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Goodwill and Intangible Assets
3 Months Ended
Mar. 31, 2017
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-month period ended March 31, 2017 were as follows (in thousands):
 
2017
Goodwill balance at January 1
$
211,927

Effect of foreign exchange
372

Additions as the result of acquisitions
7,612

Goodwill balance at March 31
$
219,911



As of March 31, 2017, we had recorded $8.3 million of accumulated goodwill impairment charges. All of the goodwill balance as of March 31, 2017 and December 31, 2016, is related to our cardiovascular segment.

Other intangible assets at March 31, 2017 and December 31, 2016, consisted of the following (in thousands):
 
March 31, 2017
 
Gross Carrying
Amount
 
Accumulated
Amortization
 
Net Carrying
Amount
Patents
$
14,780

 
$
(3,288
)
 
$
11,492

Distribution agreements
6,626

 
(3,770
)
 
2,856

License agreements
20,745

 
(3,745
)
 
17,000

Trademarks
16,786

 
(3,658
)
 
13,128

Covenants not to compete
1,028

 
(944
)
 
84

Customer lists
23,670

 
(16,054
)
 
7,616

 
 
 
 
 
 
Total
$
83,635

 
$
(31,459
)
 
$
52,176


 
December 31, 2016
 
Gross Carrying
Amount
 
Accumulated
Amortization
 
Net Carrying
Amount
Patents
$
14,130

 
$
(3,165
)
 
$
10,965

Distribution agreements
6,626

 
(3,527
)
 
3,099

License agreements
20,695

 
(3,422
)
 
17,273

Trademarks
12,380

 
(3,330
)
 
9,050

Covenants not to compete
1,028

 
(936
)
 
92

Customer lists
22,261

 
(15,401
)
 
6,860

Royalty agreements
267

 
(267
)
 

 
 
 
 
 
 
Total
$
77,387

 
$
(30,048
)
 
$
47,339



Aggregate amortization expense for the three-month periods ended March 31, 2017 and 2016 was approximately $6.2 million and $3.9 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, 2017 (in thousands):

Year Ending December 31
 
Remaining 2017
$
18,457

2018
24,063

2019
23,702

2020
22,619

2021
16,172