Document and Entity Information - shares	3 Months Ended
Document and Entity Information - shares	Mar. 31, 2019	Apr. 30, 2019
Document Information [Abstract]
Entity Registrant Name	MERIT MEDICAL SYSTEMS INC
Entity Central Index Key	0000856982
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Document Type	10-Q
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Amendment Flag	false
Entity Emerging Growth Company	false
Entity Small Business	false
Entity Common Stock, Shares Outstanding		55,004,915

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
CURRENT ASSETS:
Cash and cash equivalents	$ 49,522	$ 67,359
Trade receivables — net of allowance for uncollectible accounts — 2019 — $2,406 and 2018 — $2,355	146,488	137,174
Other receivables	10,694	11,879
Inventories	198,922	197,536
Prepaid expenses and current other assets	11,220	11,326
Prepaid income taxes	3,620	3,627
Income tax refund receivables	1,317	933
Total current assets	421,783	429,834
PROPERTY AND EQUIPMENT:
Land and land improvements	26,764	26,801
Buildings	152,974	151,251
Manufacturing equipment	225,402	221,029
Furniture and fixtures	55,378	54,765
Leasehold improvements	34,221	33,678
Construction-in-progress	61,304	53,491
Total property and equipment	556,043	541,015
Less accumulated depreciation	(215,279)	(209,563)
Property and equipment — net	340,764	331,452
OTHER ASSETS:
Intangible assets	77,104	79,566
Goodwill	334,951	335,433
Deferred income tax assets	3,083	3,001
Right-of-use operating lease assets	80,453
Other assets	60,052	57,579
Total other assets	927,246	858,726
TOTAL	1,689,793	1,620,012
CURRENT LIABILITIES:
Trade payables	51,680	54,024
Accrued expenses	91,310	96,173
Current portion of long-term debt	22,000	22,000
Short-term operating lease liability	11,825
Income taxes payable	1,644	3,146
Total current liabilities	178,459	175,343
LONG-TERM DEBT	362,187	373,152
DEFERRED INCOME TAX LIABILITIES	56,324	56,363
LONG-TERM INCOME TAXES PAYABLE	392	392
LIABILITIES RELATED TO UNRECOGNIZED TAX BENEFITS	3,013	3,013
DEFERRED COMPENSATION PAYABLE	12,480	11,219
DEFERRED CREDITS	2,227	2,261
LONG-TERM OPERATING LEASE LIABILITY	72,243
OTHER LONG-TERM OBLIGATIONS	62,357	65,494
Total liabilities	749,682	687,237
COMMITMENTS AND CONTINGENCIES (Notes 5, 10, 11, 14 and 15)
STOCKHOLDERS’ EQUITY:
Preferred stock — 5,000 shares authorized as of March 31, 2019 and December 31, 2018; no shares issued	0	0
Common stock, no par value; shares authorized — 2019 and 2018 - 100,000; issued and outstanding as of March 31, 2019 - 54,995 and December 31, 2018 - 54,893	574,946	571,383
Retained earnings	369,713	363,425
Accumulated other comprehensive loss	(4,548)	(2,033)
Total stockholders’ equity	940,111	932,775
TOTAL	1,689,793	1,620,012
Developed technology — net of accumulated amortization — 2019 — $113,765 and 2018 — $102,357
OTHER ASSETS:
Intangible assets	371,603	383,147
Other — net of accumulated amortization — 2019 — $52,469 and 2018 — $49,136
OTHER ASSETS:
Intangible assets	$ 77,104	$ 79,566

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
CURRENT ASSETS:
Trade receivables, allowances	$ 2,406	$ 2,355
OTHER ASSETS:
Intangibles, accumulated amortization	$ 52,469	$ 49,136
STOCKHOLDERS’ EQUITY:
Preferred stock shares authorized (in shares)	5,000,000	5,000,000
Preferred stock shares issued (in shares)	0	0
Common stock par value (in dollars per share)
Common stock shares authorized (in shares)	100,000,000	100,000,000
Common stock shares issued (in shares)	54,995,000	54,893,000
Common stock shares outstanding (in shares)	54,995,000	54,893,000
Developed technology
OTHER ASSETS:
Intangibles, accumulated amortization	$ 113,765	$ 102,357
Other
OTHER ASSETS:
Intangibles, accumulated amortization	$ 52,469	$ 49,136

CONSOLIDATED STATEMENTS OF INCOME - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Statement [Abstract]
NET SALES	$ 238,349	$ 203,035
COST OF SALES	133,713	114,979
GROSS PROFIT	104,636	88,056
OPERATING EXPENSES:
Selling, general and administrative	78,270	64,913
Research and development	16,043	14,322
Contingent consideration expense	775	40
Acquired in-process research and development	25	0
Total operating expenses	95,113	79,275
INCOME FROM OPERATIONS	9,523	8,781
OTHER INCOME (EXPENSE):
Interest income	357	146
Interest expense	(2,764)	(2,398)
Other expense - net	(270)	(170)
Total other expense — net	(2,677)	(2,422)
INCOME BEFORE INCOME TAXES	6,846	6,359
INCOME TAX EXPENSE	651	1,090
NET INCOME	$ 6,195	$ 5,269
EARNINGS PER COMMON SHARE:
Basic (in dollars per share)	$ 0.11	$ 0.10
Diluted (in dollars per share)	$ 0.11	$ 0.10
AVERAGE COMMON SHARES:
Basic (in shares)	54,917	50,277
Diluted (in shares)	56,490	51,910

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement of Comprehensive Income [Abstract]
Net income	$ 6,195	$ 5,269
Other comprehensive income (loss):
Cash flow hedges	(2,577)	1,992
Income tax benefit (expense)	663	(512)
Foreign currency translation adjustment	(615)	2,592
Income tax benefit	14	0
Total other comprehensive income (loss)	(2,515)	4,072
Total comprehensive income	$ 3,680	$ 9,341

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Retained Earnings	Accumulated Other Comprehensive Income (Loss)
Beginning balance at Dec. 31, 2017	$ 676,334	$ 353,392	$ 321,408	$ 1,534
Beginning balance (in shares) at Dec. 31, 2017		50,248
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	5,269
Other comprehensive income/loss	4,072			4,072
Stock-based compensation expense	1,256	$ 1,256
Options exercised	1,286	$ 1,286
Options exercised (in shares)		91
Issuance of common stock under Employee Stock Purchase Plans	294	$ 294
Issuance of common stock under Employee Stock Purchase Plans (in shares)		7
Ending balance at Mar. 31, 2018	688,511	$ 356,228	326,677	5,606
Ending balance (in shares) at Mar. 31, 2018		50,346
Beginning balance at Dec. 31, 2018	$ 932,775	$ 571,383	363,425	(2,033)
Beginning balance (in shares) at Dec. 31, 2018	54,893	54,893
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	$ 6,195
Other comprehensive income/loss	(2,515)			(2,515)
Stock-based compensation expense	1,766	$ 1,766
Options exercised	1,365	$ 1,365
Options exercised (in shares)		95
Issuance of common stock under Employee Stock Purchase Plans	432	$ 432
Issuance of common stock under Employee Stock Purchase Plans (in shares)		7
Ending balance at Mar. 31, 2019	$ 940,111	$ 574,946	$ 369,713	$ (4,548)
Ending balance (in shares) at Mar. 31, 2019	54,995	54,995

