10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

 FORM 10-Q

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

 For the quarterly period ended: March 31, 2021

 or

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from:              to

Commission File No.: 001-34634

 ICU MEDICAL, INC.

(Exact name of registrant as specified in its charter)

Delaware	33-0022692
(State or other jurisdiction of	(I.R.S. Employer
incorporation or organization)	Identification No.)

951 Calle Amanecer	,	San Clemente	,	California	92673
(Address of principal executive offices)					(Zip Code)

 (949) 366-2183

(Registrant’s telephone number including area code)

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.  Yes x  No o

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).  Yes x  No o

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and "emerging growth company" in Rule 12b-2 of the Exchange Act.

Large accelerated filer	x	Accelerated filer o
Non-accelerated filer o		Smaller reporting company	☐
		Emerging growth company	☐

 If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.    o

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act):  Yes ☐ No x

Securities registered pursuant to Section 12(b) of the Act:

Title of each class	Trading Symbol	Name of each exchange on which registered
Common stock, par value $0.10 per share	ICUI	The Nasdaq Stock Market LLC
		(Global Select Market)

Indicate the number of shares outstanding of each of the issuer’s classes of common stock, as of the latest practicable date:

Class	Outstanding at April 30, 2021
Common	21,218,759

ICU MEDICAL, INC. AND SUBSIDIARIES

Form 10-Q

March 31, 2021

Table of Contents

PART I.	Financial Information	Page Number
Item 1.	Financial Statements (Unaudited)
	Condensed Consolidated Balance Sheets, at March 31, 2021 and December 31, 2020	3
	Condensed Consolidated Statements of Operations for the Three Months Ended March 31, 2021 and 2020	4
	Condensed Consolidated Statements of Comprehensive Income for the Three Months Ended March 31, 2021 and 2020	5
	Condensed Consolidated Statements of Stockholders' Equity for the Three Months Ended March 31, 2021 and 2020	6
	Condensed Consolidated Statements of Cash Flows for the Three Months Ended March 31, 2021 and 2020	7
	Notes to Condensed Consolidated Financial Statements	9
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	24
Item 3.	Quantitative and Qualitative Disclosures About Market Risk	36
Item 4.	Controls and Procedures	37
PART II.	Other Information
Item 1.	Legal Proceedings	37
Item1A.	Risk Factors	37
Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	37
Item 6.	Exhibits	38
	Signature	39

2

PART I - FINANCIAL INFORMATION

Item1.Financial Statements (Unaudited)

ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED BALANCE SHEETS

(In thousands, except par value data) 

	March 31, 2021		December 31, 2020
	(Unaudited)		(1)
ASSETS
CURRENT ASSETS:
Cash and cash equivalents	$	424,249	$	396,097
Short-term investment securities	11,693		14,687
TOTAL CASH, CASH EQUIVALENTS AND INVESTMENT SECURITIES	435,942		410,784
Accounts receivable, net of allowance for doubtful accounts of $21,782 at March 31, 2021 and $21,490 at December 31, 2020	120,365		124,093
Inventories	300,086		314,928
Prepaid income tax	31,480		29,480
Prepaid expenses and other current assets	40,309		41,492
TOTAL CURRENT ASSETS	928,182		920,777
PROPERTY AND EQUIPMENT, net	459,072		466,628
OPERATING LEASE RIGHT-OF-USE ASSETS	45,259		46,571
LONG-TERM INVESTMENT SECURITIES	18,834		12,974
GOODWILL	32,952		33,001
INTANGIBLE ASSETS, net	193,074		197,231
DEFERRED INCOME TAXES	29,115		31,034
OTHER ASSETS	58,742		55,475
TOTAL ASSETS	$	1,765,230	$	1,763,691
LIABILITIES AND STOCKHOLDERS’ EQUITY
CURRENT LIABILITIES:
Accounts payable	$	73,049	$	71,864
Accrued liabilities	79,056		97,021
Income tax liability	1,457		303
Contingent earn-out liability	26,300		26,300
TOTAL CURRENT LIABILITIES	179,862		195,488
OTHER LONG-TERM LIABILITIES	46,110		47,835
DEFERRED INCOME TAXES	1,663		1,663
INCOME TAX LIABILITY	16,827		16,440
COMMITMENTS AND CONTINGENCIES (Note 18)	—		—
STOCKHOLDERS’ EQUITY:
Convertible preferred stock, $1.00 par value Authorized—500 shares; Issued and outstanding — none	—		—
Common stock, $0.10 par value — Authorized, 80,000 shares; Issued — 21,219 shares at March 31, 2021 and 21,058 shares at December 31, 2020 and outstanding — 21,192 shares at March 31, 2021 and 21,058 shares at December 31, 2020	2,122		2,106
Additional paid-in capital	701,586		693,068
Treasury stock, at cost ( 26,785 and 209 shares, respectively)	(5,410)		(39)
Retained earnings	832,383		808,652
Accumulated other comprehensive loss	(9,913)		(1,522)
TOTAL STOCKHOLDERS' EQUITY	1,520,768		1,502,265
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY	$	1,765,230	$	1,763,691

______________________________________________________

(1) December 31, 2020 balances were derived from audited consolidated financial statements.

The accompanying notes are an integral part of these condensed consolidated financial statements.

3

ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited)

(In thousands, except per share data)

	Three months ended March 31,
	2021		2020
TOTAL REVENUES	$	318,046	$	328,607
COST OF GOODS SOLD	205,366		207,192
GROSS PROFIT	112,680		121,415
OPERATING EXPENSES:
Selling, general and administrative	72,391		72,305
Research and development	10,709		10,746
Restructuring, strategic transaction and integration	2,883		12,307
Change in fair value of contingent earn-out	—		—
Contract settlement	127		—
TOTAL OPERATING EXPENSES	86,110		95,358
INCOME FROM OPERATIONS	26,570		26,057
INTEREST EXPENSE	(161)		(196)
OTHER INCOME (EXPENSE), net	683		(5,480)
INCOME BEFORE INCOME TAXES	27,092		20,381
PROVISION FOR INCOME TAXES	(3,361)		(3,547)
NET INCOME	$	23,731	$	16,834
NET INCOME PER SHARE
Basic	$	1.12	$	0.81
Diluted	$	1.09	$	0.78
WEIGHTED AVERAGE NUMBER OF SHARES
Basic	21,149		20,780
Diluted	21,695		21,507

The accompanying notes are an integral part of these condensed consolidated financial statements.

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ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (Unaudited)

(In thousands)

	Three months ended March 31,
	2021		2020
NET INCOME	$	23,731	$	16,834
Other comprehensive income (loss), net of tax:
Cash flow hedge adjustments, net of taxes of $298 and $932 for the three months ended March 31, 2021 and 2020, respectively	(945)		(2,952)
Foreign currency translation adjustment, net of taxes of $— for all periods	(7,458)		(10,477)
Other adjustments, net of taxes of $— for all periods	12		(81)
Other comprehensive loss, net of taxes	(8,391)		(13,510)
TOTAL COMPREHENSIVE INCOME	$	15,340	$	3,324

The accompanying notes are an integral part of these condensed consolidated financial statements.

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ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (Unaudited)

(Amounts in thousands)

	Common Stock									Accumulated
				Additional						Other
	Shares	Amount		Paid-In Capital		Treasury Stock		Retained Earnings		Comprehensive Loss		Total
Balance, January 1, 2021	21,058	$	2,106	$	693,068	$	(39)	$	808,652	$	(1,522)	$	1,502,265
Issuance of restricted stock and exercise of stock options	198	16		2,496		2,352		—		—		4,864
Tax withholding payments related to net share settlement of equity awards	(37)	—		—		(7,723)		—		—		(7,723)
Stock compensation	—	—		6,022		—		—		—		6,022
Other comprehensive loss, net of tax	—	—		—		—		—		(8,391)		(8,391)
Net income	—	—		—		—		23,731		—		23,731
Balance, March 31, 2021	21,219	$	2,122	$	701,586	$	(5,410)	$	832,383	$	(9,913)	$	1,520,768

	Common Stock									Accumulated
				Additional						Other
	Shares	Amount		Paid-In Capital		Treasury Stock		Retained Earnings		Comprehensive Loss		Total
Balance, January 1, 2020	20,742	$	2,074	$	668,947	$	(157)	$	721,782	$	(15,402)	$	1,377,244
Issuance of restricted stock and exercise of stock options	155	9		(10,207)		10,758		—		—		560
Tax withholding payments related to net share settlement of equity awards	(64)	—		—		(12,174)		—		—		(12,174)
Stock compensation	—	—		6,939		—		—		—		6,939
Other comprehensive loss, net of tax	—	—		—		—		—		(13,510)		(13,510)
Net income	—	—		—		—		16,834		—		16,834
Balance, March 31, 2020	20,833	$	2,083	$	665,679	$	(1,573)	$	738,616	$	(28,912)	$	1,375,893

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ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited)

(In thousands) 

	Three months ended March 31,
	2021		2020
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income	$	23,731	$	16,834
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	22,155		20,957
Amortization of right-of-use assets	2,372		2,305
Provision for doubtful accounts	—		5
Provision for warranty and returns	209		(821)
Stock compensation	6,022		6,939
Loss on disposal of property and equipment and other assets	659		562
Bond premium amortization	168		34
Debt issuance costs amortization	72		72
Product-related charges	—		2,626
Usage of spare parts	2,825		4,900
Other	(1,287)		876
Changes in operating assets and liabilities:
Accounts receivable	1,506		899
Inventories	13,208		19,372
Prepaid expenses and other assets	(742)		2,634
Other assets	(3,463)		(6,402)
Accounts payable	2,411		(35,063)
Accrued liabilities	(19,965)		465
Income taxes, including excess tax benefits and deferred income taxes	1,439		2,325
Net cash provided by operating activities	51,320		39,519
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property and equipment	(14,028)		(25,463)
Proceeds from sale of asset	55		131
Intangible asset additions	(1,874)		(1,958)
Purchases of investment securities	(10,034)		(7,082)
Proceeds from sale of investment securities	7,000		10,900
Net cash used in investing activities	(18,881)		(23,472)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from short-term debt	—		150,000
Proceeds from exercise of stock options	4,864		560
Payments on finance leases	(141)		—
Tax withholding payments related to net share settlement of equity awards	(7,723)		(12,174)
Net cash (used in) provided by financing activities	(3,000)		138,386
Effect of exchange rate changes on cash	(1,287)		(3,546)
NET INCREASE CASH AND CASH EQUIVALENTS	28,152		150,887
CASH AND CASH EQUIVALENTS, beginning of period	396,097		268,670
CASH AND CASH EQUIVALENTS, end of period	$	424,249	$	419,557

The accompanying notes are an integral part of these condensed consolidated financial statements.

7

ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - CONTINUED

(In thousands)

	Three months ended March 31,
	2021		2020
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES:
Accounts payable for property and equipment	$	1,068	$	7,112

The accompanying notes are an integral part of these condensed consolidated financial statements.

8

ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited)

Note 1:Basis of Presentation

The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America ("U.S.") and pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) and reflect all adjustments, consisting of only normal recurring adjustments, which are, in the opinion of management, necessary for a fair statement of the consolidated results for the interim periods presented. Results for the interim period are not necessarily indicative of results for the full year. Certain information and footnote disclosures normally included in annual consolidated financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted pursuant to such rules and regulations. The condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Annual Report on Form 10-K of ICU Medical, Inc., ("ICU") a Delaware corporation, filed with the SEC for the year ended December 31, 2020.

We are engaged in the development, manufacturing and sale of innovative medical products used in vascular therapy and critical care applications.  We sell the majority of our products through our direct sales force and through independent distributors throughout the U.S. and internationally.  Additionally, we sell our products on an original equipment manufacturer basis to other medical device manufacturers. All subsidiaries are wholly owned and are included in the condensed consolidated financial statements.  All intercompany balances and transactions have been eliminated.

Note 2:    New Accounting Pronouncements

Recently Issued Accounting Standards

    In March 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform (Topic 848) - Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The amendments in this update provide optional guidance for a limited period of time to ease the potential burden for reference rate reform on financial reporting. Due to concerns about structural risks of interbank offered rates and, particularly, the risk of cessation of the London Interbank Offered Rate ("LIBOR"), regulators around the world have undertaken reference rate reform initiatives to identify alternative reference rates that are more observable or transaction based and less susceptible to manipulation. The amendments in this update apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued as a result of reference rate reform. Optional expedients may be applied to contracts that are modified as a result of the reference rate reform. Modifications of contracts within the scope of Topic 470, Debt, should be accounted for by prospectively adjusting the effective interest rate. Modifications of contracts within the scope of ASC 842, Leases, should be accounted for as a continuation of the existing contracts with no reassessments of the lease classification and the discount rate (incremental borrowing rate). Exceptions to Topic 815, Derivatives and Hedging, results in not having a dedesignation of a hedging relationship if certain criteria are met. The amendments in this ASU are effective for all entities as of March 12, 2020 through December 31, 2022. The impact of this ASU on our contracts has not been material.        

Note 3: Restructuring, Strategic Transaction and Integration

    Restructuring, strategic transaction and integration expenses were $2.9 million and $12.3 million for the three months ended March 31, 2021, and 2020 respectively.

Restructuring

    During the three months ended March 31, 2021 and 2020, restructuring charges were $0.0 million and $7.2 million, respectively. Restructuring charges for the three months ended March 31, 2020 were primarily related to severance and costs related to office and other facility closures. Restructuring charges are included in the above restructuring, strategic transaction and integration expenses in our condensed consolidated statement of operations.

    The following table summarizes the details of changes in our restructuring-related accrual for the period ended March 31, 2021 (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Accrued Balance January 1, 2021		Charges Incurred		Payments		Currency Translation		Accrued Balance March 31, 2021
Severance pay and benefits	$	1,858	$	43	$	(435)	$	12	$	1,478
Facility closure expenses	1,563		—		—		17		1,580
	$	3,421	$	43	$	(435)	$	29	$	3,058

Strategic transaction and integration expenses

    We incurred and expensed $2.9 million and $5.1 million in strategic transaction and integration expenses during the three months ended March 31, 2021 and 2020, respectively, which are included in restructuring, strategic transaction and integration expenses in our condensed consolidated statement of operations. The strategic transaction and integration expenses during the three months ended March 31, 2021 were primarily related to integration costs associated with acquisitions, the Hospira Infusion Systems ("HIS") earn-out dispute with Pfizer and one-time costs incurred to comply with regulatory initiatives. The strategic transaction and integration expenses during the three months ended March 31, 2020 were primarily related to the integration of the HIS business acquired in 2017 from Pfizer, which included the migration of IT systems at our Austin facility.

Note 4: Revenue

    Our primary product lines are Infusion Consumables, Infusion Systems, IV Solutions and Critical Care. The vast majority of our sales of these products are made on a stand-alone basis to hospitals and distributors. Revenue is typically recognized upon transfer of control of the products, which we deem to be at point of shipment. However, for purposes of revenue recognition for our software licenses and renewals, we consider the control of these products to be transferred to a customer at a certain point in time; therefore, we recognize revenue at the start of the applicable license term.

    Payment is typically due in full within 30 days of delivery or the start of the contract term. Revenue is recorded in an amount that reflects the consideration we expect to be entitled to in exchange for those goods or services. We offer certain volume-based rebates to our distribution customers, which we record as variable consideration when calculating the transaction price. Rebates are offered on both a fixed and tiered/variable basis. In both cases, we use information available at the time and our historical experience with each customer to estimate the most likely rebate amount. We also provide chargebacks to distributors that sell to end-customers at prices determined under a contract between us and the end-customer. Chargebacks are the difference between the prices we charge our distribution customers and the contracted prices we have with the end customer which are processed as credits to our distribution customers. In estimating the expected value of chargeback amounts in order to determine the transaction price, we use information available at the time, including our historical experience.

    We also warranty products against defects and have a policy permitting the return of defective products, for which we accrue and expense at the time of sale using information available at that time and our historical experience. We also provide for extended service-type warranties, which we consider to be separate performance obligations. We allocate a portion of the transaction price to the extended service-type warranty based on its estimated relative selling price, and recognize revenue over the period the warranty service is provided. Our revenues are recorded at the net sales price, which includes an estimate for variable consideration related to rebates, chargebacks and product returns.

Revenue disaggregated

    The following table represents our revenues disaggregated by geography (in thousands):

	For the three months ended March 31,
Geography	2021		2020
Europe, the Middle East and Africa	$	34,800	$	37,928
Other Foreign	55,895		60,521
Total Foreign	90,695		98,449
United States	227,351		230,158
Total Revenues	$	318,046	$	328,607

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

    The following table represents our revenues disaggregated by product (in thousands):

	For the three months ended March 31,
Product line	2021		2020
Infusion Consumables	$	126,370	$	123,507
Infusion Systems	84,334		88,380
IV Solutions	94,176		104,291
Critical Care	13,166		12,429
Total Revenues	$	318,046	$	328,607

Contract balances

    The following table presents our changes in the contract balances for the three months ended March 31, 2021 and 2020 (in thousands):

	Contract Liabilities
Beginning balance, January 1, 2021	$	(6,430)
Equipment revenue recognized	461
Equipment revenue deferred due to implementation	(2,921)
Software revenue recognized	1,796
Software revenue deferred due to implementation	(1,794)
Ending balance, March 31, 2021	$	(8,888)
Beginning balance, January 1, 2020	$	(4,855)
Equipment revenue recognized	1,802
Equipment revenue deferred due to implementation	(3,990)
Software revenue recognized	1,235
Software revenue deferred due to implementation	(2,664)
Ending balance, March 31, 2020	$	(8,472)

    As of March 31, 2021, revenue from remaining performance obligations related to implementation of software and equipment is $7.3 million. We expect to recognize substantially all of this revenue within the next three to six months dependent on implementation restrictions due to the novel coronavirus and its variants ("COVID-19"). Revenue from remaining performance obligations related to annual software licenses is $1.5 million. We expect to recognize substantially all of this revenue over the next twelve months.

Note 5: Leases

Leases

    We determine if an arrangement is a lease at inception. Our operating lease assets are separately stated in operating lease right-of-use ("ROU") assets and our financing lease assets are included in other assets on our condensed consolidated balance sheets. Our lease liabilities are included in accrued liabilities, and other long-term liabilities on our condensed consolidated balance sheets. We have elected not to recognize an ROU asset and lease liability for leases with terms of twelve months or less.

    Lease ROU assets and lease liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. Most of our leases do not provide an implicit rate, therefore we use our incremental borrowing rate, which is the rate incurred to borrow on a collateralized basis over a similar term based on the information available at commencement date. Our lease ROU assets exclude lease incentives and initial direct costs incurred. Our lease terms include options to extend when it is reasonably certain that we will exercise that option. All of our leases have

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

stated lease payments, which may include fixed rental increases. Lease expense for minimum lease payments is recognized on a straight-line basis over the lease term.

    Our leases are for corporate, research and development and sales and support offices, a distribution facility, device service centers and certain equipment. Our leases have original lease terms of one year to fifteen years, some of which include options to extend the leases for up to an additional five years. For all of our leases, we do not include optional periods of extension in our current lease terms for the exercise of options to extend is not reasonably certain.

    The following table presents the components of our lease cost (in thousands):

	For the three months  ended March 31
	2021		2020
Operating lease cost	$	2,835	$	2,791
Finance lease cost - interest	31		29
Finance lease cost - amortization of ROU asset	151		—
Short-term lease cost	3		54
Total lease cost	$	3,020	$	2,874

Interest expense on our finance leases is included in other income (expense), net in our condensed consolidated statement of operations. The amortization of the operating and finance ROU asset is included in selling, general and administrative expenses in our condensed consolidated statement of operations.    

The following table presents the supplemental cash flow information related to our leases (in thousands):

	For the three months ended March 31,
	2021		2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	2,821	$	2,457
Operating cash flows from finance leases	$	31	$	29
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	1,095	$	19,094
Finance leases	$	184	$	800

    The following table presents the supplemental balance sheet information related to our operating leases (in thousands, except lease term and discount rate):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	As of March 31, 2021			As of December 31, 2020
Operating leases
Operating lease right-of-use assets	$	45,259		$	46,571
Accrued liabilities	$	8,872		$	8,740
Other long-term liabilities	39,588			41,019
Total operating lease liabilities	$	48,460		$	49,759
Weighted Average Remaining Lease Term
Operating leases	6.5 years			6.7 years
Weighted Average Discount Rate
Operating leases	5.00		%	5.02		%

The following table presents the supplemental balance sheet information related to our finance leases (in thousands, except lease term and discount rate):

	As of March 31, 2021			As of December 31, 2020
Financing leases
Financing lease right-of-use assets	$	2,877		$	2,915
Accrued liabilities	$	583		$	554
Other long-term liabilities	2,330			2,388
Total financing lease liabilities	$	2,913		$	2,942
Weighted Average Remaining Lease Term
Financing leases	6.2 years			6.4 years
Weighted Average Discount Rate
Financing leases	4.27		%	4.27		%

    As of March 31, 2021, the maturities of our operating and financing lease liabilities for each of the next five years is approximately (in thousands):

	Operating Leases		Finance Leases
Remainder of 2021	$	8,352	$	520
2022	10,316		693
2023	9,120		693
2024	8,317		379
2025	5,008		211
2026	4,733		189
Thereafter	10,602		614
Total Lease Payments	56,448		3,299
Less imputed interest	(7,988)		(386)
Total	$	48,460	$	2,913

Note 6:     Net Income Per Share

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Basic earnings per share is computed by dividing net income by the weighted-average number of common shares outstanding during the period. Diluted earnings per share is computed by dividing net income by the weighted-average number of common shares outstanding during the period plus dilutive securities. Dilutive securities include outstanding common stock options and unvested restricted stock units, less the number of shares that could have been purchased with the proceeds from the exercise of the options, using the treasury stock method. Options and restricted stock units that are anti-dilutive are not included in the treasury stock method calculation. There were 12,080 and 15,333 anti-dilutive securities for the three months ended March 31, 2021 and 2020, respectively.

