028

 
(886
)
 
142

Customer lists
21,216

 
(15,443
)
 
5,773

Royalty agreements
267

 
(267
)
 

 
 
 
 
 
 
Total
$
68,246

 
$
(27,605
)
 
$
40,641


 
December 31, 2015
 
Gross Carrying
Amount
 
Accumulated
Amortization
 
Net Carrying
Amount
Patents
$
12,014

 
$
(2,595
)
 
$
9,419

Distribution agreements
5,626

 
(2,853
)
 
2,773

License agreements
19,109

 
(2,438
)
 
16,671

Trademarks
7,259

 
(2,554
)
 
4,705

Covenants not to compete
1,028

 
(873
)
 
155

Customer lists
20,793

 
(15,023
)
 
5,770

Royalty agreements
267

 
(267
)
 

 
 
 
 
 
 
Total
$
66,096

 
$
(26,603
)
 
$
39,493



Aggregate amortization expense for the three-month periods ended March 31, 2016 and 2015 was approximately $3.9 million and $3.6 million, respectively.

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of March 31, 2016 (in thousands):

Year Ending December 31
 
Remaining 2016
$
13,252

2017
16,983

2018
16,395

2019
16,058

2020
15,084