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income	$ 6,195	$ 5,269
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	22,348	15,284
Loss on sales and/or abandonment of property and equipment	288	351
Amortization of right-of-use operating lease assets	2,964
Write-off of patents and intangible assets	0	57
Acquired in-process research and development	25	0
Amortization of deferred credits	(35)	(36)
Amortization of long-term debt issuance costs	201	201
Stock-based compensation expense	1,766	1,256
Changes in operating assets and liabilities, net of effects from acquisitions:
Trade receivables	(11,557)	(13,166)
Other receivables	1,070	898
Inventories	(1,340)	(5,388)
Prepaid expenses and other current assets	19	(1,223)
Prepaid income taxes	(53)	(72)
Income tax refund receivables	(442)	(205)
Other assets	(2,092)	(491)
Trade payables	(878)	8,409
Accrued expenses	(3,450)	(2,395)
Income taxes payable	(879)	(480)
Deferred compensation payable	1,261	3
Operating lease liabilities	(3,054)
Other long-term obligations	1,148	(337)
Total adjustments	7,310	2,666
Net cash provided by operating activities	13,505	7,935
Capital expenditures for:
Property and equipment	(18,255)	(16,239)
Intangible assets	(853)	(885)
Proceeds from the sale of property and equipment	3	3
Cash paid in acquisitions, net of cash acquired	(1,942)	(100,195)
Net cash used in investing activities	(21,047)	(117,316)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of common stock	1,733	1,511
Proceeds from issuance of long-term debt	43,119	256,971
Payments on long-term debt	(54,119)	(148,971)
Contingent payments related to acquisitions	(554)	(15)
Net cash provided by (used in) financing activities	(9,821)	109,496
EFFECT OF EXCHANGE RATES ON CASH	(474)	1,720
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS	(17,837)	1,835
CASH AND CASH EQUIVALENTS:
Beginning of period	67,359	32,336
End of period	49,522	34,171
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Interest (net of capitalized interest of $241 and $146, respectively)	2,721	2,383
Income taxes	1,934	1,810
SUPPLEMENTAL DISCLOSURES OF NON-CASH INVESTING AND FINANCING ACTIVITIES
Property and equipment purchases in accounts payable	4,588	$ 1,752
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 1,162

Basis of Presentation	3 Months Ended
Basis of Presentation	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation. The interim consolidated financial statements of Merit Medical Systems, Inc. ("Merit," "we" or "us") for the three-month periods ended March 31, 2019 and 2018 are not audited. Our consolidated financial statements are prepared in accordance with the requirements for unaudited interim periods and, consequently, do not include all disclosures required to be made in conformity with accounting principles generally accepted in the United States of America. In the opinion of our management, the accompanying consolidated financial statements contain all adjustments, consisting of normal recurring accruals, necessary for a fair presentation of our financial position as of March 31, 2019 and December 31, 2018, and our results of operations and cash flows for the three-month periods ended March 31, 2019 and 2018. The results of operations for the three-month periods ended March 31, 2019 and 2018 are not necessarily indicative of the results for a full-year period. These interim consolidated financial statements should be read in conjunction with the financial statements included in our Annual Report on Form 10-K (the "2018 Form 10-K") for the year ended December 31, 2018, which was filed with the Securities and Exchange Commission (the "SEC") on March 1, 2019.

Stock-Based Compensation Expense

3 Months Ended

Mar. 31, 2019

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Stock-Based Compensation Expense

Stock-Based Compensation Expense. The stock-based compensation expense before income tax expense for the three months ended March 31, 2019 and 2018, consisted of the following (in thousands):



	Three Months Ended March 31,
	2019		2018
Cost of sales	$	252	$	184
Research and development	192		124
Selling, general and administrative	1,322		948
Stock-based compensation expense before taxes	$	1,766	$	1,256

We recognize stock-based compensation expense (net of a forfeiture rate) for those awards which are expected to vest on a straight-line basis over the requisite service period. We estimate the forfeiture rate based on our historical experience and expectations about future forfeitures. As of March 31, 2019, the total remaining unrecognized compensation cost related to non-vested stock options, net of expected forfeitures, was approximately $32.8 million and was expected to be recognized over a weighted average period of 3.48 years.

During the three-month period ended March 31, 2019, we granted stock-based awards representing 909,603 shares of our common stock. During the three-month period ended March 31, 2018, we granted stock-based awards representing 492,002 shares of our common stock. We use the Black-Scholes methodology to value the stock-based compensation expense for options. In applying the Black-Scholes methodology to the option grants, the fair value of our stock-based awards granted was estimated using the following assumptions for the periods indicated below:



	Three Months Ended March 31,
	2019	2018
Risk-free interest rate	2.42% - 2.56%	2.63%
Expected option term	3.0 - 5.0 years	5.0 years
Expected dividend yield	—	—
Expected price volatility	28.93% - 33.69%	34.32%

The average risk-free interest rate is determined using the U.S. Treasury rate in effect as of the date of grant, based on the expected term of the stock options. We determine the expected term of the stock options using the historical exercise behavior of employees. The expected price volatility was determined using a weighted average of daily historical volatility of our stock price over the corresponding expected option term and implied volatility based on recent trends of the daily historical volatility. For options with a vesting period, compensation expense is recognized on a straight-line basis over the service period, which corresponds to the vesting period.

Earnings Per Common Share (EPS)

3 Months Ended

Mar. 31, 2019

Earnings Per Share, Basic and Diluted [Abstract]

Earnings Per Common Share (EPS)

Earnings Per Common Share (EPS). The computation of weighted average shares outstanding and the basic and diluted earnings per common share for the following periods consisted of the following (in thousands, except per share amounts):



	Net Income		Shares	Per Share Amount
Three-month period ended March 31, 2019:
Basic EPS	$	6,195	54,917	$	0.11
Effect of dilutive stock options			1,573

Diluted EPS	$	6,195	56,490	$	0.11

Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive			976

Three-month period ended March 31, 2018:
Basic EPS	$	5,269	50,277	$	0.10
Effect of dilutive stock options			1,633

Diluted EPS	$	5,269	51,910	$	0.10

Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive			184

Acquisitions

3 Months Ended

Mar. 31, 2019

Business Combinations [Abstract]

Acquisitions

Acquisitions. On March 28, 2019, we paid $2 million to acquire convertible participating preferred shares of Fluidx Medical Technology, LLC ("Fluidx"), owner of certain technology proposed to be used in the development of embolic and adhesive agents for use in arterial, venous, vascular graft and cardiovascular applications inside and outside the heart and related appendages. Our investment in Fluidx has been recorded as an equity investment accounted for at cost and reflected within other assets in the accompanying consolidated balance sheets because we are not able to exercise significant influence over the operations of Fluidx. Our total current investment in Fluidx represents an ownership of approximately 12.7% of the outstanding equity interests of Fluidx.

On December 14, 2018, we consummated an acquisition transaction contemplated by an asset purchase agreement with Vascular Insights, LLC and VI Management, Inc. (combined "Vascular Insights") and acquired Vascular Insight's intellectual property rights, inventory and certain other assets, including, the ClariVein® IC system and the ClariVein OC system. The ClariVein systems are specialty infusion and occlusion catheter systems with rotating wire tips designed for the controlled 360-degree dispersion of physician-specified agents to the targeted treatment area. We accounted for this acquisition as a business combination. The purchase consideration included an upfront payment of $40 million, and we are obligated to pay up to an additional $20 million based on achieving certain revenue milestones specified in the asset purchase agreement. The sales and results of operations related to this acquisition have been included in our cardiovascular segment. During the three-month period ended March 31, 2019, net sales of products acquired from Vascular Insights were approximately $1.5 million. It is not practical to separately report earnings related to the products acquired from Vascular Insights, as we cannot split out sales costs related solely to the products we acquired from Vascular Insights, principally because our sales representatives sell multiple products (including the products we acquired from Vascular Insights) in our cardiovascular business segment. Acquisition-related costs associated with the Vascular Insights acquisition, which were included in selling, general and administrative expenses during the year ended December 31, 2018, were not material. We are in the process of finalizing the net working capital adjustment pursuant to the asset purchase agreement. The purchase price was preliminarily allocated as follows (in thousands):



Inventories	$	1,353
Intangibles
Developed technology	32,750
Customer list	840
Trademarks	1,410
Goodwill	21,847

Total net assets acquired	$	58,200

We are amortizing the developed technology intangible asset acquired from Vascular Insights over 12 years, the related trademarks over nine years and the customer list on an accelerated basis over eight years. The total weighted-average amortization period for these acquired intangible assets is approximately 11.8 years.