    The following table presents the calculation of net earnings per common share (“EPS”) — basic and diluted (in thousands, except per share data): 

	Three months ended March 31,
	2021		2020
Net income	$	23,731	$	16,834
Weighted-average number of common shares outstanding (for basic calculation)	21,149		20,780
Dilutive securities	546		727
Weighted-average common and common equivalent shares outstanding (for diluted calculation)	21,695		21,507
EPS — basic	$	1.12	$	0.81
EPS — diluted	$	1.09	$	0.78

Note 7:    Derivatives and Hedging Activities

Hedge Accounting and Hedging Program

     The purpose of our hedging program is to manage the foreign currency exchange rate risk on forecasted expenses denominated in currencies other than the functional currency of the operating unit. We do not issue derivatives for trading or speculative purposes.

    To receive hedge accounting treatment, all hedging relationships are formally documented at the inception of the hedge, and the hedges must be highly effective in offsetting changes to future cash flows on hedged transactions. The par forward contract is designated and qualifies as a cash flow hedge. Our derivative instruments are recorded at fair value on the condensed consolidated balance sheets and are classified based on the instrument's maturity date. We record changes in the intrinsic value of the effective portion of the gain or loss on the derivative instrument as a component of Other Comprehensive Income and we reclassify that gain or loss into earnings in the same line item associated with the forecasted transaction and in the same period during which the hedged transaction affects earnings.

    In March 2020, we entered into a one-year cross-currency par forward contract that extends our current hedge of a portion of our Mexico forecasted expenses denominated in Pesos ("MXN"). The total notional amount of this outstanding derivative as of March 31, 2021 was approximately 327.6 million MXN. The term of the one-year contract is November 3, 2020 to December 1, 2021. The derivative instrument matures in equal monthly amounts at a fixed forward rate of 24.26 MXN/USD.

    In November 2018, we entered into a one-year cross-currency par forward contract that hedges of a portion of our Mexico forecasted expenses denominated in MXN. The term of the one-year hedge was November 1, 2019 to November 3, 2020. The derivative instrument matured in equal monthly amounts at a fixed forward rate of 22.109 MXN/USD.

    The following table presents the fair values of our derivative instruments included within the Condensed Consolidated Balance Sheets as of March 31, 2021 and December 31, 2020 (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Derivatives
	Condensed Consolidated Balance Sheet Location	March 31, 2021		December 31, 2020
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contract:
	Prepaid expenses and other current assets	$	2,312	$	3,555
Total derivatives designated as cash flow hedging instruments		$	2,312	$	3,555

    The following table presents the amounts affecting the Condensed Consolidated Statements of Operations for the three months ended March 31, 2021 and 2020 (in thousands):

	Line Item in the Condensed Consolidated Statements of Operations	Three months ended March 31,
		2021		2020
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contracts	Cost of goods sold	$	841	$	692

    We recognized the following (losses) gains on our foreign exchange contracts designated as a cash flow hedge (in thousands):

	Amount of Loss Recognized in Other Comprehensive Income on Derivatives				Amount of Gain Reclassified From Accumulated Other Comprehensive Income into Income
	Three months ended March 31,					Three months ended March 31,
	2021		2020		Location of Gain Reclassified From Accumulated Other Comprehensive Income into Income	2021		2020
Derivatives designated as cash flow hedges:
Foreign exchange forward contract	$	(402)	$	(3,192)	Cost of goods sold	$	841	$	692
Total derivatives designated as cash flow hedging instruments	$	(402)	$	(3,192)		$	841	$	692

As of March 31, 2021, we expect approximately $2.3 million of the deferred gains on the outstanding derivatives in accumulated other comprehensive income to be reclassified to net income during the next twelve months concurrent with the underlying hedged transactions also being reported in net income.    

Note 8:    Fair Value Measurement

    Fair value is the price that would be received from selling an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. There are three levels of inputs that may be used to measure fair value:

•Level 1: quoted prices in active markets for identical assets or liabilities;

•Level 2: inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices in active markets for similar assets or liabilities, quoted prices for identical or similar assets or liabilities in markets that are not active, or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities; or

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

•Level 3: unobservable inputs that are supported by little or no market activity and that are significant to the fair values of the assets or liabilities.

Earn-out Liability

    In 2017, we recognized an earn-out liability upon the acquisition of HIS from Pfizer. Pfizer was entitled to receive between $191.3 million and $225.0 million in additional cash consideration based on the achievement of certain performance targets for the combined company for the three years ending December 31, 2019. The initial fair value of the earn-out was determined by employing a Monte Carlo simulation in a risk neutral framework. The underlying simulated variable was adjusted EBITDA. The adjusted EBITDA volatility estimate was based on a study of historical asset volatility for a set of comparable public companies. The model included other assumptions including the market price of risk, which was calculated as the weighted average cost of capital ("WACC") less the long term risk free rate. The initial value assigned to the contingent consideration was a result of forecasted product demand of our HIS business. At each reporting date subsequent to the acquisition we remeasured the earn-out using the same methodology above and recognized any changes in value. As of December 31, 2019, we determined that we did not meet the necessary performance targets that would require payout of any of the HIS earn-out liability. As of the date of this filing, Pfizer has disputed our determination that the performance targets requiring payout of the HIS earn-out liability were not met. The dispute is being resolved by binding arbitration that will likely be concluded during the third quarter of 2021. Given the uncertainty of any arbitration, it may be possible that we will incur a loss with regards to this matter. If we are unsuccessful in arbitration such that it is determined that we met the necessary performance targets for any of the HIS earn-out liability, we will be obligated to pay Pfizer between $191.3 million and $225.0 million in additional cash consideration.

In the fourth quarter of 2019, we recognized an earn-out liability related to the acquisition of Pursuit Vascular, Inc. ("Pursuit"). Pursuit's former equity holders are entitled up to $50.0 million in additional cash consideration contingent upon the achievement of certain sales and gross profit targets for specific customers. The earn-out will be calculated as a percentage of gross profit achieved during the earn-out period against a pre-determined target gross profit, not to exceed $50.0 million. We used a Monte Carlo simulation model to determine the fair value of the earn-out liability. The Monte Carlo simulation model utilizes multiple input variables to determine the value of the earn-out liability including historical volatility, a risk free interest rate, counter party credit risk and projected future gross profit, see below simulation input table related to Pursuit. The historical volatility was based on the median of ICU and a certain peer group. The risk-free interest rate is equal to the yield, as of the valuation date, of the zero-coupon U.S. Treasury bill that is commensurate with the term of the earn-out. The counter party credit risk is based on a synthetic credit rating of B1. If the probabilities in the model significantly change from what we initially and subsequently anticipate, the change could have a significant impact on our financial statements in the period recognized. Our contingent earn-out liability is separately stated in our condensed consolidated balance sheets.

The following tables provide a reconciliation of the Level 3 earn-out liabilities measured at estimated fair value (in thousands):

	Pursuit
	Earn-out Liability
Accrued balance, January 1, 2021	$	26,300
Change in fair value of earn-out (included in income from operations as a separate line item)	—
Accrued balance, March 31, 2021	$	26,300

	Pursuit
	Earn-out Liability
Accrued balance, January 1, 2020	$	17,300
Change in fair value of earn-out (included in income from operations as a separate line item)	—
Accrued balance, March 31, 2020	$	17,300

    The following tables provide quantitative information about Level 3 inputs for fair value measurement of our earn-out liabilities:

Pursuit Earn-out

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Simulation Input	As of March 31, 2021		As of December 31, 2020		As of March 31, 2020
Revenue/Gross Profit Volatility	25.00	%	25.00	%	20.00	%
Discount Rate	12.50	%	12.50	%	15.00	%
Risk Free Rate	0.09	%	0.09	%	1.55	%
Counter Party Risk	3.10	%	3.10	%	6.00	%

Investments and Foreign Currency Contracts    

    The fair value of our investments is estimated using observable market-based inputs such as quoted prices, interest rates and yield curves or Level 2 inputs, which consisted of corporate bonds.     

    The fair value of our Level 2 forward currency contracts are estimated using observable market inputs such as known notional value amounts, spot and forward exchange rates. These inputs relate to liquid, heavily traded currencies with active markets which are available for the full term of the derivative.

Our assets and liabilities measured at fair value on a recurring basis consisted of the following (Level 1, 2 and 3 inputs as defined above) (in thousands):

	Fair value measurements at March 31, 2021
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	11,693	$	—	$	11,693	$	—
Long-term	18,834		—		18,834		—
Foreign exchange forwards:
Prepaid expenses and other current assets	2,312		—		2,312		—
Total Assets	$	32,839	$	—	$	32,839	$	—
Liabilities:
Earn-out liability	$	26,300	$	—	$	—	$	26,300
Total Liabilities	$	26,300	$	—	$	—	$	26,300

	Fair value measurements at December 31, 2020
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	14,687	$	—	$	14,687	$	—
Long-term	12,974		—		12,974		—
Foreign exchange forwards:
Prepaid expenses and other current assets	3,555		—		3,555		—
Total Assets	$	31,216	$	—	$	31,216	$	—
Liabilities:
Earn-out liability	$	26,300	$	—	$	—	$	26,300
Total Liabilities	$	26,300	$	—	$	—	$	26,300

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Note 9: Investment Securities

    Our investment securities currently consist of short-term and long-term corporate bonds. Our investment securities are considered available-for-sale and are “investment grade” and carried at fair value. Available-for-sale securities are recorded at fair value, and unrealized holding gains and losses are recorded, net of tax, as a component of accumulated other comprehensive income. Unrealized losses on available-for-sale securities are charged against net earnings when a decline in fair value is determined to be other than temporary. Our management reviews several factors to determine whether a loss is other than temporary, such as the length and extent of the fair value decline, the financial condition and near term prospects of the issuer, and for equity investments, our intent and ability to hold the security for a period of time sufficient to allow for any anticipated recovery in fair value. The amortized cost of the debt securities are adjusted for the amortization of premiums computed under the effective interest method. Such amortization is included in investment income in other income (expense), net on our condensed consolidated statements of operations. There have been no realized gains or losses on their disposal. Realized gains and losses are accounted for on the specific identification method. The scheduled maturities of the debt securities are between 2021 and 2024. All short-term investment securities are callable within one year.

    Our short investment securities consisted of the following (in thousands):

	As of March 31, 2021
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	11,693	$	—	$	11,693
Long-term corporate bonds	18,834		—		18,834
Total investment securities	$	30,527	$	—	$	30,527
	As of December 31, 2020
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	14,687	$	—	$	14,687
Long-term corporate bonds	12,974		—		12,974
Total investment securities	$	27,661	$	—	$	27,661

Note 10:     Prepaid Expenses and Other Current Assets

Prepaid expenses and other current assets consist of the following (in thousands): 

	March 31, 2021		December 31, 2020
Other prepaid expenses and receivables	$	16,084	$	14,964
Deferred costs	6,554		6,402
Prepaid insurance and property taxes	4,639		6,178
VAT/GST receivable	3,674		3,676
Deferred tax charge	3,856		3,542
Foreign exchange forward contract	2,312		3,555
Deposits	1,343		1,353
Other	1,847		1,822
	$	40,309	$	41,492

Note 11: Inventories

    Inventories are stated at the lower of cost or net realizable value with cost determined using the first-in, first-out method. Inventory costs consist of those costs directly attributable to products prior to sale including among other things raw material, labor and overhead. Inventories consisted of the following (in thousands): 

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	March 31, 2021		December 31, 2020
Raw materials	$	122,703	$	126,499
Work in process	39,713		33,053
Finished goods	137,670		155,376
Total inventories	$	300,086	$	314,928

Note 12:     Property and Equipment

Property and equipment consisted of the following (in thousands): 

	March 31, 2021		December 31, 2020
Machinery and equipment	$	293,653	$	291,331
Land, building and building improvements	241,608		241,199
Molds	60,381		60,381
Computer equipment and software	98,780		98,311
Furniture and fixtures	7,712		7,767
Instruments placed with customers(1)	91,909		90,383
Construction in progress	55,757		53,724
Total property and equipment, cost	849,800		843,096
Accumulated depreciation	(390,728)		(376,468)
Property and equipment, net	$	459,072	$	466,628

______________________________

(1) Instruments placed with customers consist of drug-delivery and monitoring systems placed with customers under operating leases.

    Depreciation expense was $16.3 million and $15.2 million for the three months ended March 31, 2021 and 2020, respectively.

Note 13: Goodwill and Intangible Assets, Net

Goodwill

    The following table presents the changes in the carrying amount of our goodwill (in thousands):

	Total
Balance as of January 1, 2021	$	33,001
Currency translation	(49)
Balance as of March 31, 2021	$	32,952

Intangible Assets, Net

    Intangible assets, carried at cost less accumulated amortization and amortized on a straight-lined basis, were as follows (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Weighted Average	March 31, 2021
	Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	25,423	$	15,466	$	9,957
Customer contracts	12	10,310		5,929		4,381
Non-contractual customer relationships	9	57,748		28,233		29,515
Trademarks	4	425		425		—
Trade name	15	18,268		3,808		14,460
Developed technology	13	152,893		40,062		112,831
Non-compete	3	2,500		1,181		1,319
Total amortized intangible assets		$	267,567	$	95,104	$	172,463
Internally developed software*		$	20,611			$	20,611
Total intangible assets		$	288,178	$	95,104	$	193,074

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

	Weighted Average	December 31, 2020
	Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	24,797	$	15,056	$	9,741
Customer contracts	12	10,365		5,852		4,513
Non-contractual customer relationships	9	58,061		26,711		31,350
Trademarks	4	425		425		—
Trade name	15	18,270		3,500		14,770
Developed technology	13	152,893		36,927		115,966
Non-compete	3	2,500		972		1,528
Total amortized intangible assets		$	267,311	$	89,443	$	177,868
Internally developed software*		$	19,363			$	19,363
Total intangible assets		$	286,674	$	89,443	$	197,231

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

Intangible assets with definite lives are amortized on a straight-line basis over their estimated useful lives. During the three months ended March 31, 2021 and 2020, respectively, intangible asset amortization expense was $5.8 million and $5.8 million, respectively.

As of March 31, 2021 estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Remainder of 2021	$	17,807
2022	22,806
2023	21,783
2024	21,694
2025	15,980
2026	15,116
Thereafter	57,277
Total	$	172,463

Note 14:     Accrued Liabilities and Other Long-Term Liabilities

    Accrued liabilities consist of the following (in thousands): 

	March 31, 2021		December 31, 2020
Salaries and benefits	$	26,118	$	25,786
Incentive compensation	8,130		27,023
Operating lease liability-ST	8,872		8,740
Accrued sales taxes	2,435		2,146
Restructuring accrual	3,058		3,421
Deferred revenue	8,195		5,566
Accrued other taxes	923		3,540
Accrued professional fees	730		1,273
Legal accrual	1,291		900
Distribution fees	5,080		5,300
Warranties and returns	554		1,027
Accrued freight	7,715		6,784
Other	5,955		5,515
	$	79,056	$	97,021

Other long-term liabilities consist of the following (in thousands): 

	March 31, 2021		December 31, 2020
Operating lease liability-LT	$	39,588	$	41,019
Benefits	1,180		1,183
Accrued rent	1,427		1,462
Contract liabilities-LT	303		337
Financing lease liability-LT	2,330		2,388
Deferred revenue	693		864
Other	589		582
	$	46,110	$	47,835

Note 15:     Income Taxes

Income taxes were accrued at an estimated effective tax rate of 12% and 17% for the three months ended March 31, 2021 and 2020, respectively.

    The effective tax rate for the three months ended March 31, 2021 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, global intangible low-taxed income ("GILTI"), foreign-derived intangible income ("FDII") and tax credits. The effective tax rate during the three months ended

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

March 31, 2021 included a discrete tax benefit of $1.8 million related to excess tax benefits recognized on stock option exercises and the vesting of restricted stock units during the period.

    The effective tax rate for the three months ended March 31, 2020 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, GILTI, FDII and tax credits.

Note 16:     Long-Term Obligations

Five-year Senior Secured Revolving Credit Facility ("Credit Facility")

    On November 8, 2017, we entered into a Credit Facility with various lenders for $150.0 million, with Wells Fargo Bank, N.A. as the administrative agent, swingline lender and issuing lender. During March 2020, as a result of market uncertainty caused by COVID-19, we preemptively borrowed $150.0 million on our Credit Facility as a conservative measure to manage any potential short-term liquidity risk. In September 2020, we fully repaid the borrowings under our Credit Facility.

    As of March 31, 2021, we had no borrowings and $150.0 million of availability under the Credit Facility. Principal payments on the revolving Credit Facility are made at our discretion with the unpaid amount due at maturity. The Credit Facility matures on November 8, 2022. Interest on borrowings under the Credit Facility, at our option, is based on the Base Rate plus applicable margin or the London Interbank Offered Rate ("LIBOR") plus applicable margin, see further details in Part II, Item 8, of our 2019 Annual Report on Form 10-K.

Debt Covenants

    The Credit Facility contains certain financial covenants pertaining to Consolidated Fixed Charge Coverage and Consolidated Total Leverage Ratios. In addition, the Credit Facility has restrictions pertaining to limitations on debt, liens, negative pledges, loans, advances, acquisitions, other investments, dividends, distributions, redemptions, repurchases of equity interests, fundamental changes and asset sales and other dispositions, prepayments, redemptions and purchases of subordinated debt and other junior debt, transactions with affiliates, dividend and payment restrictions affecting subsidiaries, changes in line of business, fiscal year and accounting practices and amendment of organizational documents and junior debt documents.

    The Consolidated Leverage Ratio is defined as the ratio of Consolidated Total Funded Indebtedness on such date, to Consolidated Adjusted EBITDA, as defined under the Credit Facility Agreement, for the most recently completed four fiscal quarters. The maximum Consolidated Leverage Ratio is not more than 3.00 to 1.00.

    The Consolidated Fixed Charge Coverage Ratio is defined as the ratio of: (a) Consolidated Adjusted EBITDA less the sum of (i) capital expenditures, (ii) federal, state, local and foreign income taxes paid in cash and (iii) cash restricted payments made after the closing date, to (b) Consolidated Fixed Charges for the most recently completed four fiscal quarters, calculated on a pro forma basis. The minimum Consolidated Fixed Charge Coverage Ratio is 2.00 to 1.00.

     We were in compliance with all financial covenants as of March 31, 2021.     

Note 17: Stockholders' Equity

Treasury Stock

    In August 2019, our Board of Directors approved a new share purchase plan to purchase up to $100.0 million of our common stock. This plan replaced our existing plan and has no expiration date. During the three months ended March 31, 2021, we did not purchase any shares of our common stock under our stock purchase plans. As of March 31, 2021, all of the $100.0 million available for purchase was remaining under the plan. We are currently limited on share purchases in accordance with the terms and conditions of our Credit Facility (see Note 16: Long-Term Obligations).

    For the three months ended March 31, 2021, we withheld 37,423 shares of our common stock from employee vested restricted stock units in consideration for $7.7 million in payments made on the employee's behalf for their minimum statutory income tax withholding obligations. For the three months ended March 31, 2020, we withheld 63,511 shares of our common stock from employee vested restricted stock units in consideration for $12.2 million in payments made on the employee's behalf for their minimum statutory income tax withholding obligations. Treasury stock is used to issue shares for stock option exercises, restricted stock grants and employee stock purchase plan stock purchases.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Accumulated Other Comprehensive (Loss) Income

    The components of accumulated other comprehensive (loss) income ("AOCI"), net of tax, were as follows (in thousands):

	Foreign Currency Translation Adjustments		Unrealized Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2021	$	(4,381)	$	2,784	$	75	$	(1,522)
Other comprehensive (loss) income before reclassifications	(7,458)		(306)		12		(7,752)
Amounts reclassified from AOCI	—		(639)		—		(639)
Other comprehensive (loss) income	(7,458)		(945)		12		(8,391)
Balance as of March 31, 2021	$	(11,839)	$	1,839	$	87	$	(9,913)

	Foreign Currency Translation Adjustments		Unrealized Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2020	$	(17,310)	$	1,880	$	28	$	(15,402)
Other comprehensive loss before reclassifications	(10,477)		(2,426)		(81)		(12,984)
Amounts reclassified from AOCI	—		(526)		—		(526)
Other comprehensive loss	(10,477)		(2,952)		(81)		(13,510)
Balance as of March 31, 2020	$	(27,787)	$	(1,072)	$	(53)	$	(28,912)

Note 18: Commitments and Contingencies

Legal Proceedings

From time to time, we are involved in various legal proceedings, most of which are routine litigation, in the normal course of business.  Our management does not believe that the resolution of the unsettled legal proceedings that we are involved with will have a material adverse impact on our financial position or results of operations.

