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Goodwill and Intangible Assets
12 Months Ended
Dec. 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 years ended December 31, 2017 and 2016, are as follows (in thousands):
 
2017
 
2016
Goodwill balance at January 1
$
211,927

 
$
184,472

Effect of foreign exchange
2,641

 
82

Additions as the result of acquisitions
23,579

 
27,373

Goodwill balance at December 31
$
238,147

 
$
211,927



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

Other intangible assets at December 31, 2017 and 2016, consisted of the following (in thousands):
 
2017
 
Gross Carrying
Amount
 
Accumulated
Amortization
 
Net Carrying
Amount
Patents
$
16,528

 
$
(3,737
)
 
$
12,791

Distribution agreements
7,262

 
(4,686
)
 
2,576

License agreements
23,783

 
(5,568
)
 
18,215

Trademarks
16,224

 
(4,686
)
 
11,538

Covenants not to compete
1,028

 
(968
)
 
60

Customer lists
31,935

 
(18,482
)
 
13,453

In-process technology
920

 

 
920

 
 
 
 
 
 
Total
$
97,680

 
$
(38,127
)
 
$
59,553


 
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 years ended December 31, 2017, 2016 and 2015 was approximately $26.8 million, $19.3 million and $14.8 million, respectively.

We evaluate long-lived assets, including amortizing intangible assets, for impairment whenever events or changes in circumstances indicate that their carrying amounts may not be recoverable. We perform the impairment analysis at the asset group for which the lowest level of identifiable cash flows are largely independent of the cash flows of other assets and liabilities. During the fourth quarter of 2017, we compared the carrying value of the amortizing intangible assets acquired in our July 2015 acquisition of certain assets from Distal Access, LLC, all of which pertained to our cardiovascular segment, to the undiscounted cash flows expected to result from the asset group and determined that the carrying amount was not recoverable. We then determined the fair value of the amortizing assets related to the Distal Access acquisition based on estimated future cash flows discounted back to their present value using a discount rate that reflects the risk profiles of the underlying activities. Some of the factors that influenced our estimated cash flows were slower than anticipated sales growth in the products acquired from our Distal Access acquisition and uncertainty about future sales growth. The excess of the carrying value compared to the fair value was recognized as an intangible asset impairment charge. We recorded an impairment charge for Distal Access of approximately $809,000. We did not record any impairment charges during the years ended December 31, 2016 and 2015.

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of December 31, 2017 (in thousands):

Year Ending December 31
 
2018
$
30,413

2019
29,787

2020
28,373

2021
21,001

2022
19,396