On November 13, 2018, we consummated an acquisition transaction contemplated by a merger agreement to acquire Cianna Medical, Inc. ("Cianna Medical"). The purchase consideration consisted of an upfront payment of $135 million plus a final working capital adjustment of approximately $1.2 million in cash, with potential earn-out payments of up to an additional $15 million for achievement of supply chain and scalability metrics and up to an additional $50 million for the achievement of sales milestones. Cianna Medical developed the first non-radioactive, wire-free breast cancer localization system. Its SCOUT® and SAVI® Brachy technologies are FDA-cleared and address unmet needs in the delivery of radiation therapy, tumor localization and surgical guidance. We accounted for this acquisition as a business combination. During the three-month period ended March 31, 2019, net sales of Cianna Medical products were approximately $12.8 million. It is not practical to separately report earnings related to the products acquired from Cianna Medical, as we cannot split out sales costs related solely to the products we acquired from Cianna Medical, principally because our sales representatives sell multiple products (including the products we acquired from Cianna Medical) in our cardiovascular business segment. Acquisition-related costs associated with the Cianna Medical acquisition, which were included in selling, general and administrative expenses during the year ended December 31, 2018, were approximately $3.5 million. The following table summarizes the preliminary purchase price allocated to the net assets acquired from Cianna Medical (in thousands):



Assets Acquired
Trade receivables	$	6,151
Inventories	5,803
Prepaid expenses and other current assets	315
Property and equipment	1,047
Other long-term assets	14
Intangibles
Developed technology	134,510
Customer lists	3,330
Trademarks	7,080
Goodwill	65,802
Total assets acquired	224,052

Liabilities Assumed
Trade payables	(1,497		)
Accrued expenses	(2,384		)
Other long-term liabilities	(1,527		)
Deferred income tax liabilities	(30,363		)
Total liabilities assumed	(35,771		)

Total net assets acquired	$	188,281

We are amortizing the developed technology intangible assets of Cianna Medical over 11 years, the related trademarks over ten years and the customer lists on an accelerated basis over eight years. The total weighted-average amortization period for these acquired intangible assets is approximately 10.7 years.

On May 23, 2018, we entered into an asset purchase agreement with DirectACCESS Medical, LLC (“DirectACCESS”) to acquire its assets, including, certain product distribution agreements for the FirstChoice™ Ultra High Pressure PTA Balloon Catheter. We accounted for this acquisition as a business combination. The purchase price for the assets was approximately $7.3 million. The sales and results of operations related to the acquisition have been included in our cardiovascular segment since the acquisition date and were not material. Acquisition-related costs associated with the DirectACCESS acquisition, which were included in selling, general and administrative expenses during the year ended December 31, 2018, were not material. The purchase price was preliminarily allocated as follows (in thousands):



Inventories	$	971
Intangibles
Developed technology	4,840
Customer list	120
Trademarks	400
Goodwill	938

Total net assets acquired	$	7,269

We are amortizing the developed technology intangible asset of DirectACCESS over ten years, the related trademarks over ten years and the customer list on an accelerated basis over five years. The total weighted-average amortization period for these acquired intangible assets is approximately 9.9 years.

On February 14, 2018, we acquired certain divested assets from Becton, Dickinson and Company ("BD"), for an aggregate purchase price of $100.3 million. The assets acquired include the soft tissue core needle biopsy products sold under the tradenames of Achieve® Programmable Automatic Biopsy System, Temno® Biopsy System, Tru-Cut® Biopsy Needles as well as Aspira® Pleural Effusion Drainage Kits, and the Aspira® Peritoneal Drainage System. We accounted for this acquisition as a business

combination. During the three-month periods ended March 31, 2019 and 2018, our net sales of BD products were approximately $11.6 million and $6.3 million, respectively. It is not practical to separately report earnings related to the products acquired from BD, as we cannot split out sales costs related solely to the products we acquired from BD, principally because our sales representatives sell multiple products (including the products we acquired from BD) in our cardiovascular business segment. Acquisition-related costs associated with the BD acquisition, which were included in selling, general and administrative expenses during the year ended December 31, 2018, were approximately $1.8 million. The following table summarizes the purchase price allocated to the assets acquired from BD (in thousands):



Inventories	$	5,804
Property and equipment	748
Intangibles
Developed technology	74,000
Customer list	4,200
Trademarks	4,900
In-process technology	2,500
Goodwill	9,728

Total net assets acquired	$	101,880

We are amortizing the developed technology intangible assets acquired from BD over eight years, the related trademarks over nine years and the customer lists on an accelerated basis over seven years. The total weighted-average amortization period for these acquired intangible assets is eight years.

The following table summarizes our consolidated results of operations for the three-month period ended March 31, 2018, as well as unaudited pro forma consolidated results of operations as though the acquisition of Cianna Medical and Vascular Insights had occurred on January 1, 2017 (in thousands, except per common share amounts):



	Three Months Ended
	March 31, 2018
	As Reported		Pro Forma
Net sales	$	203,035	$	222,440
Net income	5,269		(2,050		)
Earnings per common share:
Basic	$	0.10	$	(0.04	)
Diluted	$	0.10	$	(0.04	)

* The pro forma results for the three-month period ended March 31, 2019 are not included in the table above because the

operating results for the Cianna Medical and Vascular Insights acquisitions were included in our consolidated statements of income for this period.

The unaudited pro forma information set forth above is for informational purposes only and includes adjustments related to the step-up of acquired inventories, amortization expense of acquired intangible assets and interest expense on long-term debt. The pro forma information should not be considered indicative of actual results that would have been achieved if the acquisition of Cianna Medical and Vascular Insights had occurred on January 1, 2017, or results that may be obtained in any future period. The pro forma consolidated results of operations do not include the acquisition of assets from BD because it was deemed impracticable to obtain information to determine net income associated with the acquired product lines which represent a small product line of a large, consolidated company without standalone financial information. The pro forma consolidated results of operations do not include the DirectACCESS acquisition as we do not deem the pro forma effect of this transaction to be material.

The goodwill arising from the acquisitions discussed above consists largely of the synergies and economies of scale we hope to achieve from combining the acquired assets and operations with our historical operations. The goodwill recognized from certain acquisitions is expected to be deductible for income tax purposes.

Revenue from Contracts with Customers

3 Months Ended

Mar. 31, 2019

Revenue from Contract with Customer [Abstract]

Revenue from Contract with Customers

Revenue from Contracts with Customers.

In accordance with Accounting Standards Update ("ASU") 2014-09, Revenue from Contracts with Customers (Topic 606) ("ASC 606"), we recognize revenue when a customer obtains control of promised goods. The amount of revenue recognized reflects the consideration we expect to receive in exchange for these goods.

Disaggregation of Revenue

The disaggregation of revenue is based on type of product and geographical region. For descriptions of our product offerings and segments, see Note 13 in our 2018 Form 10-K.