Off-Balance Sheet Arrangements

    In the normal course of business, we have agreed to indemnify our officers and directors to the maximum extent permitted under Delaware law and to indemnify customers as to certain intellectual property matters or other matters related to sales of our products.  There is no maximum limit on the indemnification that may be required under these agreements.  Although we can provide no assurances, we have never incurred, nor do we expect to incur, any material liability for indemnification.

Contingencies

    During November 2019, we acquired Pursuit. Total consideration for the acquisition includes a potential contractual earn-out of up to $50.0 million, to be paid to former Pursuit equity holders, calculated based upon the achievement of certain performance targets during the earn-out period (see Note 8: Fair Value Measurement).

We had a contractual obligation in connection with our 2017 acquisition of HIS, which as of December 31, 2019 we determined did not meet the necessary performance targets that would require payout of any of the HIS earn-out liability. As of the date of this filing, Pfizer has disputed our determination that the performance targets requiring payout of the HIS earn-out liability were not met. The dispute is being resolved by binding arbitration that will likely be concluded during the third quarter of 2021. Given the uncertainty of any arbitration, it may be possible that we will incur a loss with regards to this matter. If we are unsuccessful in arbitration such that it is determined that we met the necessary performance targets for any of the HIS earn-

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

out liability, we will have to pay between $191.3 million and $225.0 million in additional cash consideration (see Note 8, Fair Value Measurements).

Commitments

    We have non-cancellable operating lease agreements where we are contractually obligated to pay certain lease payment amounts (see Note 5: Leases).

Note 19:     Collaborative and Other Arrangements

    On February 3, 2017, we entered into two Manufacturing and Supply Agreements ("MSAs"), (i) whereby Pfizer will manufacture and supply us with certain agreed upon products for an initial five-year term with a one-time two-year option to extend and (ii) whereby we will manufacture and supply Pfizer certain agreed upon products for a term of five or ten years depending on the product, also with a one-time two-year option to extend. The MSAs provide each party with mutually beneficial interests and both of the MSAs are to be jointly managed by both Pfizer and ICU. The initial supply price, which will be annually updated, is in full consideration for all costs associated with the manufacture, documentation, packaging and certification of the products. On January 1, 2021, we amended our MSA with Pfizer, whereby we manufacture and supply certain agreed upon products to Pfizer. The amendments included a change to the term of the agreement to end on December 31, 2024 with Pfizer's unilateral election to extend through December 31, 2025. Other changes to the terms of the MSA included (i) amendments to our level of supply of products to Pfizer, (ii) certain changes to our manufacturing lines, (iii) updates to our supply price with added volume price tiers for annual periods and (iv) certain minimum purchase requirements for certain products.

Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations

    The following information should be read in conjunction with the condensed consolidated financial statements and accompanying notes in this Form 10-Q, as well as the audited consolidated financial statements and related notes for the fiscal year ended December 31, 2020 included in our Annual Report on Form 10-K.

    When used in this report, the terms “we,” “us,” and “our” refer to ICU Medical, Inc ("ICU") and its subsidiaries included in our condensed consolidated financial statements unless context requires otherwise.

Business Overview

    We are one of the world's leading pure-play infusion therapy companies with global operations and a wide-ranging product portfolio that includes IV solutions, IV smart pumps with pain management and safety software technology, dedicated and non-dedicated IV sets and needlefree connectors designed to help meet clinical, safety and workflow goals. In addition, we manufacture automated pharmacy IV compounding systems with workflow technology, closed systems transfer devices for preparing and administering hazardous IV drugs, and cardiac monitoring systems for critically ill patients.

Our primary customers are acute care hospitals, wholesalers, ambulatory clinics and alternate site facilities, such as clinics, home health care providers and long-term care facilities. We sell our products in more than 90 countries throughout the world.

    We categorize our products into four main product lines: Infusion Consumables, Infusion Systems, IV Solutions and Critical Care. We have presented our financial results in accordance with these product lines, with our primary products in each line listed below.

Operations Overview

COVID-19

    The novel coronavirus and its variants (“COVID-19”) continues to have an impact on our business operations. Our manufacturing, distribution and pump service facilities continue to operate under our business continuity plan and our precautionary safety measures implemented to maximize the safety of our employees and mitigate disruption of our business are still in effect. For greater detail on the above mentioned safety measures and a discussion of how future results may potentially be impacted by COVID-19 see Part II, Item 7, of our 2020 Annual Report on Form 10-K.

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While we continually monitor the ongoing and evolving impact of the effect of the COVID-19 pandemic on our operations the overall impact will not be fully reflected in our results of operations until future periods. The duration and extent of the impact from the COVID-19 pandemic depends on future developments that cannot be fully predicted at this time, as such, the impact of the pandemic on our overall financial performance remain uncertain and cannot as yet be quantified.

Infusion Consumables

Infusion therapy sets, used in hospitals and ambulatory clinics, consist of a tube running from a bottle or plastic bag containing a solution to a catheter inserted in a patient’s vein, that may or may not be used with an IV pump.  Our primary Infusion Consumable products are:

•Clave™ needlefree products, including the MicroClave, MicroClave Clear, and NanoClave™ brand of connectors, accessories, extension and administration sets used for the administration of IV fluids and medications and the Neutron catheter patency device, used to help maintain patency of central venous catheters;

•SwabCap disinfecting cap, used to protect and disinfect any needlefree connector, including competitive brands of connectors;

•ClearGuard HD antimicrobial barrier caps for hemodialysis catheters; and

•TegoTM hemodialysis connector used to cap and protect hemodialysis central venous catheter hubs;

    Closed System Transfer Devices ("CSTD") and hazardous drug compounding systems are used to prepare and deliver hazardous IV medications such as those used in chemotherapy, which, if released, can have harmful effects on the healthcare worker and environment. Our products are:

•ChemoLockTM CSTD which utilizes a proprietary needlefree connection method, is used for the preparation and administration of hazardous drugs. ChemoLock is used to limit the escape of hazardous drug or vapor concentrations, block the transfer of environmental contaminants into the system, and eliminates the risk of needlestick injury;

•ChemoClaveTM, an ISO Connection standard and universally compatible CSTD used for the preparation and administration of hazardous drugs. ChemoClave utilizes standard ISO luer locking connections, making it compatible with all brands of needlefree connectors and pump delivery systems. ChemoClave also is used to limit the escape of hazardous drug or vapor concentrations, block the transfer of environmental contaminants into the system, and eliminate the risk of needlestick injury; and

•DianaTM hazardous drug compounding system, an automated sterile compounding system that incorporates ChemoClave and ChemoLock CSTD consumables and IV workflow technology for the accurate, safe, and efficient preparation of hazardous drugs. It is a user-controlled automated system that provides repeatable accuracy of drug mixes and minimizes clinician exposure to hazardous drugs while helping to maintain the sterility of the drugs being mixed.

The preparation of hazardous drugs typically takes place in a pharmacy where drugs are removed from vials and prepared for delivery to a patient. Those prepared drugs are then transferred to a nursing unit where the chemotherapy is administered via an infusion pump set to a patient. Components of the ChemoClave and ChemoLock product lines are used both in pharmacies and on the nursing floors for the preparation and administration of hazardous drugs.

Infusion Systems

    We offer a wide range of infusion pumps, dedicated IV sets and software. Our primary Infusion System products are dedicated IV sets and the following:

Infusion Pump Hardware:

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◦Plum 360™: The Plum 360™ infusion pump is an ICU Medical MedNet™ ready large volume infusion pump with an extensive drug library and wireless capability. Plum 360 was named the 2018, 2019 and 2020 Best in KLAS winner as top-performing IV smart pump and is the first medical device to be awarded UL Cybersecurity Assurance Program Certification; and

◦LifeCare PCA™: The LifeCare PCA infusion pump is an ICU Medical MedNet™ ready patient-controlled analgesia pump ("PCA"), providing complete IV-EHR interoperability since 2016.

    IV Mediation Safety Software:

•ICU Medical MedNet™: ICU Medical MedNet is an enterprise-class medication management platform for any sized healthcare system that can help reduce medication errors, improve quality of care, streamline workflows and maximize revenue capture. ICU Medical MedNet connects our industry-leading smart pumps to a hospital’s Electronic Health Records ("EHR"), asset tracking systems, and alarm notification platforms with the largest array of integration partners.

Professional Services:

•In addition to the products above, our teams of clinical, information technology, and professional services experts work with customers to develop and deliver safe and efficient infusion systems, providing customized and personalized configuration, implementation, and data analytics services to complement our infusion hardware and software.

IV Solutions

    We provide a broad portfolio of IV solutions to meet our customers’ clinical needs, providing a consistent supply of IV solutions, irrigation, and nutritionals to help provide safe and effective patient care. Our primary IV Solutions products are:

    IV Therapy and Diluents:

•Including Sodium Chloride, Dextrose, Balanced Electrolyte Solutions, Lactated Ringer's, Ringer's, Mannitol, Sodium Chloride/Dextrose and Sterile Water.

Irrigation:

•Including Sodium Chloride Irrigation, Sterile Water Irrigation, Physiologic Solutions, Ringer's Irrigation, Acetic Acid Irrigation, Glycine Irrigation, Sorbitol-Mannitol Irrigation, Flexible Containers and Pour Bottle Options.

Critical Care

    Our Critical Care products help clinicians get accurate real-time access to patients’ hemodynamic and cardiac status with an extensive portfolio of monitoring systems and advanced sensors & catheters.  Measurements provided by our systems help clinicians determine how well the heart is pumping blood and how efficiently oxygen from the blood is being used by the tissues. Our primary Critical Care products are:

•Cogent™ 2-in-1 hemodynamic monitoring system;

•CardioFlo™ hemodynamic monitoring system;

•TDQ™ and OptiQ™ cardiac output monitoring catheters;

•TriOxTM venous oximetry catheters;

•Transpac™ blood pressure transducers; and

•SafeSet™ closed blood sampling and conservation system.

    The following table summarizes our total worldwide revenue by domestic and international markets by amount and as a percentage of total revenue (in millions, except percentages):

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	Three months ended March 31,
	2021				2020
	$		% of Revenue		$		% of Revenue
Domestic	$	227.3	71	%	$	230.2	70	%
International	90.7		29	%	98.4		30	%
Total Revenue	$	318.0	100	%	$	328.6	100	%

The following table sets forth, for the periods indicated, total revenue by product line as a percentage of total revenue: 

	Three months ended March 31,
Product line	2021		2020
Infusion Consumables	40	%	37	%
Infusion Systems	26	%	27	%
IV Solutions	30	%	32	%
Critical Care	4	%	4	%
	100	%	100	%

We manage our product distribution in the U.S. through a network of two owned and one leased distribution facilities in combination with independent distributors and third-party fulfillment and logistics providers. Our end customers, which include healthcare providers and original equipment manufacturer suppliers, may order and receive our products directly from us or through an independent full-line distributor. Internationally, we manage distribution utilizing international regional hubs and through independent distributors.

In the U.S. a substantial amount of our products are sold to group purchasing organization member hospitals. We believe that as healthcare providers continue to either consolidate or join major buying organizations, the success of our products will depend, in part, on our ability, either independently or through strategic relationships to secure long-term contracts with large healthcare providers and major buying organizations. Although we believe that we are not dependent on any single distributor, large healthcare provider or major buying organization for distribution of our products, the loss of a strategic relationship with any one of these organizations or a decline in the demand for our products could have a material adverse effect on our operating results.

We believe that achievement of our growth objectives worldwide will require increased efforts by us in sales and marketing and product acquisition and development; however, there is no assurance that we will be successful in implementing our growth strategy. Product development or acquisition efforts may not succeed, and even if we do develop or acquire additional products, there is no assurance that we will achieve profitable sales of such products. Increased expenditures for sales and marketing and product acquisition and development may not yield desired results when expected, or at all. While we have taken steps to control these risks, there are certain risks that may be outside of our control, and there is no assurance that steps we have taken will succeed.

Seasonality/Quarterly Results 

    There are no significant seasonal aspects to our business. We may experience fluctuations in net sales as a result of variations in the ordering patterns of our largest customers, which may be driven more by production scheduling and their inventory levels, rather than by seasonality. Our expenses often do not fluctuate in the same manner as net sales, which may cause fluctuations in operating income that are disproportionate to fluctuations in our revenue.

Consolidated Results of Operations

    We present income statement data in Part I, Item 1 - Financial Statements. The following table shows, for the three and nine months ended March 31, 2021 and 2020, the percentages of each income statement caption in relation to total revenue: 

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	Three months ended March 31,
	2021		2020
Total revenue	100	%	100	%
Gross margin	35	%	37	%
Selling, general and administrative expenses	23	%	22	%
Research and development expenses	3	%	3	%
Restructuring and strategic transaction	1	%	4	%
Change in fair value of contingent earn-out	—	%	—	%
Contract settlement	—	%	—	%
Total operating expenses	27	%	29	%
Income from operations	8	%	8	%
Interest expense	—	%	—	%
Other income (expense), net	—	%	(2)	%
Income before income taxes	8	%	6	%
Provision for income taxes	(1)	%	(1)	%
Net income	7	%	5	%

In addition to comparing changes in revenue on a U.S. GAAP basis, we also compare the changes in revenue from one period to another using constant currency. We provide constant currency information to enhance the visibility of underlying business trends, excluding the effects of changes in foreign currency translation rates. To calculate our constant currency results, we apply the average exchange rate for revenues from the prior year to the current year results. These results should be considered in addition to, not as a substitute for, results reported in accordance with GAAP. Results on a constant currency basis, as we present them, may not be comparable to similarly titled measures used by other companies and are not measures of performance presented in accordance with GAAP.

Infusion Consumables

    The following table summarizes our total Infusion Consumables revenue (in millions):

	Three months ended March 31,
	2021		2020		$ Change		% Change
Infusion Consumables	$	126.4	$	123.5	$	2.9	2.3	%

Infusion Consumables revenue increased for the three months ended March 31, 2021, as compared to the same period in the prior year due to higher demand for our oncology and renal products and foreign exchange gains. These increases were somewhat offset by a decrease in IV therapy sales due to increased distributor orders in the prior year due to the global COVID-19 pandemic. On a constant currency basis, Infusion Consumables revenue would have been $123.1 million for the three months ended March 31, 2021, a decrease of $0.4 million or 0.3%, as compared to the same period in the prior year.

Infusion Systems

    The following table summarizes our total Infusion Systems revenue (in millions):

	Three months ended March 31,
	2021		2020		$ Change		% Change
Infusion Systems	$	84.3	$	88.4	$	(4.1)	(4.6)	%

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Infusion Systems revenue decreased for the three months ended March 31, 2021, as compared to the same period in the prior year due to a decline in our non-large volume pump business as well as lower IV set revenues due to higher COVID-19-related purchases during the first quarter of 2020. On a constant currency basis Infusion Systems revenue would have been $83.3 million for the three months ended March 31, 2021, a decrease of $5.1 million or 5.8%, as compared to the same period in the prior year.

IV Solutions

    The following table summarizes our total IV Solutions revenue (in millions):

	Three months ended March 31,
	2021		2020		$ Change		% Change
IV Solutions	$	94.2	$	104.3	$	(10.1)	(9.7)	%

IV Solutions sales decreased for the three months ended March 31, 2021, as compared to the same period in the prior year, primarily due to customer stocking in the prior year driven by the onset of the COVID-19 pandemic.

Critical Care

    The following table summarizes our total Critical Care revenue (in millions):

	Three months ended March 31,
	2021		2020		$ Change		% Change
Critical Care	$	13.1	$	12.4	$	0.7	5.6	%

Critical Care revenue increased for the three months ended March 31, 2021, as compared to the same period in the prior year, primarily as a result of increased sales of our Cogent 2-in-1 hemodynamic monitoring system.

Gross Margins

    For the three months ended March 31, 2021 and 2020, gross margins were 35.4% and 36.9%, respectively. The decrease in gross margin for the three months ended March 31, 2021, as compared to the same period in the prior year was primarily due to capitalized manufacturing variances from the shutdown of our Austin plant in the fourth quarter of 2020 and additional weather-related costs at our Austin plant during the first quarter of 2021.

Selling, General and Administrative (“SG&A”) Expenses

    The following table summarizes our total SG&A Expenses (in millions):

	Three months ended March 31,
	2021		2020		$ Change		% Change
SG&A	$	72.4	$	72.3	$	0.1	0.1	%

SG&A expenses were essentially flat for the three months ended March 31, 2021, as compared to the same period in the prior year. For the three months ended March 31, 2021 as compared to the same period in the prior year, legal fees increased $1.4 million and dealer fees increased $1.3 million. These increases were mostly offset by a decrease of $1.2 million in travel expenses and a decrease of $1.0 million in stock based compensation expenses. Legal fees increased due to additional services performed in the current year related to various legal matters. Dealer fees increased due to an increase in revenue from distributors. Travel expenses decreased due to travel restrictions in response to COVID-19. Stock compensation decreased in the current period due to a prior year change in the number of performance shares estimated to vest on one of our executive performance awards, which increased the expense in that period.

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Research and Development (“R&D”) Expenses

    The following table summarizes our total R&D Expenses (in millions):

	Three months ended March 31,
	2021		2020		$ Change		% Change
R&D	$	10.7	$	10.7	$	—	—	%

R&D expenses were flat for the three months ended March 31, 2021, as compared to the same period in the prior year. R&D expense primarily relates to compensation and related benefit expenses on current R&D projects.

Restructuring and Strategic Transaction and Integration Expenses

    Restructuring and strategic transaction and integration expenses were $2.9 million and $12.3 million for the three months ended March 31, 2021 and 2020, respectively.

Restructuring charges

    Restructuring charges were $0.0 million and $7.2 million for the three months ended March 31, 2021 and 2020, respectively. Restructuring charges for the three months ended March 31, 2020 were primarily related to severance and costs related to office and facility closures. We expect to pay our unpaid restructuring charges as of March 31, 2021 by the end of the year.

Strategic transaction and integration expenses

    Strategic transaction and integration expenses were $2.9 million and $5.1 million for the three months ended March 31, 2021 and 2020, respectively. The strategic transaction and integration expenses during the three months ended March 31, 2021 were primarily related to integration costs associated with acquisitions, the Hospira Infusion Systems ("HIS") earn-out dispute with Pfizer and one-time costs incurred to comply with regulatory initiatives. The strategic transaction and integration expenses during the three months ended March 31, 2020 were primarily related to the integration of the HIS business acquired in 2017 from Pfizer, which included the migration of IT systems at our Austin facility.

Change in Fair Value of Contingent Earn-out

    For the three months ended March 31, 2021 and 2020, there was no change in fair value of the Pursuit earn-out liability for each period, respectively, as the underlying forecasts during those periods did not materially change.

Contract Settlement

    For the three months ended March 31, 2021, we recorded $0.1 million in contract settlement expense.

Interest Expense

    Interest expense was $0.2 million and $0.2 million for the three months ended March 31, 2021 and 2020, respectively. The interest expense for both periods includes the per annum commitment fee charged on the unused portion of the revolver under our Credit Facility and the amortization of financing costs that were incurred in 2017 in connection with entering into the Credit Facility. During March 2020, we borrowed $150.0 million under our Credit Facility and, accordingly the interest expense for the three months ended March 31, 2020 also includes interest incurred on borrowings under the Credit Facility (see Note 16: Long-Term Obligations in our accompanying condensed consolidated financial statements for additional information).

Other Income (Expense), net

    Other income (expense) netted to $0.7 million and ($5.5) million for the three months ended March 31, 2021 and 2020, respectively. For the three months ended March 31, 2021, the other income, net was related to $0.7 million of interest

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income, $0.5 million in foreign exchange gains and $0.2 million of miscellaneous income partially offset by $0.7 million of loss from disposed assets. For the three months ended March 31, 2020, the other expense, net was primarily related to $6.1 million in foreign exchange losses as a result of the strengthening of the U.S. dollar from the impact of COVID-19, partially offset by interest income.

Income Taxes

    For the three months ended March 31, 2021 and 2020, income taxes were accrued at an estimated effective tax rate of 12% and 17% , respectively.

    The effective tax rate for the three months ended March 31, 2021 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, global intangible low-taxed income ("GILTI"), foreign-derived intangible income ("FDII") and tax credits. The effective tax rate during the three months ended March 31, 2021 included a tax benefit of $1.8 million related to the excess tax benefits recognized on stock option exercises and the vesting of restricted stock units during the period.

    The effective tax rate for the three months ended March 31, 2020 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, GILTI, FDII and tax credits.

Liquidity and Capital Resources

During the first three months of 2021, our cash, cash equivalents and short and long-term investments increased by $31.0 million from $423.8 million at December 31, 2020 to $454.8 million at March 31, 2021.

Cash Flows from Operating Activities

Our net cash provided by operations for the three months ended March 31, 2021 was $51.3 million. Net income plus adjustments for non-cash net expenses contributed $56.9 million. Net cash used in operations as a result of changes in operating assets and liabilities was $5.6 million. The changes in operating assets and liabilities included a $20.0 million decrease in accrued liabilities, a $3.5 million increase in other assets and a $0.7 million increase in prepaid expenses and other assets. Offsetting these amounts was a $13.2 million decrease in inventories, a $2.4 million increase in accounts payable, a $1.5 million decrease in accounts receivables and $1.4 million in net changes in income taxes, including excess tax benefits and deferred income taxes. The decrease in accrued liabilities was primarily due to the payment of annual bonuses. The net increase in prepaid expenses and other current assets was primarily due to the payment of annual software renewals, offset by the amortization of prepaid insurance and property taxes. The increase in other assets was due to the purchase of spare parts. The decrease in inventory was primarily due to the timing of production and customer purchases combined with the reduction in capitalized manufacturing variances. The increase in accounts payable was due to the timing of payments. The decrease in accounts receivable is primarily due to collection efforts. The net changes in income taxes was a result of the timing of payments.

Our net cash provided by operations for the three months ended March 31, 2020 was $39.5 million. Net income plus adjustments for non-cash net expenses contributed $55.3 million. Net cash used in operations as a result of changes in operating assets and liabilities was $15.8 million. The changes in operating assets and liabilities included a $35.1 million decrease in accounts payable, and a $6.4 million increase in other assets. Offsetting these amounts was a $19.4 million decrease in inventories, a $2.6 million decrease in prepaid expenses and other current assets, $2.3 million in net changes in income taxes,

including excess tax benefits and deferred income taxes, a $0.9 million decrease in accounts receivables, and a $0.5 million increase in accrued liabilities. The decrease in accounts payable was due to the timing of payments. The increase in other assets was due to the purchase of spare parts. The decrease in inventory was primarily due to improved inventory management and increased demand for certain products driven by the global COVID-19 pandemic. The increase in prepaid expenses and other current assets was primarily due to an increase in deferred costs. The net changes in income taxes was a result of the timing of payments.

Cash Flows from Investing Activities

    The following table summarizes the changes in our investing cash flows (in thousands):

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	Three months ended March 31,
	2021		2020		Change
Investing Cash Flows:
Purchases of property and equipment	$	(14,028)	$	(25,463)	$	11,435	(1)
Proceeds from sale of assets	55		131		(76)
Intangible asset additions	(1,874)		(1,958)		84
Purchases of investment securities	(10,034)		(7,082)		(2,952)		(2)
Proceeds from sale of investment securities	7,000		10,900		(3,900)		(3)
Net cash used in investing activities	$	(18,881)	$	(23,472)	$	4,591

______________________________

(1) Our purchases of property and equipment will vary from period to period based on additional investments needed to support new and existing products and expansion of our manufacturing facilities

(2)    Our purchases of investment securities will vary from period to period based on current cash needs, planning for known future transactions and due to changes in our investment strategy.

(3) Proceeds from the sale or maturity of our investment securities will vary from period to period based on the maturity dates of the investments we currently hold.

    While we can provide no assurances, we estimate that our capital expenditures in 2021 will be approximately $75.0 million to $85.0 million. We anticipate making additional investments in machinery and equipment in our manufacturing operations in Costa Rica, the U.S. and Mexico to support new and existing products and in infusion pumps that are placed with customers outside the U.S. We expect to use our cash and cash equivalents to fund our capital purchases. Amounts of spending are estimates and actual spending may substantially differ from those amounts.

Cash Flows from Financing Activities

    The following table summarizes the changes in our financing cash flows (in thousands):    

	Three months ended March 31,
	2021		2020		Change
Financing Cash Flows:
Proceeds from short-term debt	$	—	$	150,000	$	(150,000)	(1)
Proceeds from exercise of stock options	4,864		560		4,304		(2)
Payments on finance leases	(141)		—		(141)
Tax withholding payments related to net share settlement of equity awards	(7,723)		(12,174)		4,451		(3)
Net cash (used in) provided by financing activities	$	(3,000)	$	138,386	$	(141,386)

______________________________

(1) During March 2020, as a result of market uncertainty caused by COVID-19, we borrowed $150.0 million under our revolving Credit Facility. We fully repaid the amounts borrowed under our revolving Credit Facility in September 2020.

(2)    Proceeds from the exercise of stock options will vary from period to period based on the volume of options exercised and the exercise price of the specific options exercised.

(3) During the three months ended March 31, 2021, our employees surrendered 37,423 shares of our common stock from vested restricted stock awards as consideration for approximately $7.7 million in minimum statutory withholding obligations paid on their behalf. During the three months ended March 31, 2020, our employees surrendered 63,511 shares of our common stock from vested restricted stock awards as consideration for approximately $12.2 million in minimum statutory withholding obligations paid on their behalf.

In August 2019, our Board of Directors approved a share purchase plan to purchase up to $100.0 million of our common stock. This plan replaced our existing plan and has no expiration date. As of March 31, 2021, all of the $100 million available for purchase was remaining under the plan.

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We have a substantial cash and investment security position generated from operations. We maintain this position to address any operational challenges related to COVID-19, fund our growth, meet increasing working capital requirements, fund capital expenditures and to take advantage of acquisition opportunities that may arise. Our primary investment goal is capital preservation.

Access to Capital

We believe that our existing cash and cash equivalents along with funds expected to be generated from future operations will provide us with sufficient funds to finance our current operations for the next twelve months. In the event that we experience downturns, cyclical fluctuations in our business that are more severe or longer than anticipated, fail to achieve anticipated revenue and expense levels, or have significant unplanned cash expenditures, we may need to obtain or seek alternative sources of capital or financing, and we can provide no assurances that the terms of such capital or financing will be available to us on favorable terms, if at all. Our ability to generate cash flows from operations, issue debt or enter into other financing arrangements on acceptable terms could be adversely affected if there is a material decline in the demand for our products or in the solvency of our customers or suppliers, deterioration in our key financial ratios or credit ratings or other significantly unfavorable changes in conditions.

Credit Facility    

    We have a five-year Credit Facility with various lenders for $150.0 million, with Wells Fargo Bank, N.A. as the administrative agent (see Note 16: Long-Term Obligations). The Credit Facility has an accordion feature that would enable us to increase the borrowing capacity of the Credit Facility by the greater of (i) $100.0 million and (ii) 2.00x Total Leverage. Under the terms of the Credit Facility, we will be subject to certain financial covenants pertaining to leverage and fixed charge coverage ratios. Borrowings under the Credit Facility will bear interest at LIBOR plus an applicable margin tied to the leverage ratio in effect. Any unused portion of the Credit Facility will be subject to a per annum commitment fee which is also calculated using the leverage ratio in effect. The Credit Facility matures in 2022. During March 2020, as a precautionary measure in response to market uncertainty driven by the COVID-19 pandemic, we preemptively increased our liquidity by borrowing $150.0 million under our Credit Facility. In September 2020, we fully repaid the borrowings under our Credit Facility.

Financial Covenants

    The Credit Facility contains certain negative financial covenants, including, Consolidated Total Leverage and Consolidated Fixed Charge Coverage Ratios.

    The Consolidated Leverage Ratio is defined as the ratio of Consolidated Total Funded Indebtedness on such date, to Consolidated Adjusted EBITDA, as defined under the Credit Facility Agreement, for the most recently completed four fiscal quarters. The maximum Consolidated Leverage Ratio is not more than 3.00 to 1.00.

    The Consolidated Fixed Charge Coverage Ratio is defined as the ratio of: (a) Consolidated Adjusted EBITDA less the sum of (i) capital expenditures, (ii) federal, state, local and foreign income taxes paid in cash and (iii) cash restricted payments made after the closing date, to (b) Consolidated Fixed Charges for the most recently completed four fiscal quarters, calculated on a pro forma basis. The minimum Consolidated Fixed Charge Coverage Ratio is 2.00 to 1.00.

    We were in compliance with all financial covenants as of March 31, 2021.

Off-Balance Sheet Arrangements

In the normal course of business, we have agreed to indemnify our officers and directors to the maximum extent permitted under Delaware law and to indemnify customers as to certain intellectual property matters related to sales of our products. There is no maximum limit on the indemnification that may be required under these agreements. Although we can provide no assurances, we have never incurred, nor do we expect to incur, any material liability for indemnification. 

Contractual Obligations

    There have been no material changes to our contractual obligations disclosed in our Annual Report on Form 10-K for the fiscal year ended December 31, 2020 ("Annual Report").

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Critical Accounting Policies

In our Annual Report, we identified the critical accounting policies which affect our more significant estimates and assumptions used in preparing our consolidated financial statements, there have been no material changes to our critical accounting policies from those previously disclosed in our Annual Report.

New Accounting Pronouncements

See Note 2 to Part I, Item 1.  Financial Statements.

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Forward Looking Statements

Various portions of this Quarterly Report on Form 10-Q, including this Management’s Discussion and Analysis of Financial Condition and Results of Operations, and documents referenced herein, describe trends in our business and finances that we perceive and state some of our expectations and beliefs about our future. These statements about the future are “forward looking statements,” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and we may identify them by using words such as "anticipate," "believe," "expect," "estimate," "intend," "plan," "will," "continue," "could," "may," and by similar expressions and statements about aims, goals and plans. The forward looking statements are based on the best information currently available to us and assumptions that we believe are reasonable, but we do not intend the statements to be representations as to future results. They include, without limitation, statements about:

•future growth; future operating results and various elements of operating results, including future expenditures and effects with respect to sales and marketing and product development and acquisition efforts; future sales and unit volumes of products; expected increases and decreases in sales; deferred revenue; accruals for restructuring charges, future license, royalty and revenue share income; production costs; gross margins; litigation expense; future SG&A and R&D expenses; manufacturing expenses; future costs of expanding our business; income; losses; cash flow; amortization; source of funds for capital purchases and operations; future tax rates; alternative sources of capital or financing; changes in working capital items such as receivables and inventory; selling prices; and income taxes;

•factors affecting operating results, such as shipments to specific customers; reduced dependence on current proprietary products; loss of a strategic relationship; change in demand; domestic and international sales; expansion in international markets, selling prices; future increases or decreases in sales of certain products and in certain markets and distribution channels; maintaining strategic relationships and securing long-term and multi-product contracts with large healthcare providers and major buying organizations; increases in systems capabilities; introduction, development and sales of new products, acquisition and integration of businesses and product lines; benefits of our products over competing systems; qualification of our new products for the expedited Section 510(k) clearance procedure; possibility of lengthier clearance process for new products; planned increases in marketing; warranty claims; rebates; product returns; bad debt expense; amortization expense; inventory requirements; lives of property and equipment; manufacturing efficiencies and cost savings; unit manufacturing costs; establishment or expansion of production facilities inside or outside of the United States; planned new orders for semi-automated or fully automated assembly machines for new products; adequacy of production capacity; results of R&D; our plans to repurchase shares of our common stock; asset impairment losses; relocation of manufacturing facilities and personnel; effect of expansion of manufacturing facilities on production efficiencies and resolution of production inefficiencies; the effect of costs to customers and delivery times; business seasonality and fluctuations in quarterly results; customer ordering patterns and the effects of new accounting pronouncements; and

•new or extended contracts with manufacturers and buying organizations; dependence on a small number of customers; loss of larger distributors and the ability to locate other distributors; growth of our Clave products in future years; design features of Clave products; the outcome of our strategic initiatives; regulatory approvals and compliance; outcome of litigation; patent protection and intellectual property landscape; patent infringement claims and the impact of newly issued patents on other medical devices; competitive and market factors, including continuing development of competing products by other manufacturers; improved production processes and higher volume production; innovation requirements; consolidation of the healthcare provider market and downward pressure on selling prices; distribution or financial capabilities of competitors; healthcare reform legislation; use of treasury stock; working capital requirements; liquidity and realizable value of our investment securities; future investment alternatives; foreign currency denominated financial instruments; foreign exchange risk; commodity price risk; our expectations regarding liquidity and capital resources over the next twelve months; capital expenditures; plans to convert existing space; acquisitions of other businesses or product lines, indemnification liabilities and contractual liabilities.

 Forward-looking statements involve certain risks and uncertainties, which may cause actual results to differ materially from those discussed in each such statement.  First, one should consider the factors and risks described in the statements themselves or otherwise discussed herein. Those factors are uncertain, and if one or more of them turn out differently than we currently expect, our operating results may differ materially from our current expectations.

35

Second, investors should read the forward looking statements in conjunction with the Risk Factors discussed in Part I, Item 1A of our Annual Report on Form 10-K with the SEC for the year ended December 31, 2020, Part II, Item 1A of this Quarterly Report on Form 10-Q and our other reports filed with the SEC.  Also, actual future operating results are subject to other important factors and risks that we cannot predict or control, including without limitation, the following:

•the impacts of the COVID-19 pandemic on us, our business and on domestic and global economies generally;

•general economic and business conditions, both in the U.S. and internationally;

•unexpected changes in our arrangements with Pfizer or our other large customers;

•outcome of litigation;

•fluctuations in foreign exchange rates and other risks of doing business internationally;

•increases in labor costs or competition for skilled workers;

•increases in costs or availability of the raw materials need to manufacture our products;

•the effect of price and safety considerations on the healthcare industry;

•competitive factors, such as product innovation, new technologies, marketing and distribution strength and price erosion;

•the successful development and marketing of new products;

•unanticipated market shifts and trends;

•the impact of legislation affecting government reimbursement of healthcare costs;

•changes by our major customers and independent distributors in their strategies that might affect their efforts to market our products;

•the effects of additional governmental regulations;

•unanticipated production problems;

•the availability of patent protection and the cost of enforcing and of defending patent claims; and

•natural disasters and outbreak of disease or illness.

The forward-looking statements in this report are subject to additional risks and uncertainties, including those detailed from time to time in our other filings with the Securities and Exchange Commission. These forward-looking statements are made only as of the date hereof and, except as required by law, we undertake no obligation to update or revise any of them, whether as a result of new information, future events or otherwise.

Item 3.Quantitative and Qualitative Disclosures about Market Risk

Interest Rate Risk    

    If we were to incur borrowings under our Credit Facility, we would face market risk stemming from changes in interest rates.

Foreign Exchange Risk    

    We transact business globally in multiple currencies, some of which are considered volatile. Our international revenues and expenses and working capital positions denominated in these foreign currencies expose us to the risk of fluctuations in foreign currency exchange rates against the U.S. dollar. As the receiver of foreign currencies we are adversely affected by the strengthening of the U.S. dollar relative to the foreign currency.

    In our European operations, our net Euro asset position at March 31, 2021 was approximately €43.5 million. A 10% change in the conversion of the Euro to the U.S. dollar for our cash, accounts receivable, accounts payable and accrued liabilities from the March 31, 2021 spot rate would impact our consolidated amounts on these balance sheet items by approximately $5.1 million, or 0.7% of these consolidated net assets. We expect that in the future, with the growth of our

36

European distribution operations, net Euro denominated instruments will continue to increase. We currently do not hedge our Euro foreign currency exposures.

    We have manufacturing facilities and conduct business transactions denominated in the Mexican Peso. We hedge a portion of our manufacturing spend, which reduces our exposure to the foreign currency exchange risk related to the Mexican Peso (see Note 7: Derivatives and Hedging to the condensed consolidated financial statements in Part I, Item 1 of this Form 10-Q).

Item 4.Controls and Procedures

Evaluation of Disclosure Controls and Procedures

Our principal executive officer and principal financial officer have concluded, based on their evaluation of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended (the "Exchange Act")), as of the end of the period covered by this Report, that our disclosure controls and procedures are effective to ensure that the information we are required to disclose in the reports that we file or submit under the Exchange Act is accumulated and communicated to our management, including our principal executive officer and principal financial officer, as appropriate, to allow timely decisions regarding required disclosure and that such information is recorded, processed, summarized and reported within the time periods specified in the rules and forms of the SEC.

There was no change in our internal control over financial reporting during the quarter ended March 31, 2021 that has materially affected or is reasonably likely to materially affect our internal control over financial reporting.

PART II - OTHER INFORMATION

Item 1.Legal Proceedings

    Certain legal proceedings in which we are involved are discussed in Part I, Item 1. "Financial Statements" of this Form 10-Q in Note 18. Commitments and Contingencies to the Condensed Consolidated Financial Statements, and is incorporated herein by reference.

Item 1A.Risk Factors

    In evaluating an investment in our common stock, investors should consider carefully, among other things, the risk factors previously disclosed in Part I, Item 1A of our Annual Report on Form 10-K filed with the SEC for the year ended December 31, 2020, as well as the information contained in this Quarterly Report and our other reports and registration statements filed with the SEC.

Item 2.Unregistered Sales of Equity Securities and Use of Proceeds

Purchase of Equity Securities

    The following is a summary of our stock repurchasing activity during the first quarter of 2021:

Period	Total number of shares purchased	Average price paid per share		Total number of shares purchased as part of a publicly announced program	Approximate dollar value that may yet be purchased under the program(1)
01/01/2021 — 01/31/2021	—	$	—	—	$	100,000,000
02/01/2021 — 02/28/2021	—	$	—	—	$	100,000,000
03/01/2021 — 03/31/2021	—	$	—	—	$	100,000,000
First quarter of 2021 total	—	$	—	—	$	100,000,000

____________________________

37

(1)    Our common stock purchase plan, which authorized the repurchase of up to $100.0 million of our common stock, was authorized by our Board of Directors and publicly announced in August, 2019.  This plan has no expiration date. We are not obligated to make any purchases under our stock purchase program. Subject to applicable state and federal corporate and securities laws, purchases under a stock purchase program may be made at such times and in such amounts as we deem appropriate. Purchases made under our stock purchase program can be discontinued at any time we feel additional purchases are not warranted.

Item 6. Exhibits

    See the Exhibit Index following the signature page to this Quarterly Report on Form 10-Q for a list of exhibits filed or furnished with this report, which Exhibit Index is incorporated herein by reference.

38

Signature

Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

ICU Medical, Inc.