The following tables present revenue from contracts with customers for the three months ended March 31, 2019 and 2018 (in thousands):



	Three Months Ended March 31, 2019						Three Months Ended March 31, 2018
	United States		International		Total		United States		International		Total
Cardiovascular
Stand-alone devices	$	53,400	$	42,027	$	95,427	$	44,010	$	39,236	$	83,246
Cianna Medical	12,849		—		12,849		—		—		—
Custom kits and procedure trays	22,055		10,888		32,943		22,318		10,954		33,272
Inflation devices	7,972		14,045		22,017		7,668		14,751		22,419
Catheters	19,412		23,627		43,039		15,270		18,595		33,865
Embolization devices	4,706		7,121		11,827		5,033		7,554		12,587
CRM/EP	10,098		2,280		12,378		8,838		1,628		10,466
Total	130,492		99,988		230,480		103,137		92,718		195,855

Endoscopy
Endoscopy devices	7,568		301		7,869		6,918		262		7,180

Total	$	138,060	$	100,289	$	238,349	$	110,055	$	92,980	$	203,035

Segment Reporting

3 Months Ended

Mar. 31, 2019

Segment Reporting [Abstract]

Segment Reporting

Segment Reporting. We report our operations in two operating segments: cardiovascular and endoscopy. Our cardiovascular segment consists of cardiology and radiology medical device products which assist in diagnosing and treating coronary artery disease, peripheral vascular disease and other non-vascular diseases and includes embolotherapeutic, cardiac rhythm management ("CRM"), electrophysiology ("EP"), critical care, interventional oncology and spine devices, and our Cianna Medical product line. Our endoscopy segment focuses on the gastroenterology, pulmonary and thoracic surgery specialties, with a portfolio consisting primarily of stents, dilation balloons, certain inflation devices, guide wires, and other disposable products, as well as the products related to our distribution agreement with NinePoint Medical Inc. ("NinePoint Medical"). We evaluate the performance of our operating segments based on net sales and operating income.

Financial information relating to our reportable operating segments and reconciliations to the consolidated totals for the three-month periods ended March 31, 2019 and 2018, are as follows (in thousands):



	Three Months Ended March 31,
	2019			2018
Net Sales
Cardiovascular	$	230,480		$	195,855
Endoscopy	7,869			7,180
Total net sales	$	238,349		$	203,035

Operating Income
Cardiovascular	7,619			6,397
Endoscopy	1,904			2,384
Total operating income	9,523			8,781

Total other expense - net	(2,677		)	(2,422		)

Income tax expense	651			1,090

Net income	$	6,195		$	5,269

Recently Issued Financial Accounting Standards	3 Months Ended
Recently Issued Financial Accounting Standards	Mar. 31, 2019
Accounting Policies [Abstract]
Recently Issued Financial Accounting Standards	Recently Issued Financial Accounting Standards. Recently Adopted In February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2016-02, Leases (Topic 842) ("ASC 842"), which requires lessees to recognize right-of-use ("ROU") assets and related lease liabilities on the balance sheet for all leases greater than one year in duration. We adopted ASC 842 on January 1, 2019 using a modified retrospective transition approach for leases existing at, or entered into after, the beginning of the earliest comparative period presented in the financial statements. The modified retrospective approach did not require any transition accounting for leases that expired before the earliest comparative period presented. The adoption of this standard resulted in the recording of ROU assets and lease liabilities for all of our lease agreements with original terms of greater than one year. The adoption of ASC 842 did not have a significant impact on our consolidated statements of operations or cash flows. See Note 14 for the required disclosures relating to our lease agreements. In June 2018, the FASB issued ASU 2018-07, Compensation-Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting, which simplifies the accounting for nonemployee share-based payment transactions by expanding the scope of ASC Topic 718, Compensation - Stock Compensation, to include share-based payment transactions for acquiring goods and services from nonemployees. Under the new standard, most of the guidance on stock compensation payments to nonemployees would be aligned with the requirements for share-based payments granted to employees. This standard became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. In February 2018, the FASB issued ASU 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income, which allows a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from U.S. federal tax legislation commonly referred to as the Tax Cuts and Jobs Act, which was enacted in December 2017 (the "2017 Tax Act"). ASU 2018-02 became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities, which expands and refines hedge accounting for both financial and non-financial risk components, aligns the recognition and presentation of the effects of hedging instruments and hedge items in the financial statements, and includes certain targeted improvements to ease the application of current guidance related to the assessment of hedge effectiveness. ASU 2017-12 became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. We do not believe any other issued and not yet effective accounting standards will be relevant to our consolidated financial statements.

Income Taxes	3 Months Ended
Income Taxes	Mar. 31, 2019
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes. Our provision for income taxes for the three months ended March 31, 2019 and 2018 was a tax expense of approximately $651,000 and $1.1 million, respectively, which resulted in an effective tax rate of 9.5% and 17.1%, respectively. The decrease in the income tax expense and effective income tax rate for the first quarter of 2019 as compared to the first quarter of 2018 was primarily due to an increase in the discrete tax benefit related to share-based payment awards.

Revolving Credit Facility and Long-Term Debt

3 Months Ended

Mar. 31, 2019

Debt Disclosure [Abstract]

Revolving Credit Facility and Long-Term Debt

Revolving Credit Facility and Long-Term Debt. Principal balances outstanding under our long-term debt obligations as of March 31, 2019 and December 31, 2018, consisted of the following (in thousands):



	March 31, 2019			December 31, 2018
2016 Term loan	$	68,750		$	72,500
2016 Revolving credit loans	308,750			316,000
Collateralized debt facility	7,000			7,000
Less unamortized debt issuance costs	(313		)	(348		)
Total long-term debt	384,187			395,152
Less current portion	22,000			22,000
Long-term portion	$	362,187		$	373,152

2016 Term Loan and Revolving Credit Loans

On July 6, 2016, we entered into a Second Amended and Restated Credit Agreement (as amended to date, the “Second Amended Credit Agreement”), with Wells Fargo Bank, National Association, as administrative agent, swingline lender and a lender, and Wells Fargo Securities, LLC, as sole lead arranger and sole bookrunner. In addition to Wells Fargo Bank, National Association, Bank of America, N.A., U.S. Bank, National Association, and HSBC Bank USA, National Association, are parties to the Second Amended Credit Agreement as lenders. The Second Amended Credit Agreement amends and restates in its entirety our previously outstanding Amended and Restated Credit Agreement and all amendments thereto. The Second Amended Credit Agreement was amended on September 28, 2016 to allow for a new revolving credit loan to our wholly-owned subsidiary, on March 20, 2017 to allow flexibility in how we apply net proceeds received from equity issuances to prepay outstanding indebtedness, on December 13, 2017 to increase the revolving credit commitment by $100 million to $375 million, and on March 28, 2018 to amend certain debt covenants.

The Second Amended Credit Agreement provides for a term loan of $150 million and a revolving credit commitment up to an aggregate amount of $375 million, which includes a reserve of $25 million to make swingline loans from time to time. The term loan is payable in quarterly installments in the amounts provided in the Second Amended Credit Agreement until the maturity date of July 6, 2021, at which time the term and revolving credit loans, together with accrued interest thereon, will be due and payable. At any time prior to the maturity date, we may repay any amounts owing under all revolving credit loans, term loans, and all swingline loans in whole or in part, subject to certain minimum thresholds, without premium or penalty, other than breakage costs.

Revolving credit loans denominated in dollars and term loans made under the Second Amended Credit Agreement bear interest, at our election, at either a Base Rate or Eurocurrency Base Rate (as such terms are defined in the Second Amended Credit Agreement) plus the applicable margin, which increases as our Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) increases. Revolving credit loans denominated in an Alternative Currency (as defined in the Second Amended Credit Agreement) bear interest at the Eurocurrency rate plus the applicable margin. Swingline loans bear interest at the Base Rate plus the applicable margin. Upon an event of default, the interest rate may be increased by 2.0%. The revolving credit commitment also carries a commitment fee of 0.15% to 0.40% per annum on the unused portion.