(Registrant)
/s/ Brian M. Bonnell	Date:	May 7, 2021
Brian M. Bonnell
Chief Financial Officer
(Principal Financial Officer)

39

Exhibit Index

Exhibit 31.1	Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
Exhibit 31.2	Certification of Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
Exhibit 32.1	Certifications of Chief Executive Officer and Chief Financial Officer pursuant to Section 906 of the Sarbanes-Oxley Act of 2002
Exhibit 101.INS	XBRL Instance Document - this instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
Exhibit 101.SCH	XBRL Taxonomy Extension Schema Document
Exhibit 101.CAL	XBRL Taxonomy Extension Calculation Linkbase Document
Exhibit 101.DEF	XBRL Taxonomy Extension Definition Linkbase Document
Exhibit 101.LAB	XBRL Taxonomy Extension Label Linkbase Document
Exhibit 101.PRE	XBRL Taxonomy Extension Presentation Linkbase Document
Exhibit 104	Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)

40

EX-31.1

Exhibit 31.1

CERTIFICATION OF CHIEF EXECUTIVE OFFICER PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Vivek Jain, certify that:

1.I have reviewed this quarterly report on Form 10-Q of ICU Medical, Inc.;

2.Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a)Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b)Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c)Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d)Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5.The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a)All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b)Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date:	May 7, 2021	/s/ Vivek Jain
		Chief Executive Officer

EX-31.2

Exhibit 31.2

CERTIFICATION OF CHIEF FINANCIAL OFFICER PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Brian M. Bonnell, certify that:

1.I have reviewed this quarterly report on Form 10-Q of ICU Medical, Inc.;

2.Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a)Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b)Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c)Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d)Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a)All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b)Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date:	May 7, 2021	/s/ Brian M. Bonnell
		Chief Financial Officer

EX-32.1

Exhibit 32.1

CERTIFICATION OF CHIEF EXECUTIVE OFFICER

PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of ICU Medical, Inc. (the “Company”) on Form 10-Q for the period ended March 31, 2021 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Vivek Jain, Chief Executive Officer of the Company, certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that:

(1)The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2)The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

May 7, 2021	/s/ Vivek Jain
	Vivek Jain

CERTIFICATION OF CHIEF FINANCIAL OFFICER

PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of ICU Medical, Inc. (the “Company”) on Form 10-Q for the period ended March 31, 2021 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Brian M. Bonnell, Chief Financial Officer of the Company, certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that:

(1)The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2)The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

May 7, 2021	/s/ Brian M. Bonnell
	Brian M. Bonnell

XML

DEI Document - shares	3 Months Ended
	Mar. 31, 2021	Apr. 30, 2021
Document And Entity Information [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2021
Document Transition Report	false
Entity File Number	001-34634
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	33-0022692
Entity Address, Address Line One	951 Calle Amanecer
Entity Address, City or Town	San Clemente
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92673
City Area Code	949
Local Phone Number	366-2183
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Title of 12(b) Security	Common stock, par value $0.10 per share
Trading Symbol	ICUI
Security Exchange Name	NASDAQ
Entity Common Stock, Shares Outstanding		21,218,759
Entity Central Index Key	0000883984
Entity Registrant Name	ICU MEDICAL INC/DE
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q1

XML

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
CURRENT ASSETS:
Cash and cash equivalents	$ 424,249	$ 396,097	[1]
Short-term investment securities	11,693	14,687	[1]
TOTAL CASH, CASH EQUIVALENTS AND INVESTMENT SECURITIES	435,942	410,784	[1]
Accounts receivable, net of allowance for doubtful accounts of $21,782 at March 31, 2021 and $21,490 at December 31, 2020	120,365	124,093	[1]
Inventories	300,086	314,928	[1]
Prepaid income taxes	31,480	29,480	[1]
Prepaid expenses and other current assets	40,309	41,492	[1]
TOTAL CURRENT ASSETS	928,182	920,777	[1]
PROPERTY AND EQUIPMENT, net	459,072	466,628	[1]
Operating Lease, Right-of-Use Asset	45,259	46,571	[1]
Long-term investment securities	18,834	12,974
GOODWILL	32,952	33,001	[1]
INTANGIBLE ASSETS, net	193,074	197,231	[1]
Deferred Income Tax Assets	29,115	31,034
OTHER ASSETS	58,742	55,475	[1]
TOTAL ASSETS	1,765,230	1,763,691	[1]
CURRENT LIABILITIES:
Accounts payable	73,049	71,864	[1]
Accrued liabilities	79,056	97,021	[1]
Income tax liability	1,457	303	[1]
Contingent earn-out liability	26,300	26,300
TOTAL CURRENT LIABILITIES	179,862	195,488	[1]
Other long-term liabilities	46,110	47,835
DEFERRED INCOME TAXES	1,663	1,663	[1]
INCOME TAX LIABILITY	16,827	16,440	[1]
COMMITMENTS AND CONTINGENCIES	0	0	[1]
STOCKHOLDERS' EQUITY:
Convertible preferred stock, $1.00 par value Authorized-500 shares; Issued and outstanding - none	0	0	[1]
Common stock, $0.10 par value - Authorized-80,000 shares; Issued 21,219 shares at March 31, 2021 and 21,058 shares at December 31, 2020 and outstanding 21,192 shares at March 31, 2021 and 21,058 shares at December 31, 2020	2,122	2,106	[1]
Additional paid-in capital	701,586	693,068	[1]
Treasury Stock, at cost (26,785 and 209 shares, respectively)	(5,410)	(39)	[1]
Retained earnings	832,383	808,652	[1]
Accumulated other comprehensive loss	(9,913)	(1,522)	[1]
TOTAL STOCKHOLDERS' EQUITY	1,520,768	1,502,265	[1]
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY	$ 1,765,230	$ 1,763,691	[1]

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

XML

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Accounts Receivable, Allowance for Credit Loss	$ 21,782	$ 21,490
Convertible preferred stock, par value	$ 1.00
Convertible preferred stock, authorized shares	500,000
Convertible preferred stock, issued shares	0	0
Convertible preferred stock, outstanding shares	0	0
Common stock, par value	$ 0.10
Common stock, shares authorized	80,000,000
Common stock, shares issued	21,219,000	21,058,000
Common stock, shares outstanding	21,192,000	21,058,000
Treasury Stock, Shares	26,785	209

XML

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
REVENUES:
Revenue from Contract with Customer, Excluding Assessed Tax	$ 318,046	$ 328,607
Cost of goods sold	205,366	207,192
Gross Profit	112,680	121,415
OPERATING EXPENSES:
Selling, general and administrative	72,391	72,305
Research and development	10,709	10,746
Restructuring, strategic transaction and integration	2,883	12,307
Change in fair value of contingent earn-out	0	0
contract settlement	127	0
TOTAL OPERATING EXPENSES	86,110	95,358
INCOME FROM OPERATIONS	26,570	26,057
Interest Expense	(161)	(196)
OTHER INCOME (EXPENSE), net	683	(5,480)
INCOME BEFORE INCOME TAXES	27,092	20,381
PROVISION FOR INCOME TAXES	(3,361)	(3,547)
NET INCOME	$ 23,731	$ 16,834
NET INCOME PER SHARE
Basic (in dollars per share)	$ 1.12	$ 0.81
Diluted (in dollars per share)	$ 1.09	$ 0.78
WEIGHTED AVERAGE NUMBER OF SHARES
Basic (in shares)	21,149	20,780
Diluted (in shares)	21,695	21,507

XML

Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Net Income	$ 23,731	$ 16,834
Other comprehensive income (loss), net of tax
Cash flow hedge adjustments, net of taxes of $356 and $116 for the three and months ended June 30, 2020 and 2019, respectively, and ($577) and $322 for the six months ended June 30, 2020 and 2019, respectively	(945)	(2,952)
Foreign currency translation adjustment, net of taxes of $0 for all periods	(7,458)	(10,477)
Other Comprehensive Income (Loss), Other Adjustments, after Tax	12	(81)
Other comprehensive income (loss), net of taxes	(8,391)	(13,510)
Comprehensive Income	$ 15,340	$ 3,324

XML

Condensed Consolidated Statements of Comprehensive Income (Paranthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Statement of Comprehensive Income [Abstract]
Other Comprehensive Income (Loss), Derivatives Qualifying as Hedges, Tax	$ 298	$ 932
Other Comprehensive Income (Loss), Foreign Currency Translation Adjustment, Tax	0	0
Other Comprehensive (Income) Loss, Defined Benefit Plan, after Reclassification Adjustment, Tax	$ 0	$ 0

XML

Condensed Consolidated Statements of Stockholders' Equity Statement - USD ($) $ in Thousands	Total	Common Stock Shares [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Treasury Stock [Member]	Retained Earnings [Member]	AOCI Attributable to Parent [Member]
Common stock, shares outstanding at Dec. 31, 2019		20,742,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2019	$ 1,377,244		$ 2,074	$ 668,947	$ (157)	$ 721,782	$ (15,402)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		155,000
Stock Issued During Period, Value, New Issues	$ 560		9		10,758
Adjustments to Additional Paid in Capital, Other				(10,207)
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	(63,511)	(64,000)
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	$ (12,174)				(12,174)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	6,939			6,939
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	(13,510)
Net Income Attributable to Parent	16,834					16,834
Stockholders' Equity Attributable to Parent at Mar. 31, 2020	1,375,893		2,083	665,679	(1,573)	738,616	(28,912)
Common stock, shares outstanding at Mar. 31, 2020		20,833,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Other Comprehensive income (loss), net of Tax	$ (13,510)						(13,510)
Common stock, shares outstanding at Dec. 31, 2020	21,058,000	21,058,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2020	$ 1,502,265		2,106	693,068	(39)	808,652	(1,522)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		198,000
Stock Issued During Period, Value, New Issues	$ 4,864		16		2,352
Adjustments to Additional Paid in Capital, Other				2,496
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	(37,423)	(37,000)
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	$ (7,723)				(7,723)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	6,022			6,022
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	(8,391)
Net Income Attributable to Parent	23,731					23,731
Stockholders' Equity Attributable to Parent at Mar. 31, 2021	$ 1,520,768		$ 2,122	$ 701,586	$ (5,410)	$ 832,383	(9,913)
Common stock, shares outstanding at Mar. 31, 2021	21,192,000	21,219,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Other Comprehensive income (loss), net of Tax	$ (8,391)						$ (8,391)

XML

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021		Mar. 31, 2020
CASH FLOWS FROM OPERATING ACTIVITIES:
Net Income	$ 23,731		$ 16,834
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	22,155		20,957
Operatingleaserightofuseassetamortization	2,372		2,305
Provision for doubtful accounts	0		5
Provision for warranty and returns	209		(821)
Stock compensation	6,022		6,939
Loss on disposal of property and equipment	659		562
Bond premium amortization	168		34
Debt Issuance Costs amortization	72		72
Change in fair value of contingent earn-out	0		0
Inventory Recall Expense	0		2,626
Sparepartsusage	2,825		4,900
Other Noncash Income (Expense)	(1,287)		876
Cash provided by (used in) changes in operating assets and liabilities
Accounts receivable	1,506		899
Inventories	13,208		19,372
Prepaid expenses and other assets	(742)		2,634
Increase (Decrease) in Other Operating Assets	(3,463)		(6,402)
Accounts payable	2,411		(35,063)
Accrued liabilities	(19,965)		465
Income taxes, including excess tax benefits and deferred income taxes	1,439		2,325
Net cash provided by operating activities	51,320		39,519
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property and equipment	(14,028)		(25,463)
Proceeds from sale of asset	55		131
Intangible assets additions	(1,874)		(1,958)
Purchases of investment securities	(10,034)		(7,082)
Proceeds from sale of investment securities	7,000		10,900
Net cash used in investing activities	(18,881)		(23,472)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from Lines of Credit	0		150,000
Proceeds from exercise of stock options	4,864		560
Finance Lease, Principal Payments	(141)		0
Payment, Tax Withholding, Share-based Payment Arrangement	7,723		12,174
Net cash (used in) provided by financing activities	(3,000)		138,386
Effect of exchange rate changes on cash	(1,287)		(3,546)
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect	28,152		150,887
CASH AND CASH EQUIVALENTS, beginning of period	396,097	[1]	268,670
CASH AND CASH EQUIVALENTS, end of period	424,249		419,557
NON-CASH INVESTING ACTIVITIES
Capital Expenditures Incurred but Not yet Paid	$ 1,068		$ 7,112

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

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Basis of Presentation:

3 Months Ended

Mar. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Basis of Presentation [Text Block]

Basis of Presentation

The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America ("U.S.") and pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) and reflect all adjustments, consisting of only normal recurring adjustments, which are, in the opinion of management, necessary for a fair statement of the consolidated results for the interim periods presented. Results for the interim period are not necessarily indicative of results for the full year. Certain information and footnote disclosures normally included in annual consolidated financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted pursuant to such rules and regulations. The condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Annual Report on Form 10-K of ICU Medical, Inc., ("ICU") a Delaware corporation, filed with the SEC for the year ended December 31, 2020.

We are engaged in the development, manufacturing and sale of innovative medical products used in vascular therapy and critical care applications.  We sell the majority of our products through our direct sales force and through independent distributors throughout the U.S. and internationally.  Additionally, we sell our products on an original equipment manufacturer basis to other medical device manufacturers. All subsidiaries are wholly owned and are included in the condensed consolidated financial statements.  All intercompany balances and transactions have been eliminated.

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New Accounting Pronouncements:	3 Months Ended
	Mar. 31, 2021
Accounting Standards Update and Change in Accounting Principle [Abstract]
New Accounting Pronouncements and Changes in Accounting Principles [Text Block]	New Accounting PronouncementsRecently Issued Accounting Standards    In March 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform (Topic 848) - Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The amendments in this update provide optional guidance for a limited period of time to ease the potential burden for reference rate reform on financial reporting. Due to concerns about structural risks of interbank offered rates and, particularly, the risk of cessation of the London Interbank Offered Rate ("LIBOR"), regulators around the world have undertaken reference rate reform initiatives to identify alternative reference rates that are more observable or transaction based and less susceptible to manipulation. The amendments in this update apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued as a result of reference rate reform. Optional expedients may be applied to contracts that are modified as a result of the reference rate reform. Modifications of contracts within the scope of Topic 470, Debt, should be accounted for by prospectively adjusting the effective interest rate. Modifications of contracts within the scope of ASC 842, Leases, should be accounted for as a continuation of the existing contracts with no reassessments of the lease classification and the discount rate (incremental borrowing rate). Exceptions to Topic 815, Derivatives and Hedging, results in not having a dedesignation of a hedging relationship if certain criteria are met. The amendments in this ASU are effective for all entities as of March 12, 2020 through December 31, 2022. The impact of this ASU on our contracts has not been material.
Description of New Accounting Pronouncements Not yet Adopted [Text Block]	Recently Issued Accounting Standards    In March 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform (Topic 848) - Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The amendments in this update provide optional guidance for a limited period of time to ease the potential burden for reference rate reform on financial reporting. Due to concerns about structural risks of interbank offered rates and, particularly, the risk of cessation of the London Interbank Offered Rate ("LIBOR"), regulators around the world have undertaken reference rate reform initiatives to identify alternative reference rates that are more observable or transaction based and less susceptible to manipulation. The amendments in this update apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued as a result of reference rate reform. Optional expedients may be applied to contracts that are modified as a result of the reference rate reform. Modifications of contracts within the scope of Topic 470, Debt, should be accounted for by prospectively adjusting the effective interest rate. Modifications of contracts within the scope of ASC 842, Leases, should be accounted for as a continuation of the existing contracts with no reassessments of the lease classification and the discount rate (incremental borrowing rate). Exceptions to Topic 815, Derivatives and Hedging, results in not having a dedesignation of a hedging relationship if certain criteria are met. The amendments in this ASU are effective for all entities as of March 12, 2020 through December 31, 2022. The impact of this ASU on our contracts has not been material.

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Restructuring, Strategic Transaction and Integration (Notes)

3 Months Ended

Mar. 31, 2021

Restructuring and Related Activities [Abstract]

Restructuring and Related Activities Disclosure

Restructuring, Strategic Transaction and Integration

    Restructuring, strategic transaction and integration expenses were $2.9 million and $12.3 million for the three months ended March 31, 2021, and 2020 respectively.

Restructuring

    During the three months ended March 31, 2021 and 2020, restructuring charges were $0.0 million and $7.2 million, respectively. Restructuring charges for the three months ended March 31, 2020 were primarily related to severance and costs related to office and other facility closures. Restructuring charges are included in the above restructuring, strategic transaction and integration expenses in our condensed consolidated statement of operations.

    The following table summarizes the details of changes in our restructuring-related accrual for the period ended March 31, 2021 (in thousands):

	Accrued Balance January 1, 2021		Charges Incurred		Payments		Currency Translation		Accrued Balance March 31, 2021
Severance pay and benefits	$	1,858	$	43	$	(435)	$	12	$	1,478
Facility closure expenses	1,563		—		—		17		1,580
	$	3,421	$	43	$	(435)	$	29	$	3,058

Strategic transaction and integration expenses

    We incurred and expensed $2.9 million and $5.1 million in strategic transaction and integration expenses during the three months ended March 31, 2021 and 2020, respectively, which are included in restructuring, strategic transaction and integration expenses in our condensed consolidated statement of operations. The strategic transaction and integration expenses during the three months ended March 31, 2021 were primarily related to integration costs associated with acquisitions, the Hospira Infusion Systems ("HIS") earn-out dispute with Pfizer and one-time costs incurred to comply with regulatory initiatives. The strategic transaction and integration expenses during the three months ended March 31, 2020 were primarily related to the integration of the HIS business acquired in 2017 from Pfizer, which included the migration of IT systems at our Austin facility.

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Revenue (Notes)

3 Months Ended

Mar. 31, 2021

Revenue from Contract with Customer [Abstract]

Revenue from Contract with Customer [Text Block]

Revenue

    Our primary product lines are Infusion Consumables, Infusion Systems, IV Solutions and Critical Care. The vast majority of our sales of these products are made on a stand-alone basis to hospitals and distributors. Revenue is typically recognized upon transfer of control of the products, which we deem to be at point of shipment. However, for purposes of revenue recognition for our software licenses and renewals, we consider the control of these products to be transferred to a customer at a certain point in time; therefore, we recognize revenue at the start of the applicable license term.

    Payment is typically due in full within 30 days of delivery or the start of the contract term. Revenue is recorded in an amount that reflects the consideration we expect to be entitled to in exchange for those goods or services. We offer certain volume-based rebates to our distribution customers, which we record as variable consideration when calculating the transaction price. Rebates are offered on both a fixed and tiered/variable basis. In both cases, we use information available at the time and our historical experience with each customer to estimate the most likely rebate amount. We also provide chargebacks to distributors that sell to end-customers at prices determined under a contract between us and the end-customer. Chargebacks are the difference between the prices we charge our distribution customers and the contracted prices we have with the end customer which are processed as credits to our distribution customers. In estimating the expected value of chargeback amounts in order to determine the transaction price, we use information available at the time, including our historical experience.

    We also warranty products against defects and have a policy permitting the return of defective products, for which we accrue and expense at the time of sale using information available at that time and our historical experience. We also provide for extended service-type warranties, which we consider to be separate performance obligations. We allocate a portion of the transaction price to the extended service-type warranty based on its estimated relative selling price, and recognize revenue over the period the warranty service is provided. Our revenues are recorded at the net sales price, which includes an estimate for variable consideration related to rebates, chargebacks and product returns.

Revenue disaggregated

    The following table represents our revenues disaggregated by geography (in thousands):

	For the three months ended March 31,
Geography	2021		2020
Europe, the Middle East and Africa	$	34,800	$	37,928
Other Foreign	55,895		60,521
Total Foreign	90,695		98,449
United States	227,351		230,158
Total Revenues	$	318,046	$	328,607

    The following table represents our revenues disaggregated by product (in thousands):

	For the three months ended March 31,
Product line	2021		2020
Infusion Consumables	$	126,370	$	123,507
Infusion Systems	84,334		88,380
IV Solutions	94,176		104,291
Critical Care	13,166		12,429
Total Revenues	$	318,046	$	328,607

Contract balances

    The following table presents our changes in the contract balances for the three months ended March 31, 2021 and 2020 (in thousands):

	Contract Liabilities
Beginning balance, January 1, 2021	$	(6,430)
Equipment revenue recognized	461
Equipment revenue deferred due to implementation	(2,921)
Software revenue recognized	1,796
Software revenue deferred due to implementation	(1,794)
Ending balance, March 31, 2021	$	(8,888)
Beginning balance, January 1, 2020	$	(4,855)
Equipment revenue recognized	1,802
Equipment revenue deferred due to implementation	(3,990)
Software revenue recognized	1,235
Software revenue deferred due to implementation	(2,664)
Ending balance, March 31, 2020	$	(8,472)

    As of March 31, 2021, revenue from remaining performance obligations related to implementation of software and equipment is $7.3 million. We expect to recognize substantially all of this revenue within the next three to six months dependent on implementation restrictions due to the novel coronavirus and its variants ("COVID-19"). Revenue from remaining performance obligations related to annual software licenses is $1.5 million. We expect to recognize substantially all of this revenue over the next twelve months.

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Leases (Notes)

3 Months Ended

Mar. 31, 2021

Leases [Abstract]

Lessee, Operating Leases [Text Block]

Leases

Leases

    We determine if an arrangement is a lease at inception. Our operating lease assets are separately stated in operating lease right-of-use ("ROU") assets and our financing lease assets are included in other assets on our condensed consolidated balance sheets. Our lease liabilities are included in accrued liabilities, and other long-term liabilities on our condensed consolidated balance sheets. We have elected not to recognize an ROU asset and lease liability for leases with terms of twelve months or less.

    Lease ROU assets and lease liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. Most of our leases do not provide an implicit rate, therefore we use our incremental borrowing rate, which is the rate incurred to borrow on a collateralized basis over a similar term based on the information available at commencement date. Our lease ROU assets exclude lease incentives and initial direct costs incurred. Our lease terms include options to extend when it is reasonably certain that we will exercise that option. All of our leases have

stated lease payments, which may include fixed rental increases. Lease expense for minimum lease payments is recognized on a straight-line basis over the lease term.

    Our leases are for corporate, research and development and sales and support offices, a distribution facility, device service centers and certain equipment. Our leases have original lease terms of one year to fifteen years, some of which include options to extend the leases for up to an additional five years. For all of our leases, we do not include optional periods of extension in our current lease terms for the exercise of options to extend is not reasonably certain.

    The following table presents the components of our lease cost (in thousands):

	For the three months  ended March 31
	2021		2020
Operating lease cost	$	2,835	$	2,791
Finance lease cost - interest	31		29
Finance lease cost - amortization of ROU asset	151		—
Short-term lease cost	3		54
Total lease cost	$	3,020	$	2,874

Interest expense on our finance leases is included in other income (expense), net in our condensed consolidated statement of operations. The amortization of the operating and finance ROU asset is included in selling, general and administrative expenses in our condensed consolidated statement of operations.    

The following table presents the supplemental cash flow information related to our leases (in thousands):

	For the three months ended March 31,
	2021		2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	2,821	$	2,457
Operating cash flows from finance leases	$	31	$	29
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	1,095	$	19,094
Finance leases	$	184	$	800

    The following table presents the supplemental balance sheet information related to our operating leases (in thousands, except lease term and discount rate):

	As of March 31, 2021			As of December 31, 2020
Operating leases
Operating lease right-of-use assets	$	45,259		$	46,571
Accrued liabilities	$	8,872		$	8,740
Other long-term liabilities	39,588			41,019
Total operating lease liabilities	$	48,460		$	49,759
Weighted Average Remaining Lease Term
Operating leases	6.5 years			6.7 years
Weighted Average Discount Rate
Operating leases	5.00		%	5.02		%

The following table presents the supplemental balance sheet information related to our finance leases (in thousands, except lease term and discount rate):

	As of March 31, 2021			As of December 31, 2020
Financing leases
Financing lease right-of-use assets	$	2,877		$	2,915
Accrued liabilities	$	583		$	554
Other long-term liabilities	2,330			2,388
Total financing lease liabilities	$	2,913		$	2,942
Weighted Average Remaining Lease Term
Financing leases	6.2 years			6.4 years
Weighted Average Discount Rate
Financing leases	4.27		%	4.27		%

    As of March 31, 2021, the maturities of our operating and financing lease liabilities for each of the next five years is approximately (in thousands):

	Operating Leases		Finance Leases
Remainder of 2021	$	8,352	$	520
2022	10,316		693
2023	9,120		693
2024	8,317		379
2025	5,008		211
2026	4,733		189
Thereafter	10,602		614
Total Lease Payments	56,448		3,299
Less imputed interest	(7,988)		(386)
Total	$	48,460	$	2,913

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Net Income Per Share:

3 Months Ended

Mar. 31, 2021

Earnings Per Share [Abstract]

Net Income Per Share [Text Block]

Net Income Per Share 

Basic earnings per share is computed by dividing net income by the weighted-average number of common shares outstanding during the period. Diluted earnings per share is computed by dividing net income by the weighted-average number of common shares outstanding during the period plus dilutive securities. Dilutive securities include outstanding common stock options and unvested restricted stock units, less the number of shares that could have been purchased with the proceeds from the exercise of the options, using the treasury stock method. Options and restricted stock units that are anti-dilutive are not included in the treasury stock method calculation. There were 12,080 and 15,333 anti-dilutive securities for the three months ended March 31, 2021 and 2020, respectively.

    The following table presents the calculation of net earnings per common share (“EPS”) — basic and diluted (in thousands, except per share data): 

	Three months ended March 31,
	2021		2020
Net income	$	23,731	$	16,834
Weighted-average number of common shares outstanding (for basic calculation)	21,149		20,780
Dilutive securities	546		727
Weighted-average common and common equivalent shares outstanding (for diluted calculation)	21,695		21,507
EPS — basic	$	1.12	$	0.81
EPS — diluted	$	1.09	$	0.78

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Derivative Financial Instruments (Notes)

3 Months Ended

Mar. 31, 2021

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Derivative Instruments and Hedging Activities Disclosure [Text Block]

Derivatives and Hedging Activities

Hedge Accounting and Hedging Program

     The purpose of our hedging program is to manage the foreign currency exchange rate risk on forecasted expenses denominated in currencies other than the functional currency of the operating unit. We do not issue derivatives for trading or speculative purposes.

    To receive hedge accounting treatment, all hedging relationships are formally documented at the inception of the hedge, and the hedges must be highly effective in offsetting changes to future cash flows on hedged transactions. The par forward contract is designated and qualifies as a cash flow hedge. Our derivative instruments are recorded at fair value on the condensed consolidated balance sheets and are classified based on the instrument's maturity date. We record changes in the intrinsic value of the effective portion of the gain or loss on the derivative instrument as a component of Other Comprehensive Income and we reclassify that gain or loss into earnings in the same line item associated with the forecasted transaction and in the same period during which the hedged transaction affects earnings.

    In March 2020, we entered into a one-year cross-currency par forward contract that extends our current hedge of a portion of our Mexico forecasted expenses denominated in Pesos ("MXN"). The total notional amount of this outstanding derivative as of March 31, 2021 was approximately 327.6 million MXN. The term of the one-year contract is November 3, 2020 to December 1, 2021. The derivative instrument matures in equal monthly amounts at a fixed forward rate of 24.26 MXN/USD.

    In November 2018, we entered into a one-year cross-currency par forward contract that hedges of a portion of our Mexico forecasted expenses denominated in MXN. The term of the one-year hedge was November 1, 2019 to November 3, 2020. The derivative instrument matured in equal monthly amounts at a fixed forward rate of 22.109 MXN/USD.

    The following table presents the fair values of our derivative instruments included within the Condensed Consolidated Balance Sheets as of March 31, 2021 and December 31, 2020 (in thousands):

	Derivatives
	Condensed Consolidated Balance Sheet Location	March 31, 2021		December 31, 2020
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contract:
	Prepaid expenses and other current assets	$	2,312	$	3,555
Total derivatives designated as cash flow hedging instruments		$	2,312	$	3,555

    The following table presents the amounts affecting the Condensed Consolidated Statements of Operations for the three months ended March 31, 2021 and 2020 (in thousands):

	Line Item in the Condensed Consolidated Statements of Operations	Three months ended March 31,
		2021		2020
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contracts	Cost of goods sold	$	841	$	692

    We recognized the following (losses) gains on our foreign exchange contracts designated as a cash flow hedge (in thousands):

	Amount of Loss Recognized in Other Comprehensive Income on Derivatives				Amount of Gain Reclassified From Accumulated Other Comprehensive Income into Income
	Three months ended March 31,					Three months ended March 31,
	2021		2020		Location of Gain Reclassified From Accumulated Other Comprehensive Income into Income	2021		2020
Derivatives designated as cash flow hedges:
Foreign exchange forward contract	$	(402)	$	(3,192)	Cost of goods sold	$	841	$	692
Total derivatives designated as cash flow hedging instruments	$	(402)	$	(3,192)		$	841	$	692

As of March 31, 2021, we expect approximately $2.3 million of the deferred gains on the outstanding derivatives in accumulated other comprehensive income to be reclassified to net income during the next twelve months concurrent with the underlying hedged transactions also being reported in net income.

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Fair Value Measures and Disclosures (Notes)

3 Months Ended

Mar. 31, 2021

Fair Value Disclosures [Abstract]

Fair Value Disclosures

Fair Value Measurement

    Fair value is the price that would be received from selling an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. There are three levels of inputs that may be used to measure fair value:

•Level 1: quoted prices in active markets for identical assets or liabilities;

•Level 2: inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices in active markets for similar assets or liabilities, quoted prices for identical or similar assets or liabilities in markets that are not active, or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities; or

•Level 3: unobservable inputs that are supported by little or no market activity and that are significant to the fair values of the assets or liabilities.

Earn-out Liability

    In 2017, we recognized an earn-out liability upon the acquisition of HIS from Pfizer. Pfizer was entitled to receive between $191.3 million and $225.0 million in additional cash consideration based on the achievement of certain performance targets for the combined company for the three years ending December 31, 2019. The initial fair value of the earn-out was determined by employing a Monte Carlo simulation in a risk neutral framework. The underlying simulated variable was adjusted EBITDA. The adjusted EBITDA volatility estimate was based on a study of historical asset volatility for a set of comparable public companies. The model included other assumptions including the market price of risk, which was calculated as the weighted average cost of capital ("WACC") less the long term risk free rate. The initial value assigned to the contingent consideration was a result of forecasted product demand of our HIS business. At each reporting date subsequent to the acquisition we remeasured the earn-out using the same methodology above and recognized any changes in value. As of December 31, 2019, we determined that we did not meet the necessary performance targets that would require payout of any of the HIS earn-out liability. As of the date of this filing, Pfizer has disputed our determination that the performance targets requiring payout of the HIS earn-out liability were not met. The dispute is being resolved by binding arbitration that will likely be concluded during the third quarter of 2021. Given the uncertainty of any arbitration, it may be possible that we will incur a loss with regards to this matter. If we are unsuccessful in arbitration such that it is determined that we met the necessary performance targets for any of the HIS earn-out liability, we will be obligated to pay Pfizer between $191.3 million and $225.0 million in additional cash consideration.

In the fourth quarter of 2019, we recognized an earn-out liability related to the acquisition of Pursuit Vascular, Inc. ("Pursuit"). Pursuit's former equity holders are entitled up to $50.0 million in additional cash consideration contingent upon the achievement of certain sales and gross profit targets for specific customers. The earn-out will be calculated as a percentage of gross profit achieved during the earn-out period against a pre-determined target gross profit, not to exceed $50.0 million. We used a Monte Carlo simulation model to determine the fair value of the earn-out liability. The Monte Carlo simulation model utilizes multiple input variables to determine the value of the earn-out liability including historical volatility, a risk free interest rate, counter party credit risk and projected future gross profit, see below simulation input table related to Pursuit. The historical volatility was based on the median of ICU and a certain peer group. The risk-free interest rate is equal to the yield, as of the valuation date, of the zero-coupon U.S. Treasury bill that is commensurate with the term of the earn-out. The counter party credit risk is based on a synthetic credit rating of B1. If the probabilities in the model significantly change from what we initially and subsequently anticipate, the change could have a significant impact on our financial statements in the period recognized. Our contingent earn-out liability is separately stated in our condensed consolidated balance sheets.

The following tables provide a reconciliation of the Level 3 earn-out liabilities measured at estimated fair value (in thousands):

	Pursuit
	Earn-out Liability
Accrued balance, January 1, 2021	$	26,300
Change in fair value of earn-out (included in income from operations as a separate line item)	—
Accrued balance, March 31, 2021	$	26,300

	Pursuit
	Earn-out Liability
Accrued balance, January 1, 2020	$	17,300
Change in fair value of earn-out (included in income from operations as a separate line item)	—
Accrued balance, March 31, 2020	$	17,300

    The following tables provide quantitative information about Level 3 inputs for fair value measurement of our earn-out liabilities:

Pursuit Earn-out

Simulation Input	As of March 31, 2021		As of December 31, 2020		As of March 31, 2020
Revenue/Gross Profit Volatility	25.00	%	25.00	%	20.00	%
Discount Rate	12.50	%	12.50	%	15.00	%
Risk Free Rate	0.09	%	0.09	%	1.55	%
Counter Party Risk	3.10	%	3.10	%	6.00	%

Investments and Foreign Currency Contracts    

    The fair value of our investments is estimated using observable market-based inputs such as quoted prices, interest rates and yield curves or Level 2 inputs, which consisted of corporate bonds.     

    The fair value of our Level 2 forward currency contracts are estimated using observable market inputs such as known notional value amounts, spot and forward exchange rates. These inputs relate to liquid, heavily traded currencies with active markets which are available for the full term of the derivative.

Our assets and liabilities measured at fair value on a recurring basis consisted of the following (Level 1, 2 and 3 inputs as defined above) (in thousands):

	Fair value measurements at March 31, 2021
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	11,693	$	—	$	11,693	$	—
Long-term	18,834		—		18,834		—
Foreign exchange forwards:
Prepaid expenses and other current assets	2,312		—		2,312		—
Total Assets	$	32,839	$	—	$	32,839	$	—
Liabilities:
Earn-out liability	$	26,300	$	—	$	—	$	26,300
Total Liabilities	$	26,300	$	—	$	—	$	26,300

	Fair value measurements at December 31, 2020
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	14,687	$	—	$	14,687	$	—
Long-term	12,974		—		12,974		—
Foreign exchange forwards:
Prepaid expenses and other current assets	3,555		—		3,555		—
Total Assets	$	31,216	$	—	$	31,216	$	—
Liabilities:
Earn-out liability	$	26,300	$	—	$	—	$	26,300
Total Liabilities	$	26,300	$	—	$	—	$	26,300

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Investment Securities (Notes)

3 Months Ended

Mar. 31, 2021

Investments, Debt and Equity Securities [Abstract]

Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block]

Investment Securities

    Our investment securities currently consist of short-term and long-term corporate bonds. Our investment securities are considered available-for-sale and are “investment grade” and carried at fair value. Available-for-sale securities are recorded at fair value, and unrealized holding gains and losses are recorded, net of tax, as a component of accumulated other comprehensive income. Unrealized losses on available-for-sale securities are charged against net earnings when a decline in fair value is determined to be other than temporary. Our management reviews several factors to determine whether a loss is other than temporary, such as the length and extent of the fair value decline, the financial condition and near term prospects of the issuer, and for equity investments, our intent and ability to hold the security for a period of time sufficient to allow for any anticipated recovery in fair value. The amortized cost of the debt securities are adjusted for the amortization of premiums computed under the effective interest method. Such amortization is included in investment income in other income (expense), net on our condensed consolidated statements of operations. There have been no realized gains or losses on their disposal. Realized gains and losses are accounted for on the specific identification method. The scheduled maturities of the debt securities are between 2021 and 2024. All short-term investment securities are callable within one year.

    Our short investment securities consisted of the following (in thousands):

	As of March 31, 2021
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	11,693	$	—	$	11,693
Long-term corporate bonds	18,834		—		18,834
Total investment securities	$	30,527	$	—	$	30,527
	As of December 31, 2020
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	14,687	$	—	$	14,687
Long-term corporate bonds	12,974		—		12,974
Total investment securities	$	27,661	$	—	$	27,661

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Prepaids and Other Current Assets (Notes)

3 Months Ended

Mar. 31, 2021

Prepaid Expense and Other Assets, Current [Abstract]

Other Current Assets [Text Block]

Prepaid Expenses and Other Current Assets

Prepaid expenses and other current assets consist of the following (in thousands): 

	March 31, 2021		December 31, 2020
Other prepaid expenses and receivables	$	16,084	$	14,964
Deferred costs	6,554		6,402
Prepaid insurance and property taxes	4,639		6,178
VAT/GST receivable	3,674		3,676
Deferred tax charge	3,856		3,542
Foreign exchange forward contract	2,312		3,555
Deposits	1,343		1,353
Other	1,847		1,822
	$	40,309	$	41,492

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Inventories:

3 Months Ended

Mar. 31, 2021

Inventory Disclosure [Abstract]

Inventories [Text Block]

Inventories

    Inventories are stated at the lower of cost or net realizable value with cost determined using the first-in, first-out method. Inventory costs consist of those costs directly attributable to products prior to sale including among other things raw material, labor and overhead. Inventories consisted of the following (in thousands): 

	March 31, 2021		December 31, 2020
Raw materials	$	122,703	$	126,499
Work in process	39,713		33,053
Finished goods	137,670		155,376
Total inventories	$	300,086	$	314,928

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Property and Equipment:

3 Months Ended

Mar. 31, 2021

Property, Plant and Equipment [Abstract]

Property and Equipment [Text Block]

Property and Equipment

Property and equipment consisted of the following (in thousands): 

	March 31, 2021		December 31, 2020
Machinery and equipment	$	293,653	$	291,331
Land, building and building improvements	241,608		241,199
Molds	60,381		60,381
Computer equipment and software	98,780		98,311
Furniture and fixtures	7,712		7,767
Instruments placed with customers(1)	91,909		90,383
Construction in progress	55,757		53,724
Total property and equipment, cost	849,800		843,096
Accumulated depreciation	(390,728)		(376,468)
Property and equipment, net	$	459,072	$	466,628

______________________________

(1) Instruments placed with customers consist of drug-delivery and monitoring systems placed with customers under operating leases.

    Depreciation expense was $16.3 million and $15.2 million for the three months ended March 31, 2021 and 2020, respectively.

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Goodwill and Intangible Assets (Notes)

3 Months Ended

Mar. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets Disclosure [Text Block]

Goodwill and Intangible Assets, Net

Goodwill

    The following table presents the changes in the carrying amount of our goodwill (in thousands):

	Total
Balance as of January 1, 2021	$	33,001
Currency translation	(49)
Balance as of March 31, 2021	$	32,952

Intangible Assets, Net

    Intangible assets, carried at cost less accumulated amortization and amortized on a straight-lined basis, were as follows (in thousands):

	Weighted Average	March 31, 2021
	Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	25,423	$	15,466	$	9,957
Customer contracts	12	10,310		5,929		4,381
Non-contractual customer relationships	9	57,748		28,233		29,515
Trademarks	4	425		425		—
Trade name	15	18,268		3,808		14,460
Developed technology	13	152,893		40,062		112,831
Non-compete	3	2,500		1,181		1,319
Total amortized intangible assets		$	267,567	$	95,104	$	172,463
Internally developed software*		$	20,611			$	20,611
Total intangible assets		$	288,178	$	95,104	$	193,074

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

	Weighted Average	December 31, 2020
	Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	24,797	$	15,056	$	9,741
Customer contracts	12	10,365		5,852		4,513
Non-contractual customer relationships	9	58,061		26,711		31,350
Trademarks	4	425		425		—
Trade name	15	18,270		3,500		14,770
Developed technology	13	152,893		36,927		115,966
Non-compete	3	2,500		972		1,528
Total amortized intangible assets		$	267,311	$	89,443	$	177,868
Internally developed software*		$	19,363			$	19,363
Total intangible assets		$	286,674	$	89,443	$	197,231

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

Intangible assets with definite lives are amortized on a straight-line basis over their estimated useful lives. During the three months ended March 31, 2021 and 2020, respectively, intangible asset amortization expense was $5.8 million and $5.8 million, respectively.

As of March 31, 2021 estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):

Remainder of 2021	$	17,807
2022	22,806
2023	21,783
2024	21,694
2025	15,980
2026	15,116
Thereafter	57,277
Total	$	172,463

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Accrued Liabilities (Notes)

3 Months Ended

Mar. 31, 2021

Accrued Liabilities [Abstract]

Accounts Payable and Accrued Liabilities Disclosure [Text Block]

Accrued Liabilities and Other Long-Term Liabilities

    Accrued liabilities consist of the following (in thousands): 

	March 31, 2021		December 31, 2020
Salaries and benefits	$	26,118	$	25,786
Incentive compensation	8,130		27,023
Operating lease liability-ST	8,872		8,740
Accrued sales taxes	2,435		2,146
Restructuring accrual	3,058		3,421
Deferred revenue	8,195		5,566
Accrued other taxes	923		3,540
Accrued professional fees	730		1,273
Legal accrual	1,291		900
Distribution fees	5,080		5,300
Warranties and returns	554		1,027
Accrued freight	7,715		6,784
Other	5,955		5,515
	$	79,056	$	97,021

Other long-term liabilities consist of the following (in thousands): 

	March 31, 2021		December 31, 2020
Operating lease liability-LT	$	39,588	$	41,019
Benefits	1,180		1,183
Accrued rent	1,427		1,462
Contract liabilities-LT	303		337
Financing lease liability-LT	2,330		2,388
Deferred revenue	693		864
Other	589		582
	$	46,110	$	47,835

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Income Taxes:

3 Months Ended

Mar. 31, 2021

Income Tax Disclosure [Abstract]

Income Tax Disclosure [Text Block]

Income Taxes

Income taxes were accrued at an estimated effective tax rate of 12% and 17% for the three months ended March 31, 2021 and 2020, respectively.

    The effective tax rate for the three months ended March 31, 2021 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, global intangible low-taxed income ("GILTI"), foreign-derived intangible income ("FDII") and tax credits. The effective tax rate during the three months ended

March 31, 2021 included a discrete tax benefit of $1.8 million related to excess tax benefits recognized on stock option exercises and the vesting of restricted stock units during the period.     The effective tax rate for the three months ended March 31, 2020 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, GILTI, FDII and tax credits.

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Long-Term Obligations (Notes)

3 Months Ended

Mar. 31, 2021

LOng-Term Obligations Disclosure [Abstract]

Long-term Debt [Text Block]

Long-Term Obligations

Five-year Senior Secured Revolving Credit Facility ("Credit Facility")

    On November 8, 2017, we entered into a Credit Facility with various lenders for $150.0 million, with Wells Fargo Bank, N.A. as the administrative agent, swingline lender and issuing lender. During March 2020, as a result of market uncertainty caused by COVID-19, we preemptively borrowed $150.0 million on our Credit Facility as a conservative measure to manage any potential short-term liquidity risk. In September 2020, we fully repaid the borrowings under our Credit Facility.

    As of March 31, 2021, we had no borrowings and $150.0 million of availability under the Credit Facility. Principal payments on the revolving Credit Facility are made at our discretion with the unpaid amount due at maturity. The Credit Facility matures on November 8, 2022. Interest on borrowings under the Credit Facility, at our option, is based on the Base Rate plus applicable margin or the London Interbank Offered Rate ("LIBOR") plus applicable margin, see further details in Part II, Item 8, of our 2019 Annual Report on Form 10-K.

Debt Covenants

    The Credit Facility contains certain financial covenants pertaining to Consolidated Fixed Charge Coverage and Consolidated Total Leverage Ratios. In addition, the Credit Facility has restrictions pertaining to limitations on debt, liens, negative pledges, loans, advances, acquisitions, other investments, dividends, distributions, redemptions, repurchases of equity interests, fundamental changes and asset sales and other dispositions, prepayments, redemptions and purchases of subordinated debt and other junior debt, transactions with affiliates, dividend and payment restrictions affecting subsidiaries, changes in line of business, fiscal year and accounting practices and amendment of organizational documents and junior debt documents.

    The Consolidated Leverage Ratio is defined as the ratio of Consolidated Total Funded Indebtedness on such date, to Consolidated Adjusted EBITDA, as defined under the Credit Facility Agreement, for the most recently completed four fiscal quarters. The maximum Consolidated Leverage Ratio is not more than 3.00 to 1.00.

    The Consolidated Fixed Charge Coverage Ratio is defined as the ratio of: (a) Consolidated Adjusted EBITDA less the sum of (i) capital expenditures, (ii) federal, state, local and foreign income taxes paid in cash and (iii) cash restricted payments made after the closing date, to (b) Consolidated Fixed Charges for the most recently completed four fiscal quarters, calculated on a pro forma basis. The minimum Consolidated Fixed Charge Coverage Ratio is 2.00 to 1.00.

     We were in compliance with all financial covenants as of March 31, 2021.