The Second Amended Credit Agreement is collateralized by substantially all our assets. The Second Amended Credit Agreement contains covenants, representations and warranties, and other terms customary for loans of this nature. The Second Amended Credit Agreement requires that we maintain certain financial covenants, as follows:



		Covenant Requirement
Consolidated Total Leverage Ratio ⁽¹⁾
	January 1, 2018 and thereafter	3.5 to 1.0
Consolidated EBITDA ⁽²⁾		1.25 to 1.0
Consolidated Net Income ⁽³⁾		$0
Facility Capital Expenditures ⁽⁴⁾		$30 million

⁽¹⁾	Maximum Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) as of any fiscal quarter end.
⁽²⁾	Minimum ratio of Consolidated EBITDA (as defined in the Second Amended Credit Agreement and adjusted for certain expenditures) to Consolidated Fixed Charges (as defined in the Second Amended Credit Agreement) for any period of four consecutive fiscal quarters.
⁽³⁾	Minimum level of Consolidated Net Income (as defined in the Second Amended Credit Agreement) for certain periods, and subject to certain adjustments.
⁽⁴⁾	Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Second Amended Credit Agreement) in any fiscal year.

Additionally, the Second Amended Credit Agreement contains customary events of default and affirmative and negative covenants for transactions of this type. As of March 31, 2019, we believe we were in compliance with all covenants set forth in the Second Amended Credit Agreement.

As of March 31, 2019, we had outstanding borrowings of approximately $377.5 million under the Second Amended Credit Agreement, with additional available borrowings of approximately $65.5 million, based on the leverage ratio required pursuant to the Second Amended Credit Agreement. Our interest rate as of March 31, 2019 was a fixed rate of 2.62% on $175 million as a result an interest rate swap (see Note 11) and a variable floating rate of 4.00% on $202.5 million. Our interest rate as of December 31, 2018 was a fixed rate of 2.12% on $175 million as a result of an interest rate swap and a variable floating rate of 3.52% on $213.5 million.

Collateralized Debt Facility

On January 11, 2019, we renewed our loan agreement with HSBC Bank USA, National Association ("HSBC Bank") whereby HSBC Bank agreed to provide us with a loan in the amount of $7.0 million. The loan matured and was settled on April 10, 2019. The loan agreement bore interest at the three-month London Inter-Bank Offered Rate (“LIBOR”) plus 1.0%, which reset quarterly. The loan was secured by assets having a value not less than the outstanding loan balance. The loan contained covenants, representations and warranties and other terms customary for loans of this nature. As of March 31, 2019, our interest rate on the loan was a variable rate of 3.43%.

Future Payments

Future minimum principal payments on our long-term debt as of March 31, 2019, are as follows (in thousands):



Years Ending	Future Minimum
December 31	Principal Payments
Remaining 2019	$	18,250
2020	17,500
2021	348,750
Total future minimum principal payments	$	384,500

Derivatives

3 Months Ended

Mar. 31, 2019

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Derivatives

Derivatives.

General. Our earnings and cash flows are subject to fluctuations due to changes in interest rates and foreign currency exchange rates, and we seek to mitigate a portion of these risks by entering into derivative contracts. The derivatives we use are interest rate swaps and foreign currency forward contracts. We recognize derivatives as either assets or liabilities at fair value in the accompanying consolidated balance sheets, regardless of whether or not hedge accounting is applied. We report cash flows arising from our hedging instruments consistent with the classification of cash flows from the underlying hedged items. Accordingly, cash flows associated with our derivative instruments are classified as operating activities in the accompanying consolidated statements of cash flows.

We formally document, designate and assess the effectiveness of transactions that receive hedge accounting initially and on an ongoing basis. Changes in the fair value of derivatives that qualify for hedge accounting treatment are recorded, net of applicable taxes, in accumulated other comprehensive income (loss), a component of stockholders’ equity in the accompanying consolidated balance sheets. When the hedged transaction occurs, gains or losses are reclassified into earnings in the same line item associated with the forecasted transaction and in the same period or periods during which the hedged transaction affects earnings. Changes in the fair value of derivatives not designated as hedging instruments are recorded in earnings throughout the term of the derivative.

Interest Rate Risk. A portion of our debt bears interest at variable interest rates and, therefore, we are subject to variability in the cash paid for interest expense. In order to mitigate a portion of this risk, we use a hedging strategy to reduce the variability of cash flows in the interest payments associated with a portion of the variable-rate debt outstanding under our Second Amended Credit Agreement that is solely due to changes in the benchmark interest rate.

Derivative Instruments Designated as Cash Flow Hedges

On August 5, 2016, we entered into a pay-fixed, receive-variable interest rate swap with a current notional amount of $175 million with Wells Fargo to fix the one-month LIBOR rate at 1.12%. The variable portion of the interest rate swap is tied to the one-month LIBOR rate (the benchmark interest rate). On a monthly basis, the interest rates under both the interest rate swap and the underlying debt reset, the swap is settled with the counterparty, and interest is paid. The interest rate swap is scheduled to expire on July 6, 2021.

At March 31, 2019 and December 31, 2018, our interest rate swap qualified as a cash flow hedge. The fair value of our interest rate swap at March 31, 2019 was an asset of approximately $4.3 million, which was partially offset by approximately $1.1 million in deferred taxes. The fair value of our interest rate swap at December 31, 2018 was an asset of approximately $5.8 million, which was offset by approximately $1.5 million in deferred taxes.

Foreign Currency Risk. We operate on a global basis and are exposed to the risk that our financial condition, results of operations, and cash flows could be adversely affected by changes in foreign currency exchange rates. To reduce the potential effects of foreign currency exchange rate movements on net earnings, we enter into derivative financial instruments in the form of foreign currency exchange forward contracts with major financial institutions. Our policy is to enter into foreign currency derivative contracts with maturities of up to two years. We are primarily exposed to foreign currency exchange rate risk with respect to transactions and balances denominated in Euros, British Pounds, Chinese Renminbi, Mexican Pesos, Brazilian Reals, Australian Dollars, Hong Kong Dollars, Swiss Francs, Swedish Krona, Canadian Dollars, Danish Krone, Japanese Yen, Korean Won, and Singapore Dollars. We do not use derivative financial instruments for trading or speculative purposes. We are not subject to any credit risk contingent features related to our derivative contracts, and counterparty risk is managed by allocating derivative contracts among several major financial institutions.

Derivative Instruments Designated as Cash Flow Hedges

We enter into forward contracts on various foreign currencies to manage the risk associated with forecasted exchange rates which impact revenues, cost of sales, and operating expenses in various international markets. The objective of the hedges is to reduce the variability of cash flows associated with the forecasted purchase or sale of the associated foreign currencies. We enter into approximately 150 cash flow foreign currency hedges every month. As of March 31, 2019, we had entered into foreign currency forward contracts, which qualified as cash flow hedges, with the following notional amounts (in thousands and in local currencies):



Currency	Symbol	Forward Notional Amount
Australian Dollar	AUD	3,100
Canadian Dollar	CAD	3,850
Swiss Franc	CHF	2,125
Chinese Renminbi	CNY	238,000
Danish Krone	DKK	15,725
Euro	EUR	18,065
British Pound	GBP	4,915
Japanese Yen	JPY	1,305,000
Korean Won	KRW	3,750,000
Mexican Peso	MXN	215,500
Swedish Krona	SEK	25,180

Derivative Instruments Not Designated as Cash Flow Hedges

We forecast our net exposure in various receivables and payables to fluctuations in the value of various currencies, and we enter into foreign currency forward contracts to mitigate that exposure. We enter into approximately 20 foreign currency fair value hedges every month. As of March 31, 2019, we had entered into foreign currency forward contracts related to those balance sheet accounts, with the following notional amounts (in thousands and in local currencies):



Currency	Symbol	Forward Notional Amount
Australian Dollar	AUD	11,400
Brazilian Real	BRL	9,000
Canadian Dollar	CAD	1,136
Swiss Franc	CHF	500
Chinese Renminbi	CNY	50,920
Danish Krone	DKK	4,550
Euro	EUR	7,293
British Pound	GBP	3,350
Hong Kong Dollar	HKD	11,000
Japanese Yen	JPY	265,000
Korean Won	KRW	5,500,000
Mexican Peso	MXN	18,000
Swedish Krona	SEK	12,000
Singapore Dollar	SGD	8,500

Balance Sheet Presentation of Derivative Instruments. As of March 31, 2019, and December 31, 2018, all derivative instruments, both those designated as hedging instruments and those that were not designated as hedging instruments, were recorded gross at fair value on our consolidated balance sheets. We are not subject to any master netting agreements.