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Commitments and Contingencies:

3 Months Ended

Mar. 31, 2021

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies [Text Block]

Commitments and Contingencies

Legal Proceedings

From time to time, we are involved in various legal proceedings, most of which are routine litigation, in the normal course of business.  Our management does not believe that the resolution of the unsettled legal proceedings that we are involved with will have a material adverse impact on our financial position or results of operations.

Off-Balance Sheet Arrangements

    In the normal course of business, we have agreed to indemnify our officers and directors to the maximum extent permitted under Delaware law and to indemnify customers as to certain intellectual property matters or other matters related to sales of our products.  There is no maximum limit on the indemnification that may be required under these agreements.  Although we can provide no assurances, we have never incurred, nor do we expect to incur, any material liability for indemnification.

Contingencies

    During November 2019, we acquired Pursuit. Total consideration for the acquisition includes a potential contractual earn-out of up to $50.0 million, to be paid to former Pursuit equity holders, calculated based upon the achievement of certain performance targets during the earn-out period (see Note 8: Fair Value Measurement).

We had a contractual obligation in connection with our 2017 acquisition of HIS, which as of December 31, 2019 we determined did not meet the necessary performance targets that would require payout of any of the HIS earn-out liability. As of the date of this filing, Pfizer has disputed our determination that the performance targets requiring payout of the HIS earn-out liability were not met. The dispute is being resolved by binding arbitration that will likely be concluded during the third quarter of 2021. Given the uncertainty of any arbitration, it may be possible that we will incur a loss with regards to this matter. If we are unsuccessful in arbitration such that it is determined that we met the necessary performance targets for any of the HIS earn-

out liability, we will have to pay between $191.3 million and $225.0 million in additional cash consideration (see Note 8, Fair Value Measurements).

Commitments

    We have non-cancellable operating lease agreements where we are contractually obligated to pay certain lease payment amounts (see Note 5: Leases).

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Collaborative and Other Arrangements (Notes)

3 Months Ended

Mar. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Collaborative Arrangement Disclosure [Text Block]

Collaborative and Other Arrangements

    On February 3, 2017, we entered into two Manufacturing and Supply Agreements ("MSAs"), (i) whereby Pfizer will manufacture and supply us with certain agreed upon products for an initial five-year term with a one-time two-year option to extend and (ii) whereby we will manufacture and supply Pfizer certain agreed upon products for a term of five or ten years depending on the product, also with a one-time two-year option to extend. The MSAs provide each party with mutually beneficial interests and both of the MSAs are to be jointly managed by both Pfizer and ICU. The initial supply price, which will be annually updated, is in full consideration for all costs associated with the manufacture, documentation, packaging and certification of the products. On January 1, 2021, we amended our MSA with Pfizer, whereby we manufacture and supply certain agreed upon products to Pfizer. The amendments included a change to the term of the agreement to end on December 31, 2024 with Pfizer's unilateral election to extend through December 31, 2025. Other changes to the terms of the MSA included (i) amendments to our level of supply of products to Pfizer, (ii) certain changes to our manufacturing lines, (iii) updates to our supply price with added volume price tiers for annual periods and (iv) certain minimum purchase requirements for certain products.

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Equity

3 Months Ended

Mar. 31, 2021

Equity [Abstract]

Stockholders' Equity Note Disclosure

Stockholders' Equity

Treasury Stock

    In August 2019, our Board of Directors approved a new share purchase plan to purchase up to $100.0 million of our common stock. This plan replaced our existing plan and has no expiration date. During the three months ended March 31, 2021, we did not purchase any shares of our common stock under our stock purchase plans. As of March 31, 2021, all of the $100.0 million available for purchase was remaining under the plan. We are currently limited on share purchases in accordance with the terms and conditions of our Credit Facility (see Note 16: Long-Term Obligations).

    For the three months ended March 31, 2021, we withheld 37,423 shares of our common stock from employee vested restricted stock units in consideration for $7.7 million in payments made on the employee's behalf for their minimum statutory income tax withholding obligations. For the three months ended March 31, 2020, we withheld 63,511 shares of our common stock from employee vested restricted stock units in consideration for $12.2 million in payments made on the employee's behalf for their minimum statutory income tax withholding obligations. Treasury stock is used to issue shares for stock option exercises, restricted stock grants and employee stock purchase plan stock purchases.

Accumulated Other Comprehensive (Loss) Income

    The components of accumulated other comprehensive (loss) income ("AOCI"), net of tax, were as follows (in thousands):

	Foreign Currency Translation Adjustments		Unrealized Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2021	$	(4,381)	$	2,784	$	75	$	(1,522)
Other comprehensive (loss) income before reclassifications	(7,458)		(306)		12		(7,752)
Amounts reclassified from AOCI	—		(639)		—		(639)
Other comprehensive (loss) income	(7,458)		(945)		12		(8,391)
Balance as of March 31, 2021	$	(11,839)	$	1,839	$	87	$	(9,913)

	Foreign Currency Translation Adjustments		Unrealized Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2020	$	(17,310)	$	1,880	$	28	$	(15,402)
Other comprehensive loss before reclassifications	(10,477)		(2,426)		(81)		(12,984)
Amounts reclassified from AOCI	—		(526)		—		(526)
Other comprehensive loss	(10,477)		(2,952)		(81)		(13,510)
Balance as of March 31, 2020	$	(27,787)	$	(1,072)	$	(53)	$	(28,912)

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Restructuring, Strategic Transaction and Integration (Tables)

3 Months Ended

Mar. 31, 2021

Restructuring and Related Activities [Abstract]

Restructuring and Related Costs [Table Text Block]

The following table summarizes the details of changes in our restructuring-related accrual for the period ended March 31, 2021 (in thousands):

	Accrued Balance January 1, 2021		Charges Incurred		Payments		Currency Translation		Accrued Balance March 31, 2021
Severance pay and benefits	$	1,858	$	43	$	(435)	$	12	$	1,478
Facility closure expenses	1,563		—		—		17		1,580
	$	3,421	$	43	$	(435)	$	29	$	3,058

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Revenue (Tables)

3 Months Ended

Mar. 31, 2021

Revenue from Contract with Customer [Abstract]

Disaggregation of Revenue [Table Text Block]

The following table represents our revenues disaggregated by geography (in thousands):

	For the three months ended March 31,
Geography	2021		2020
Europe, the Middle East and Africa	$	34,800	$	37,928
Other Foreign	55,895		60,521
Total Foreign	90,695		98,449
United States	227,351		230,158
Total Revenues	$	318,046	$	328,607

    The following table represents our revenues disaggregated by product (in thousands):

	For the three months ended March 31,
Product line	2021		2020
Infusion Consumables	$	126,370	$	123,507
Infusion Systems	84,334		88,380
IV Solutions	94,176		104,291
Critical Care	13,166		12,429
Total Revenues	$	318,046	$	328,607

Contract with Customer, Asset and Liability [Table Text Block]

The following table presents our changes in the contract balances for the three months ended March 31, 2021 and 2020 (in thousands):

	Contract Liabilities
Beginning balance, January 1, 2021	$	(6,430)
Equipment revenue recognized	461
Equipment revenue deferred due to implementation	(2,921)
Software revenue recognized	1,796
Software revenue deferred due to implementation	(1,794)
Ending balance, March 31, 2021	$	(8,888)
Beginning balance, January 1, 2020	$	(4,855)
Equipment revenue recognized	1,802
Equipment revenue deferred due to implementation	(3,990)
Software revenue recognized	1,235
Software revenue deferred due to implementation	(2,664)
Ending balance, March 31, 2020	$	(8,472)

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Leases (Tables)

3 Months Ended

Mar. 31, 2021

Leases [Abstract]

Lease, Cost [Table Text Block]

The following table presents the components of our lease cost (in thousands):

	For the three months  ended March 31
	2021		2020
Operating lease cost	$	2,835	$	2,791
Finance lease cost - interest	31		29
Finance lease cost - amortization of ROU asset	151		—
Short-term lease cost	3		54
Total lease cost	$	3,020	$	2,874

Cash Flow, Supplemental Disclosures [Text Block]

The following table presents the supplemental cash flow information related to our leases (in thousands):

	For the three months ended March 31,
	2021		2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	2,821	$	2,457
Operating cash flows from finance leases	$	31	$	29
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	1,095	$	19,094
Finance leases	$	184	$	800

Assets and Liabilities, Leases [Table Text Block]

The following table presents the supplemental balance sheet information related to our operating leases (in thousands, except lease term and discount rate):

	As of March 31, 2021			As of December 31, 2020
Operating leases
Operating lease right-of-use assets	$	45,259		$	46,571
Accrued liabilities	$	8,872		$	8,740
Other long-term liabilities	39,588			41,019
Total operating lease liabilities	$	48,460		$	49,759
Weighted Average Remaining Lease Term
Operating leases	6.5 years			6.7 years
Weighted Average Discount Rate
Operating leases	5.00		%	5.02		%

The following table presents the supplemental balance sheet information related to our finance leases (in thousands, except lease term and discount rate):

	As of March 31, 2021			As of December 31, 2020
Financing leases
Financing lease right-of-use assets	$	2,877		$	2,915
Accrued liabilities	$	583		$	554
Other long-term liabilities	2,330			2,388
Total financing lease liabilities	$	2,913		$	2,942
Weighted Average Remaining Lease Term
Financing leases	6.2 years			6.4 years
Weighted Average Discount Rate
Financing leases	4.27		%	4.27		%

Lessee, Operating Lease, Liability, Maturity [Table Text Block]

As of March 31, 2021, the maturities of our operating and financing lease liabilities for each of the next five years is approximately (in thousands):

	Operating Leases		Finance Leases
Remainder of 2021	$	8,352	$	520
2022	10,316		693
2023	9,120		693
2024	8,317		379
2025	5,008		211
2026	4,733		189
Thereafter	10,602		614
Total Lease Payments	56,448		3,299
Less imputed interest	(7,988)		(386)
Total	$	48,460	$	2,913

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Net Income Per Share (Tables)

3 Months Ended

Mar. 31, 2021

Earnings Per Share [Abstract]

Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]

The following table presents the calculation of net earnings per common share (“EPS”) — basic and diluted (in thousands, except per share data): 

	Three months ended March 31,
	2021		2020
Net income	$	23,731	$	16,834
Weighted-average number of common shares outstanding (for basic calculation)	21,149		20,780
Dilutive securities	546		727
Weighted-average common and common equivalent shares outstanding (for diluted calculation)	21,695		21,507
EPS — basic	$	1.12	$	0.81
EPS — diluted	$	1.09	$	0.78

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Derivative Financial Instruments (Tables)

3 Months Ended

Mar. 31, 2021

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Cash Flow Hedging Instruments, Statements of Financial Performance and Financial Position, Location [Table Text Block]

The following table presents the fair values of our derivative instruments included within the Condensed Consolidated Balance Sheets as of March 31, 2021 and December 31, 2020 (in thousands):

	Derivatives
	Condensed Consolidated Balance Sheet Location	March 31, 2021		December 31, 2020
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contract:
	Prepaid expenses and other current assets	$	2,312	$	3,555
Total derivatives designated as cash flow hedging instruments		$	2,312	$	3,555

    The following table presents the amounts affecting the Condensed Consolidated Statements of Operations for the three months ended March 31, 2021 and 2020 (in thousands):

	Line Item in the Condensed Consolidated Statements of Operations	Three months ended March 31,
		2021		2020
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contracts	Cost of goods sold	$	841	$	692

Schedule of Cash Flow Hedges Included in Accumulated Other Comprehensive Income (Loss) [Table Text Block]

We recognized the following (losses) gains on our foreign exchange contracts designated as a cash flow hedge (in thousands):

	Amount of Loss Recognized in Other Comprehensive Income on Derivatives				Amount of Gain Reclassified From Accumulated Other Comprehensive Income into Income
	Three months ended March 31,					Three months ended March 31,
	2021		2020		Location of Gain Reclassified From Accumulated Other Comprehensive Income into Income	2021		2020
Derivatives designated as cash flow hedges:
Foreign exchange forward contract	$	(402)	$	(3,192)	Cost of goods sold	$	841	$	692
Total derivatives designated as cash flow hedging instruments	$	(402)	$	(3,192)		$	841	$	692

As of March 31, 2021, we expect approximately $2.3 million of the deferred gains on the outstanding derivatives in accumulated other comprehensive income to be reclassified to net income during the next twelve months concurrent with the underlying hedged transactions also being reported in net income.

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Fair Value Measures and Disclosures (Tables)

3 Months Ended

Mar. 31, 2021

Fair Value Disclosures [Abstract]

Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation

The following tables provide a reconciliation of the Level 3 earn-out liabilities measured at estimated fair value (in thousands):

	Pursuit
	Earn-out Liability
Accrued balance, January 1, 2021	$	26,300
Change in fair value of earn-out (included in income from operations as a separate line item)	—
Accrued balance, March 31, 2021	$	26,300

	Pursuit
	Earn-out Liability
Accrued balance, January 1, 2020	$	17,300
Change in fair value of earn-out (included in income from operations as a separate line item)	—
Accrued balance, March 31, 2020	$	17,300

Fair Value Measurement Inputs and Valuation Techniques

The following tables provide quantitative information about Level 3 inputs for fair value measurement of our earn-out liabilities:Pursuit Earn-out

Simulation Input	As of March 31, 2021		As of December 31, 2020		As of March 31, 2020
Revenue/Gross Profit Volatility	25.00	%	25.00	%	20.00	%
Discount Rate	12.50	%	12.50	%	15.00	%
Risk Free Rate	0.09	%	0.09	%	1.55	%
Counter Party Risk	3.10	%	3.10	%	6.00	%

Fair Value, by Balance Sheet Grouping

Our assets and liabilities measured at fair value on a recurring basis consisted of the following (Level 1, 2 and 3 inputs as defined above) (in thousands):

	Fair value measurements at March 31, 2021
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	11,693	$	—	$	11,693	$	—
Long-term	18,834		—		18,834		—
Foreign exchange forwards:
Prepaid expenses and other current assets	2,312		—		2,312		—
Total Assets	$	32,839	$	—	$	32,839	$	—
Liabilities:
Earn-out liability	$	26,300	$	—	$	—	$	26,300
Total Liabilities	$	26,300	$	—	$	—	$	26,300

	Fair value measurements at December 31, 2020
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	14,687	$	—	$	14,687	$	—
Long-term	12,974		—		12,974		—
Foreign exchange forwards:
Prepaid expenses and other current assets	3,555		—		3,555		—
Total Assets	$	31,216	$	—	$	31,216	$	—
Liabilities:
Earn-out liability	$	26,300	$	—	$	—	$	26,300
Total Liabilities	$	26,300	$	—	$	—	$	26,300

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Investment Securities (Tables)

3 Months Ended

Mar. 31, 2021

Investments, Debt and Equity Securities [Abstract]

Available-for-sale Securities [Table Text Block]

Our short investment securities consisted of the following (in thousands):

	As of March 31, 2021
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	11,693	$	—	$	11,693
Long-term corporate bonds	18,834		—		18,834
Total investment securities	$	30,527	$	—	$	30,527
	As of December 31, 2020
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	14,687	$	—	$	14,687
Long-term corporate bonds	12,974		—		12,974
Total investment securities	$	27,661	$	—	$	27,661

XML

Prepaids and Other Current Assets (Tables)

3 Months Ended

Mar. 31, 2021

Related Party Transaction [Line Items]

Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Table Text Block]

Prepaid expenses and other current assets consist of the following (in thousands): 

	March 31, 2021		December 31, 2020
Other prepaid expenses and receivables	$	16,084	$	14,964
Deferred costs	6,554		6,402
Prepaid insurance and property taxes	4,639		6,178
VAT/GST receivable	3,674		3,676
Deferred tax charge	3,856		3,542
Foreign exchange forward contract	2,312		3,555
Deposits	1,343		1,353
Other	1,847		1,822
	$	40,309	$	41,492

XML

Inventories (Tables)

3 Months Ended

Mar. 31, 2021

Inventory Disclosure [Abstract]

Schedule of Inventory, Current [Table Text Block]

Inventories consisted of the following (in thousands): 

	March 31, 2021		December 31, 2020
Raw materials	$	122,703	$	126,499
Work in process	39,713		33,053
Finished goods	137,670		155,376
Total inventories	$	300,086	$	314,928

XML

Property and Equipment (Tables)

3 Months Ended

Mar. 31, 2021

Property, Plant and Equipment [Abstract]

Property, Plant and Equipment [Table Text Block]

Property and equipment consisted of the following (in thousands): 

	March 31, 2021		December 31, 2020
Machinery and equipment	$	293,653	$	291,331
Land, building and building improvements	241,608		241,199
Molds	60,381		60,381
Computer equipment and software	98,780		98,311
Furniture and fixtures	7,712		7,767
Instruments placed with customers(1)	91,909		90,383
Construction in progress	55,757		53,724
Total property and equipment, cost	849,800		843,096
Accumulated depreciation	(390,728)		(376,468)
Property and equipment, net	$	459,072	$	466,628

XML

Goodwill and Intangible Assets (Tables)

3 Months Ended

Mar. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Goodwill [Table Text Block]

The following table presents the changes in the carrying amount of our goodwill (in thousands):

	Total
Balance as of January 1, 2021	$	33,001
Currency translation	(49)
Balance as of March 31, 2021	$	32,952

Schedule of Intangible Assets and Goodwill [Table Text Block]

Intangible assets, carried at cost less accumulated amortization and amortized on a straight-lined basis, were as follows (in thousands):

	Weighted Average	March 31, 2021
	Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	25,423	$	15,466	$	9,957
Customer contracts	12	10,310		5,929		4,381
Non-contractual customer relationships	9	57,748		28,233		29,515
Trademarks	4	425		425		—
Trade name	15	18,268		3,808		14,460
Developed technology	13	152,893		40,062		112,831
Non-compete	3	2,500		1,181		1,319
Total amortized intangible assets		$	267,567	$	95,104	$	172,463
Internally developed software*		$	20,611			$	20,611
Total intangible assets		$	288,178	$	95,104	$	193,074

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

	Weighted Average	December 31, 2020
	Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	24,797	$	15,056	$	9,741
Customer contracts	12	10,365		5,852		4,513
Non-contractual customer relationships	9	58,061		26,711		31,350
Trademarks	4	425		425		—
Trade name	15	18,270		3,500		14,770
Developed technology	13	152,893		36,927		115,966
Non-compete	3	2,500		972		1,528
Total amortized intangible assets		$	267,311	$	89,443	$	177,868
Internally developed software*		$	19,363			$	19,363
Total intangible assets		$	286,674	$	89,443	$	197,231

Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block]

As of March 31, 2021 estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):

Remainder of 2021	$	17,807
2022	22,806
2023	21,783
2024	21,694
2025	15,980
2026	15,116
Thereafter	57,277
Total	$	172,463

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Accrued Liabilities (Tables)

3 Months Ended

Mar. 31, 2021

Accrued Liabilities [Abstract]

Schedule of Accrued Liabilities [Table Text Block]

Accrued liabilities consist of the following (in thousands): 

	March 31, 2021		December 31, 2020
Salaries and benefits	$	26,118	$	25,786
Incentive compensation	8,130		27,023
Operating lease liability-ST	8,872		8,740
Accrued sales taxes	2,435		2,146
Restructuring accrual	3,058		3,421
Deferred revenue	8,195		5,566
Accrued other taxes	923		3,540
Accrued professional fees	730		1,273
Legal accrual	1,291		900
Distribution fees	5,080		5,300
Warranties and returns	554		1,027
Accrued freight	7,715		6,784
Other	5,955		5,515
	$	79,056	$	97,021

Other long-term liabilities consist of the following (in thousands): 

	March 31, 2021		December 31, 2020
Operating lease liability-LT	$	39,588	$	41,019
Benefits	1,180		1,183
Accrued rent	1,427		1,462
Contract liabilities-LT	303		337
Financing lease liability-LT	2,330		2,388
Deferred revenue	693		864
Other	589		582
	$	46,110	$	47,835

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Equity (Tables)

3 Months Ended

Mar. 31, 2021

Equity [Abstract]

Schedule of Accumulated Other Comprehensive Income (Loss)

The components of accumulated other comprehensive (loss) income ("AOCI"), net of tax, were as follows (in thousands):

	Foreign Currency Translation Adjustments		Unrealized Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2021	$	(4,381)	$	2,784	$	75	$	(1,522)
Other comprehensive (loss) income before reclassifications	(7,458)		(306)		12		(7,752)
Amounts reclassified from AOCI	—		(639)		—		(639)
Other comprehensive (loss) income	(7,458)		(945)		12		(8,391)
Balance as of March 31, 2021	$	(11,839)	$	1,839	$	87	$	(9,913)

	Foreign Currency Translation Adjustments		Unrealized Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2020	$	(17,310)	$	1,880	$	28	$	(15,402)
Other comprehensive loss before reclassifications	(10,477)		(2,426)		(81)		(12,984)
Amounts reclassified from AOCI	—		(526)		—		(526)
Other comprehensive loss	(10,477)		(2,952)		(81)		(13,510)
Balance as of March 31, 2020	$	(27,787)	$	(1,072)	$	(53)	$	(28,912)

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Restructuring, Strategic Transaction and Integration Restructuring (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Restructuring and Related Activities [Abstract]
Restructuring, strategic transaction and integration	$ 2,900	$ 12,300
Restructuring Costs	$ 0	$ 7,200

XML

Restructuring, Strategic Transaction and Integration Liability (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021 USD ($)
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	$ 3,421
Restructuring Charges	43
Payments for Restructuring	435
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	(29)
Restructuring Reserve	3,058
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	1,858
Restructuring Charges	43
Payments for Restructuring	435
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	(12)
Restructuring Reserve	1,478
Facility Closing [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	1,563
Restructuring Charges	0
Payments for Restructuring	0
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	(17)
Restructuring Reserve	$ 1,580

XML

Strategic Transaction and Integration (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Restructuring and Related Activities [Abstract]
Strategic Transaction and Integration	$ 2.9	$ 5.1

XML

Revenue (Details) $ in Millions	Mar. 31, 2021 USD ($)
Equipment revenue [Member]
Disaggregation of Revenue [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ 7.3
Software revenue [Member]
Disaggregation of Revenue [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ 1.5

XML

Revenue Disaggregated Revenue by Geography (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Disaggregation of Revenue [Line Items]
Revenues	$ 318,046	$ 328,607
EMEA [Member]
Disaggregation of Revenue [Line Items]
Revenues	34,800	37,928
Other foreign countries [Member]
Disaggregation of Revenue [Line Items]
Revenues	55,895	60,521
Foreign [Member]
Disaggregation of Revenue [Line Items]
Revenues	90,695	98,449
UNITED STATES
Disaggregation of Revenue [Line Items]
Revenues	$ 227,351	$ 230,158

XML

Revenue Disaggregated Revenue by Product Line (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Disaggregation of Revenue [Line Items]
Revenues	$ 318,046	$ 328,607
Infusion Consumables [Member]
Disaggregation of Revenue [Line Items]
Revenues	126,370	123,507
Infusion Systems [Member]
Disaggregation of Revenue [Line Items]
Revenues	84,334	88,380
IV Solutions [Member]
Disaggregation of Revenue [Line Items]
Revenues	94,176	104,291
Critical Care [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 13,166	$ 12,429

XML

Revenue Contract Liabilities (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Movement in Deferred Revenue [Roll Forward]
Contract with Customer, Liability	$ (6,430)	$ (4,855)
Contract with Customer, Liability	(8,888)	(8,472)
Equipment revenue [Member]
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	461	1,802
Deferred Revenue, Additions	(2,921)	(3,990)
Software revenue [Member]
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	1,796	1,235
Deferred Revenue, Additions	$ (1,794)	$ (2,664)

XML

Leases Text (Details)	3 Months Ended
	Mar. 31, 2021
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Option to Extend	5 years
Maximum [Member]
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Term of Contract	15 years

XML

Leases (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Leases [Abstract]
Operating Lease, Cost	$ 2,835	$ 2,791
Finance Lease, Interest Expense	31	29
Finance Lease, Right-of-Use Asset, Amortization	151	0
Short-term Lease, Cost	3	54
Lease, Cost	$ 3,020	$ 2,874

XML

Leases Cash Flow, Operating Activities, Lessee (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Leases [Abstract]
Operating Lease, Payments	$ 2,821	$ 2,457
Finance Lease, Interest Payment on Liability	31	29
Right-of-Use Asset Obtained in Exchange for Operating Lease Liability	1,095	19,094
Right-of-Use Asset Obtained in Exchange for Finance Lease Liability	$ 184	$ 800

XML

Leases Assets and Liabilities, Lessee (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating Lease, Right-of-Use Asset	$ 45,259	$ 46,571	[1]
Operating Lease, Liability, Current	8,872	8,740
Operating Lease, Liability, Noncurrent	39,588	41,019
Operating Lease, Liability	$ 48,460	$ 49,759
Operating Lease, Weighted Average Remaining Lease Term	6 years 6 months	6 years 8 months 12 days
Operating Lease, Weighted Average Discount Rate, Percent	5.00%	5.02%
Finance Lease, Right-of-Use Asset	$ 2,877	$ 2,915
Finance Lease, Liability, Current	583	554
Finance Lease, Liability, Noncurrent	2,330	2,388
Finance Lease, Liability	$ 2,913	$ 2,942
Finance Lease, Weighted Average Remaining Lease Term	6 years 2 months 12 days	6 years 4 months 24 days
Finance Lease, Weighted Average Discount Rate, Percent	4.27%	4.27%

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

XML

Leases Maturity (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Lessee, Operating Lease, Liability, Payments, Remainder of Fiscal Year	$ 8,352
Lessee, Operating Lease, Liability, Payments, Due Next Twelve Months	10,316
Lessee, Operating Lease, Liability, Payments, Due Year Two	9,120
Lessee, Operating Lease, Liability, Payments, Due Year Three	8,317
Lessee, Operating Lease, Liability, Payments, Due Year Four	5,008
Lessee, Operating Lease, Liability, Payments, Due Year Five	4,733
Lessee, Operating Lease, Liability, Payments, Due after Year Five	10,602
Lessee, Operating Lease, Liability, Payments, Due	56,448
Lessee, Operating Lease, Liability, Undiscounted Excess Amount	(7,988)
Operating Lease, Liability	48,460	$ 49,759
Finance Lease, Liability, Payments, Remainder of Fiscal Year	520
Finance Lease, Liability, Payments, Due Next Twelve Months	693
Finance Lease, Liability, Payments, Due Year Two	693
Finance Lease, Liability, Payments, Due Year Three	379
Finance Lease, Liability, Payments, Due Year Four	211
Finance Lease, Liability, Payments, Due Year Five	189
Finance Lease, Liability, Payments, Due after Year Five	614
Finance Lease, Liability, Payment, Due	3,299
Finance Lease, Liability, Undiscounted Excess Amount	(386)
Finance Lease, Liability	$ 2,913	$ 2,942

XML

Net Income Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	12,080	15,333
Net Income	$ 23,731	$ 16,834
Weighted average number of common shares outstanding (for basic calculation)	21,149,000	20,780,000
Dilutive securities	546,000	727,000
Diluted (in shares)	21,695,000	21,507,000
EPS - basic	$ 1.12	$ 0.81
Diluted (In dollars per share)	$ 1.09	$ 0.78

XML

Net Income Per Share (Details 1) - $ / shares	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Earnings Per Share [Abstract]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	12,080	15,333
Dilutive securities	546,000	727,000
Diluted (in shares)	21,695,000	21,507,000
Basic (in dollars per share)	$ 1.12	$ 0.81
Diluted (in dollars per share)	$ 1.09	$ 0.78

XML

Derivative Financial Instruments (Details) $ in Millions	Mar. 31, 2021 MXN ($)	Mar. 31, 2021 USD ($)
Derivative [Line Items]
Foreign Currency Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months		$ 2,300,000
Hedge 2 [Member]
Derivative [Line Items]
Derivative, Forward Exchange Rate	24.26	24.26
Derivative Asset, Notional Amount	$ 327.6
Hedge 3 [Member] [Member]
Derivative [Line Items]
Derivative, Forward Exchange Rate	22.109	22.109

XML

Derivative Financial Instruments Derivative Instruments and Hedging Activities - FV of Derivative Instruments Included Within Consolidated Balance Sheet (Details) - Foreign Exchange Forward [Member] - Designated as Hedging Instrument [Member] - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	$ 2,312	$ 3,555
Derivative Financial Instruments, Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	$ 2,312	$ 3,555

XML

Derivative Financial Instruments Derivative Instruments and Hedging Activities - Amounts Affecting Consolidated Statements of Income (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Derivative Instruments, Gain (Loss) [Line Items]
Derivative, Gain (Loss) on Derivative, Net	$ 841	$ 692

XML

Derivative Financial Instruments Derivative Instruments and Hedging Activities - Cash Flow Hedge Activity Included in Accumulated Other Comprehensive Income (Loss) (Details) - Cost of Sales [Member] - Foreign Exchange Forward [Member] - Cash Flow Hedging [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain Recognized in Other Comprehensive Income (Loss), Effective Portion	$ (402)	$ (3,192)
Derivative Instruments, Gain Reclassified from Accumulated OCI into Income, Effective Portion	$ 841	$ 692

XML

Fair Value Measures and Disclosures (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Hospira [Member] | Maximum [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross		$ 225.0
Hospira [Member] | Minimum [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross		$ 191.3
Pursuit Vascular, Inc. [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	$ 50.0

XML

Fair Value Measures and Disclosures Liabilities Recurring Basis Unobservable Input Reconciliation Pursuit (Details) - Pursuit Vascular, Inc. [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY	$ 26,300	$ 17,300	$ 26,300	$ 17,300
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)	$ 0	$ 0

XML

Fair Value Measures and Disclosures Liabilities Recurring Basis Unobservable Input Reconciliation Hospira (Details) - Pursuit Vascular, Inc. [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY	$ 26,300	$ 17,300	$ 26,300	$ 17,300
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)	$ 0	$ 0

XML

Fair Value Measures and Disclosures Liability Measurement Inputs (Details) - Pursuit Vascular, Inc. [Member]	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020
MeasurementinputadjustedEBITDAvolatility [Domain]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.2500	0.2500	0.2000
Measurement Input, Discount Rate [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.1250	0.1250	0.1500
Measurement Input, Risk Free Interest Rate [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.0009	0.0009	0.0155
Measurement Input, Market Price of Risk [Domain]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.0310	0.0310	0.0600

XML

Fair Value Measures and Disclosures Assets and Liabilities by Balance Sheet Grouping (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	$ 11,693	$ 14,687	[1]
Long-term investment securities	18,834	12,974
Assets, Fair Value Disclosure	32,839	31,216
Earn-out liability [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	26,300	26,300
Liabilities, Total [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	26,300	26,300
Prepaid Expenses and Other Current Assets [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	2,312	3,555
Fair Value, Inputs, Level 1 [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	0	0
Long-term investment securities	0	0
Assets, Fair Value Disclosure	0	0
Fair Value, Inputs, Level 1 [Member] | Earn-out liability [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	0
Fair Value, Inputs, Level 1 [Member] | Liabilities, Total [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	0
Fair Value, Inputs, Level 1 [Member] | Prepaid Expenses and Other Current Assets [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0	0
Fair Value, Inputs, Level 2 [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	11,693	14,687
Long-term investment securities	18,834	12,974
Assets, Fair Value Disclosure	32,839	31,216
Fair Value, Inputs, Level 2 [Member] | Earn-out liability [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	0
Fair Value, Inputs, Level 2 [Member] | Liabilities, Total [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	0
Fair Value, Inputs, Level 2 [Member] | Prepaid Expenses and Other Current Assets [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	2,312	3,555
Fair Value, Inputs, Level 3 [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	0	0
Long-term investment securities	0	0
Assets, Fair Value Disclosure	0	0
Fair Value, Inputs, Level 3 [Member] | Earn-out liability [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	26,300	26,300
Fair Value, Inputs, Level 3 [Member] | Liabilities, Total [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	26,300	26,300
Fair Value, Inputs, Level 3 [Member] | Prepaid Expenses and Other Current Assets [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	$ 0	$ 0

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

XML

Investment Securities (Details) $ in Millions	3 Months Ended
	Mar. 31, 2021 USD ($)
Debt Securities, Available-for-sale [Line Items]
Gain (Loss) on Sale of Investments	$ 0

XML

Investment Securities Table (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2021	Dec. 31, 2020
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-sale, Current	$ 11,693	$ 14,687
Debt Securities, Available-for-sale, Maturity, Allocated and Single Maturity Date, within One Year, Fair Value	11,693	14,687
Available-for-sale Equity Securities, Amortized Cost Basis	30,527	27,661
OCI, Debt Securities, Available-for-Sale, Gain (Loss), after Adjustment, before Tax	0	0
Available-for-sale Securities	30,527	27,661
Available-for-sale Debt Security Current [Member]
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-sale, Continuous Unrealized Loss Position, Less than 12 Months, Accumulated Loss	0	0
Long-term Investments [Domain]
Debt Securities, Available-for-sale [Line Items]
Available-for-sale Equity Securities, Amortized Cost Basis	18,834	12,974
OCI, Debt Securities, Available-for-Sale, Gain (Loss), after Adjustment, before Tax	0	0
Available-for-sale Securities	$ 18,834	$ 12,974

XML

Prepaids and Other Current Assets Prepaids and Other Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Prepaid Expense and Other Assets, Current [Abstract]
Other Prepaid Expense, Current	$ 16,084	$ 14,964
Deferred Costs and Other Assets	6,554	6,402
Prepaid insurance and property taxes	4,639	6,178
Prepaid Taxes	3,674	3,676
Deferred tax charge	3,856	3,542
Derivative Asset, Current	2,312	3,555
Deposit Assets	1,343	1,353
Other Assets, Current	1,847	1,822
Prepaid expenses and other current assets	$ 40,309	$ 41,492	[1]

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

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Inventories (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Inventory, Raw Materials, Net of Reserves	$ 122,703	$ 126,499
Inventory, Work in Process, Net of Reserves	39,713	33,053
Inventory, Finished Goods, Net of Reserves	137,670	155,376
Total	$ 300,086	$ 314,928	[1]

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

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Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 849,800	$ 843,096
Accumulated depreciation	(390,728)	(376,468)
Net property and equipment	459,072	466,628	[1]
Machinery and Equipment, Gross	293,653	291,331
Furniture and Fixtures, Gross	7,712	7,767
Construction in Progress, Gross	55,757	53,724
Land, Buildings and Improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	241,608	241,199
Molds [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	60,381	60,381
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	98,780	98,311
Instruments Placed with Customers [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 91,909	$ 90,383

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

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Property and Equipment Text (Details) $ in Millions	3 Months Ended
	Mar. 31, 2021 USD ($)
Property, Plant and Equipment [Abstract]
Depreciation	$ 16.3

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Goodwill and Intangible Assets Goodwill Table (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Dec. 31, 2020	[1]
Goodwill and Intangible Assets Disclosure [Abstract]
GOODWILL	$ 32,952	$ 33,001
Goodwill, Foreign Currency Translation Gain (Loss)	$ (49)

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

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Goodwill and Intangible Assets Intangibles Table (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Gross	$ 267,567	$ 267,311
Finite-Lived Intangible Assets, Accumulated Amortization	95,104	89,443
Finite-Lived Intangible Assets, Net	172,463	177,868
Indefinite-lived Intangible Assets (Excluding Goodwill)	20,611	19,363
Intangible Assets, Gross (Excluding Goodwill)	288,178	286,674
INTANGIBLE ASSETS, net	$ 193,074	$ 197,231	[1]
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	10 years	10 years
Finite-Lived Intangible Assets, Gross	$ 25,423	$ 24,797
Finite-Lived Intangible Assets, Accumulated Amortization	15,466	15,056
Finite-Lived Intangible Assets, Net	$ 9,957	$ 9,741
Customer Contracts [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	12 years	12 years
Finite-Lived Intangible Assets, Gross	$ 10,310	$ 10,365
Finite-Lived Intangible Assets, Accumulated Amortization	5,929	5,852
Finite-Lived Intangible Assets, Net	$ 4,381	$ 4,513
Customer-Related Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	9 years	9 years
Finite-Lived Intangible Assets, Gross	$ 57,748	$ 58,061
Finite-Lived Intangible Assets, Accumulated Amortization	28,233	26,711
Finite-Lived Intangible Assets, Net	$ 29,515	$ 31,350
Trademarks [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	4 years	4 years
Finite-Lived Intangible Assets, Gross	$ 425	$ 425
Finite-Lived Intangible Assets, Accumulated Amortization	425	425
Finite-Lived Intangible Assets, Net	$ 0	$ 0
Trade Names [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	15 years	15 years
Finite-Lived Intangible Assets, Gross	$ 18,268	$ 18,270
Finite-Lived Intangible Assets, Accumulated Amortization	3,808	3,500
Finite-Lived Intangible Assets, Net	$ 14,460	$ 14,770
Developed Technology Rights [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	13 years	13 years
Finite-Lived Intangible Assets, Gross	$ 152,893	$ 152,893
Finite-Lived Intangible Assets, Accumulated Amortization	40,062	36,927
Finite-Lived Intangible Assets, Net	$ 112,831	$ 115,966
Noncompete Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	3 years	3 years
Finite-Lived Intangible Assets, Gross	$ 2,500	$ 2,500
Finite-Lived Intangible Assets, Accumulated Amortization	1,181	972
Finite-Lived Intangible Assets, Net	$ 1,319	$ 1,528

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

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Goodwill and Intangible Assets Text (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of Intangible Assets	$ 5.8	$ 5.8

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Goodwill and Intangible Assets 5-Year Amortization (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Finite-Lived Intangible Assets, Amortization Expense, Next Twelve Months	$ 17,807
Finite-Lived Intangible Assets, Amortization Expense, Next Twelve Months	22,806
Finite-Lived Intangible Assets, Amortization Expense, Year Two	21,783
Finite-Lived Intangible Assets, Amortization Expense, Year Four	21,694
Finite-Lived Intangible Assets, Amortization Expense, Year Five	15,980
Finite-Lived Intangible Assets, Amortization Expense, Year Five	15,116
Finite-Lived Intangible Assets, Amortization Expense, after Year Five	57,277
Finite-Lived Intangible Assets, Net	$ 172,463	$ 177,868

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Accrued Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Accrued Liabilities [Abstract]
Salaries and benefits	$ 26,118	$ 25,786
Incentive compensation	8,130	27,023
Operating Lease, Liability, Current	8,872	8,740
Sales taxes	2,435	2,146
Restructuring accrual	3,058	3,421
UnfavorablecontractliabilityST	8,195	5,566
Accrued other taxes	923	3,540
Accrued Professional Fees	730	1,273
Legal accrual	1,291	900
Distribution Fees	5,080	5,300
Warranties and returns	554	1,027
Accrued freight	7,715	6,784
Other	5,955	5,515
Accrued liabilities	$ 79,056	$ 97,021	[1]

[1] December 31, 2020 balances were derived from audited consolidated financial statements.

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Accrued Liabilities Long-term liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Accrued Liabilities [Abstract]
Operating Lease, Liability, Noncurrent	$ 39,588	$ 41,019
Accrued Employee Benefits	1,180	1,183
Accrued Rent	1,427	1,462
Liabilities for contracts	303	337
Finance Lease, Liability, Noncurrent	2,330	2,388
Contract with Customer, Liability, Noncurrent	693	864
Other Accrued Liabilities, Noncurrent	589	582
OTHER LONG-TERM LIABILITIES	$ 46,110	$ 47,835

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Income Taxes Effective tax rate (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Income Tax Disclosure [Abstract]
Effective Income Tax Rate	12.00%	17.00%
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent	21.00%	21.00%
Share-based Payment Arrangement, Expense, Tax Benefit	$ 1.8

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Long-Term Obligations (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
LOng-Term Obligations Disclosure [Abstract]
Line of Credit Facility, Maximum Borrowing Capacity	$ 150.0
Line of Credit, Current	0.0	$ 150.0
Line of Credit Facility, Remaining Borrowing Capacity	$ 150.0
Line of Credit Facility, Expiration Date	Nov. 08, 2022

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Commitments and Contingencies Contingency (Details) $ in Millions	3 Months Ended
	Mar. 31, 2021 USD ($)
Pursuit Vascular, Inc. [Member]
Business Acquisition, Contingent Consideration [Line Items]
contingent consideration gross	$ 50.0

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Equity (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Equity [Abstract]
Treasury Stock Purchase Plan	$ 100,000
Stock Repurchase Program, Remaining Authorized Repurchase Amount	$ 100,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	37,423	63,511
Payment, Tax Withholding, Share-based Payment Arrangement	$ 7,723	$ 12,174

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Equity Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020		Dec. 31, 2019
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	$ (9,913)	$ (28,912)	$ (1,522)	[1]	$ (15,402)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(7,752)	(12,984)
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(639)	(526)
Other Comprehensive income (loss), net of Tax	(8,391)	(13,510)
Accumulated Foreign Currency Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	(11,839)	(27,787)	(4,381)		(17,310)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(7,458)	(10,477)
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0
Other Comprehensive income (loss), net of Tax	(7,458)	(10,477)
Accumulated Net Gain (Loss) from Cash Flow Hedges Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	1,839	(1,072)	2,784		1,880
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, Net of Tax	(306)	(2,426)
Other Comprehensive Income (Loss), Reclassification Adjustment from AOCI on Derivatives, Net of Tax	(639)	(526)
Other Comprehensive Income (Loss), Derivatives Qualifying as Hedges, Net of Tax, Portion Attributable to Parent	(945)	(2,952)
Accumulated Defined Benefit Plans Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	87	(53)	$ 75		$ 28
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	12	(81)
Other Comprehensive Income (Loss), Defined Benefit Plan, Gain (Loss), Reclassification Adjustment from AOCI, after Tax	0	0
Other Comprehensive (Income) Loss, Defined Benefit Plan, after Tax and Reclassification Adjustment, Attributable to Parent	$ 12	$ (81)

[1] December 31, 2020 balances were derived from audited consolidated financial statements.