The fair value of derivative instruments on a gross basis was as follows on the dates indicated (in thousands):



		Fair Value
	Balance Sheet Location	March 31, 2019			December 31, 2018
Derivative instruments designated as hedging instruments
Assets
Interest rate swap	Other assets (long-term)	$	4,321		$	5,772
Foreign currency forward contracts	Prepaid expenses and other assets	636			613
Foreign currency forward contracts	Other assets (long-term)	162			151

Liabilities
Foreign currency forward contracts	Accrued expenses	(1,458		)	(711		)
Foreign currency forward contracts	Other long-term obligations	(194		)	(101		)

Derivative instruments not designated as hedging instruments
Assets
Foreign currency forward contracts	Prepaid expenses and other assets	$	633		$	814
Liabilities
Foreign currency forward contracts	Accrued expenses	(405		)	(796		)

Income Statement Presentation of Derivative Instruments.

Derivative Instruments Designated as Cash Flow Hedges

Derivative instruments designated as cash flow hedges had the following effects, before income taxes, on other comprehensive income and net earnings in our consolidated statements of income, consolidated statements of comprehensive income and consolidated balance sheets (in thousands):



	Amount of Gain/(Loss) recognized in OCI						Consolidated Statements of Income						Amount of Gain/(Loss) reclassified from AOCI
	Three Months Ended March 31,						Three Months Ended March 31,						Three Months Ended March 31,
	2019			2018			2019			2018			2019			2018
Derivative instrument						Location in statements of income
Interest rate swaps	$	(857	)	$	2,120	Interest expense	$	(2,764	)	$	(2,398	)	$	595		$	213
Foreign currency forward contracts	(1,013		)	174		Revenue	238,349			203,035			194			(151		)
						Cost of sales	(133,713		)	(114,979		)	(82		)	241

As of March 31, 2019, approximately $1.1 million, or $0.8 million after taxes, was expected to be reclassified from accumulated other comprehensive income to earnings in revenue and cost of sales over the succeeding twelve months. As of March 31, 2019, approximately $2.2 million, or $1.7 million after taxes, was expected to be reclassified from accumulated other comprehensive income to earnings in interest expense over the succeeding twelve months.

Derivative Instruments Not Designated as Hedging Instruments

The following gains/(losses) from these derivative instruments were recognized in our consolidated statements of income for the periods presented (in thousands):



		Three Months Ended March 31,
Derivative Instrument	Location in statements of income	2019			2018
Foreign currency forward contracts	Other expense	$	(266	)	$	(1,115	)

Fair Value Measurements

3 Months Ended

Mar. 31, 2019

Fair Value Disclosures [Abstract]

Fair Value Measurements

Fair Value Measurements. Our financial assets and (liabilities) carried at fair value measured on a recurring basis as of March 31, 2019 and December 31, 2018, consisted of the following (in thousands):



				Fair Value Measurements Using
	Total Fair			Quoted prices in		Significant other			Significant
	Value at			active markets		observable inputs			unobservable inputs
Description	March 31, 2019			(Level 1)		(Level 2)			(Level 3)
Interest rate contracts ⁽¹⁾	$	4,321		$	—	$	4,321		$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	1,431		$	—	$	1,431		$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(2,057	)	$	—	$	(2,057	)	$	—
Contingent receivable asset	$	627		$	—	$	—		$	627
Contingent consideration liabilities	$	(82,457	)	$	—	$	—		$	(82,457	)

				Fair Value Measurements Using
	Total Fair			Quoted prices in		Significant other			Significant
	Value at			active markets		observable inputs			unobservable inputs
Description	December 31, 2018			(Level 1)		(Level 2)			(Level 3)
Interest rate contracts ⁽¹⁾	$	5,772		$	—	$	5,772		$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	1,578		$	—	$	1,578		$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(1,608	)	$	—	$	(1,608	)	$	—
Contingent receivable asset	$	607		$	—	$	—		$	607
Contingent consideration liabilities	$	(82,236	)	$	—	$	—		$	(82,236	)

(1) The fair value of the interest rate contracts is determined using Level 2 fair value inputs and is recorded as other assets or other long-term obligations in the consolidated balance sheets.

(2) The fair value of the foreign currency contract assets (including those designated as hedging instruments and those not designated as hedging instruments) is determined using Level 2 fair value inputs and is recorded as prepaid expenses and other assets or other long-term assets in the consolidated balance sheets.

(3) The fair value of the foreign currency contract liabilities (including those designated as hedging instruments and those not designated as hedging instruments) is determined using Level 2 fair value inputs and is recorded as accrued expenses or other long-term obligations in the consolidated balance sheets.

Certain of our business combinations involve the potential for the payment of future contingent consideration, generally based on a percentage of future product sales or upon attaining specified future revenue milestones. See Note 5 for further information regarding these acquisitions. The contingent consideration liability is re-measured at the estimated fair value at the end of each reporting period with the change in fair value recognized within operating expenses in the accompanying consolidated statements of income for such period. We measure the initial liability and re-measure the liability on a recurring basis using Level 3 inputs as defined under authoritative guidance for fair value measurements. Changes in the fair value of our contingent consideration liability during the three-month periods ended March 31, 2019 and 2018, consisted of the following (in thousands):



	Three Months Ended March 31,
	2019			2018
Beginning balance	$	82,236		$	10,956
Fair value adjustments recorded to income during the period	775			(13		)
Contingent payments made	(554		)	(15		)
Ending balance	$	82,457		$	10,928

As of March 31, 2019, approximately $59.2 million in contingent consideration liability was included in other long-term obligations and approximately $23.3 million was included in accrued expenses in our consolidated balance sheet. As of December 31, 2018, approximately $58.5 million in contingent consideration liability was included in other long-term obligations and $23.8 million was included in accrued expenses in our consolidated balance sheet. Cash paid to settle the contingent consideration liability recognized at fair value as of the acquisition date (including measurement-period adjustments) has been reflected as a cash outflow from financing activities in the accompanying consolidated statements of cash flows.

During the year ended December 31, 2016, we sold a cost method investment for cash and for the right to receive additional payments based on various contingent milestones. We determined the fair value of the contingent payments using Level 3 inputs defined under authoritative guidance for fair value measurements, and we recorded a contingent receivable asset, which as of March 31, 2019 and December 31, 2018 had a value of approximately $627,000 and $607,000, respectively, recorded as a current asset in other receivables in our consolidated balance sheets. We record any changes in fair value to operating expenses as part of our cardiovascular segment in our consolidated statements of income. During the three months ended March 31, 2019, we recorded a gain on the contingent receivable of approximately $20,000. During the three months ended March 31, 2018, we recorded a loss of approximately $53,000 and received payments of approximately $153,000 related to the contingent receivable.

The recurring Level 3 measurement of our contingent consideration liability and contingent receivable included the following significant unobservable inputs at March 31, 2019 and December 31, 2018 (amounts in thousands):



Contingent consideration asset or liability	Fair value at March 31, 2019		Valuation technique	Unobservable inputs	Range
Revenue-based royalty	$	9,966	Discounted cash flow	Discount rate	14% - 25%
payments contingent liability			Discounted cash flow	Projected year of payments	2019-2034

Supply chain milestone	$	14,100	Discounted cash flow	Discount rate	3.9%
contingent liability			Discounted cash flow	Probability of milestone payment	95%
				Projected year of payments	2019

Revenue milestones	$	58,391	Discounted cash flow	Discount rate	3.1% - 15%
contingent liability			Discounted cash flow	Projected year of payments	2019-2023

Contingent receivable	$	627	Discounted cash flow	Discount rate	10%
asset			Discounted cash flow	Probability of milestone payment	68%
				Projected year of payments	2019

Contingent consideration asset or liability	Fair value at December 31, 2018		Valuation technique	Unobservable inputs	Range
Revenue-based royalty	$	10,661	Discounted cash flow	Discount rate	9.9% - 25%
payments contingent liability			Discounted cash flow	Projected year of payments	2018-2037

Supply chain milestone	$	13,593	Discounted cash flow	Discount rate	5.3%
contingent liability			Discounted cash flow	Probability of milestone payment	95%
				Projected year of payments	2019

Revenue milestones	$	57,982	Discounted cash flow	Discount rate	3.3% - 13%
contingent liability			Discounted cash flow	Projected year of payments	2019-2023

Contingent receivable	$	607	Discounted cash flow	Discount rate	10%
asset			Discounted cash flow	Probability of milestone payment	67%
				Projected year of payments	2019

The contingent consideration liability and contingent receivable are re-measured to fair value each reporting period using projected revenues, discount rates, probabilities of payment, and projected payment dates. Projected contingent payment amounts are discounted back to the current period using a discounted cash flow model. Projected revenues are based on our most recent internal operational budgets and long-range strategic plans. An increase (decrease) in either the discount rate or the time to payment, in isolation, may result in a significantly lower (higher) fair value measurement. A decrease in the probability of any milestone payment may result in lower fair value measurements. Our determination of the fair value of the contingent consideration liability and contingent receivable could change in future periods based upon our ongoing evaluation of these significant unobservable inputs. We intend to record any such change in fair value to operating expenses in our consolidated statements of income.

During the three-month period ended March 31, 2019, we had losses of approximately $211,000, compared to losses of approximately $57,000 for the three-month period ended March 31, 2018, related to the measurement of non-financial assets at fair value on a nonrecurring basis subsequent to their initial recognition.

We believe the carrying amount of cash and cash equivalents, receivables, and trade payables approximate fair value because of the immediate, short-term maturity of these financial instruments. Our long-term debt re-prices frequently due to variable rates and entails no significant changes in credit risk and, as a result, we believe the fair value of long-term debt approximates carrying value. The fair value of assets and liabilities whose carrying value approximates fair value is determined using Level 2 inputs, with the exception of cash and cash equivalents, which are Level 1 inputs.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Goodwill and Intangible Assets

3 Months Ended

Mar. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

Goodwill and Intangible Assets. The changes in the carrying amount of goodwill for the three-month period ended March 31, 2019 were as follows (in thousands):



	2019
Goodwill balance at January 1	$	335,433
Effect of foreign exchange	(413		)
Purchase price adjustments as the result of acquisitions	(69		)
Goodwill balance at March 31	$	334,951

Total accumulated goodwill impairment losses aggregated to approximately $8.3 million as of March 31, 2019 and December 31, 2018. We did not have any goodwill impairments for the three-month periods ended March 31, 2019 and 2018. The total goodwill balance as of March 31, 2019 and December 31, 2018, was related to our cardiovascular segment.

Other intangible assets at March 31, 2019 and December 31, 2018, consisted of the following (in thousands):



	March 31, 2019
	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount
Patents	$	20,231	$	(5,467	)	$	14,764
Distribution agreements	8,012		(6,023		)	1,989
License agreements	26,926		(7,941		)	18,985
Trademarks	29,991		(7,298		)	22,693
Covenants not to compete	1,028		(1,008		)	20
Customer lists	39,965		(24,732		)	15,233
In-process technology	3,420		—			3,420

Total	$	129,573	$	(52,469	)	$	77,104



	December 31, 2018
	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount
Patents	$	19,378	$	(5,012	)	$	14,366
Distribution agreements	8,012		(5,766		)	2,246
License agreements	26,930		(7,411		)	19,519
Trademarks	29,998		(6,586		)	23,412
Covenants not to compete	1,028		(1,000		)	28
Customer lists	39,936		(23,361		)	16,575
In-process technology	3,420		—			3,420

Total	$	128,702	$	(49,136	)	$	79,566

Aggregate amortization expense for the three-month periods ended March 31, 2019 and 2018 was approximately $14.8 million and $8.5 million, respectively.

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of March 31, 2019 (in thousands):



Year Ending December 31
Remaining 2019	$	44,351
2020	56,238
2021	48,864
2022	47,398
2023	46,136

Leases

3 Months Ended

Mar. 31, 2019

Leases [Abstract]

Leases

Leases. We adopted ASC 842 using the modified retrospective approach, electing the practical expedient that allows us not to restate our comparative periods prior to the adoption of the standard on January 1, 2019. As such, the disclosures required under ASC 842 are not presented for periods before the date of adoption. For the comparative periods prior to adoption, we present the disclosures which were required under ASC 840.

We have operating leases for facilities used for manufacturing, R&D, sales and distribution, and office space, as well as leases for manufacturing and office equipment, vehicles, and land (in Singapore and South Jordan, Utah). Our leases have remaining terms of approximately one year to 19 years. A number of our lease agreements contain options to renew at our discretion for periods of up to 30 years and options to terminate the leases within one year. The lease term used to calculate right-of-use ("ROU") assets and lease liabilities includes renewal and termination options that are deemed reasonably certain to be exercised. Lease agreements with lease and non-lease components are generally accounted for as a single lease component. We do not have any bargain purchase options in our leases. For leases with an initial term of one year or less, we do not record a ROU asset or lease liability on our consolidated balance sheet. Substantially all of the ROU assets and lease liabilities as of March 31, 2019 recorded on our consolidated balance sheet are related to our cardiovascular segment.

We sublease a portion of one of our facilities to a third party. We also lease certain hardware consoles to customers through our distribution agreement with NinePoint Medical and record rental revenue as a component of net sales. Rental revenue under such console leasing arrangements for the three months ended March 31, 2019 and 2018 was insignificant.

The following was included in our consolidated balance sheet as of March 31, 2019 (in thousands):



Leases	As of March 31, 2019
Assets
ROU operating lease assets	$	80,453

Liabilities
Short-term operating lease liabilities	11,825
Long-term operating lease liabilities	72,243
Total operating lease liabilities	$	84,068

During the year ended December 31, 2015, we entered into sale and leaseback transactions to finance certain production equipment for approximately $2.0 million. At that time, we deferred the gain from the sale and leaseback transaction, of which approximately $93,000 remained as of December 31, 2018. As part of the adoption of ASC 842, we wrote-off the deferred gain as an adjustment to equity through retained earnings during the three months ended March 31, 2019.

We recognize lease expense on a straight-line basis over the term of the lease. The components of lease costs for the three months ended March 31, 2019 are as follows, in thousands:



		Three months ended
Lease Cost	Classification	March 31, 2019
Operating lease cost (a)	Selling, general and administrative expenses	$	3,827
Sublease (income) (b)	Selling, general and administrative expenses	(146		)
Net lease cost		$	3,681

(a) Includes expense related to short-term leases and variable payments, which were insignificant.

(b) Does not include rental revenue from leases of NinePoint consoles, which was insignificant.

Supplemental cash flow information for the three months ended March 31, 2019 is as follows:



	Three Months Ended
	March 31, 2019
Cash paid for amounts included in the measurement of lease liabilities	$	3,713
Right-of-use assets obtained in exchange for lease obligations	$	1,162

Generally, our lease agreements do not specify an implicit rate. Therefore, we estimate our incremental borrowing rate, which is defined as the interest rate we would pay to borrow on a collateralized basis, considering such factors as length of lease term and the risks of the economic environment in which the leased asset operates. As of March 31, 2019, the following disclosures for remaining lease term and incremental borrowing rates were applicable:



Supplemental disclosure		March 31, 2019
Weighted average remaining lease term		12 years
Weighted average discount rate		3.3%

As of March 31, 2019, maturities of operating lease liabilities were the following, in thousands:



Year ended December 31,	Amounts under Operating Leases
Remaining 2019	$	10,380
2020	12,251
2021	11,109
2022	8,822
2023	7,026
Thereafter	53,203
Total lease payments	102,791
Less: Imputed interest	(18,723		)
Total	$	84,068

As previously disclosed in our 2018 Form 10-K under the prior guidance of ASC 840, minimum payments under operating lease agreements as of December 31, 2018 were as follows, in thousands:



Year ended December 31,	Operating Leases
2019	$	13,421
2020	11,319
2021	9,995
2022	8,053
2023	6,953
Thereafter	52,754
Total	$	102,495

As of March 31, 2019, we had additional operating leases for office space that had not yet commenced. These leases will commence during 2019 and are not significant.

Commitments and Contingencies	3 Months Ended
Commitments and Contingencies	Mar. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies. In the ordinary course of business, we are involved in various claims and litigation matters. These claims and litigation matters may include actions involving product liability, intellectual property, contract disputes, and employment or other matters that are significant to our business. Based upon our review of currently available information, we do not believe any such actions are likely to be, individually or in the aggregate, materially adverse to our business, financial condition, results of operations or liquidity. In addition to the foregoing matters, in October 2016, we received a subpoena from the U.S. Department of Justice seeking information on certain of our marketing and promotional practices. We are in the process of responding to the subpoena, which we anticipate will continue during 2019. We have incurred, and anticipate that we will continue to incur, substantial costs in connection with the matter. The investigation is ongoing and at this stage we are unable to predict its scope, duration or outcome. Investigations such as this may result in the imposition of, among other things, significant damages, injunctions, fines or civil or criminal claims or penalties against our company or individuals. Legal expenses we incurred in responding to the U.S. Department of Justice subpoena for the three-month periods ended March 31, 2019 and 2018 were approximately $1.7 million and $1.7 million, respectively. In the event of unexpected further developments, it is possible that the ultimate resolution of any of the foregoing matters, or other similar matters, if resolved in a manner unfavorable to us, may be materially adverse to our business, financial condition, results of operations or liquidity. Legal costs for these matters, such as outside counsel fees and expenses, are charged to expense in the period incurred.

Basis of Presentation (Policies)	3 Months Ended
Basis of Presentation (Policies)	Mar. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Principles of Consolidation	The interim consolidated financial statements of Merit Medical Systems, Inc. ("Merit," "we" or "us") for the three-month periods ended March 31, 2019 and 2018 are not audited. Our consolidated financial statements are prepared in accordance with the requirements for unaudited interim periods and, consequently, do not include all disclosures required to be made in conformity with accounting principles generally accepted in the United States of America. In the opinion of our management, the accompanying consolidated financial statements contain all adjustments, consisting of normal recurring accruals, necessary for a fair presentation of our financial position as of March 31, 2019 and December 31, 2018, and our results of operations and cash flows for the three-month periods ended March 31, 2019 and 2018. The results of operations for the three-month periods ended March 31, 2019 and 2018 are not necessarily indicative of the results for a full-year period. These interim consolidated financial statements should be read in conjunction with the financial statements included in our Annual Report on Form 10-K (the "2018 Form 10-K") for the year ended December 31, 2018, which was filed with the Securities and Exchange Commission (the "SEC") on March 1, 2019.
Revenue from Contracts with Customers	Revenue from Contracts with Customers. In accordance with Accounting Standards Update ("ASU") 2014-09, Revenue from Contracts with Customers (Topic 606) ("ASC 606"), we recognize revenue when a customer obtains control of promised goods. The amount of revenue recognized reflects the consideration we expect to receive in exchange for these goods.
Recently Issued Financial Accounting Standards	Recently Issued Financial Accounting Standards. Recently Adopted In February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2016-02, Leases (Topic 842) ("ASC 842"), which requires lessees to recognize right-of-use ("ROU") assets and related lease liabilities on the balance sheet for all leases greater than one year in duration. We adopted ASC 842 on January 1, 2019 using a modified retrospective transition approach for leases existing at, or entered into after, the beginning of the earliest comparative period presented in the financial statements. The modified retrospective approach did not require any transition accounting for leases that expired before the earliest comparative period presented. The adoption of this standard resulted in the recording of ROU assets and lease liabilities for all of our lease agreements with original terms of greater than one year. The adoption of ASC 842 did not have a significant impact on our consolidated statements of operations or cash flows. See Note 14 for the required disclosures relating to our lease agreements. In June 2018, the FASB issued ASU 2018-07, Compensation-Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting, which simplifies the accounting for nonemployee share-based payment transactions by expanding the scope of ASC Topic 718, Compensation - Stock Compensation, to include share-based payment transactions for acquiring goods and services from nonemployees. Under the new standard, most of the guidance on stock compensation payments to nonemployees would be aligned with the requirements for share-based payments granted to employees. This standard became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. In February 2018, the FASB issued ASU 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income, which allows a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from U.S. federal tax legislation commonly referred to as the Tax Cuts and Jobs Act, which was enacted in December 2017 (the "2017 Tax Act"). ASU 2018-02 became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities, which expands and refines hedge accounting for both financial and non-financial risk components, aligns the recognition and presentation of the effects of hedging instruments and hedge items in the financial statements, and includes certain targeted improvements to ease the application of current guidance related to the assessment of hedge effectiveness. ASU 2017-12 became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. We do not believe any other issued and not yet effective accounting standards will be relevant to our consolidated financial statements.
Derivatives	Derivative Instruments Not Designated as Cash Flow Hedges We forecast our net exposure in various receivables and payables to fluctuations in the value of various currencies, and we enter into foreign currency forward contracts to mitigate that exposure.Derivatives. General. Our earnings and cash flows are subject to fluctuations due to changes in interest rates and foreign currency exchange rates, and we seek to mitigate a portion of these risks by entering into derivative contracts. The derivatives we use are interest rate swaps and foreign currency forward contracts. We recognize derivatives as either assets or liabilities at fair value in the accompanying consolidated balance sheets, regardless of whether or not hedge accounting is applied. We report cash flows arising from our hedging instruments consistent with the classification of cash flows from the underlying hedged items. Accordingly, cash flows associated with our derivative instruments are classified as operating activities in the accompanying consolidated statements of cash flows. We formally document, designate and assess the effectiveness of transactions that receive hedge accounting initially and on an ongoing basis. Changes in the fair value of derivatives that qualify for hedge accounting treatment are recorded, net of applicable taxes, in accumulated other comprehensive income (loss), a component of stockholders’ equity in the accompanying consolidated balance sheets. When the hedged transaction occurs, gains or losses are reclassified into earnings in the same line item associated with the forecasted transaction and in the same period or periods during which the hedged transaction affects earnings. Changes in the fair value of derivatives not designated as hedging instruments are recorded in earnings throughout the term of the derivative. Interest Rate Risk. A portion of our debt bears interest at variable interest rates and, therefore, we are subject to variability in the cash paid for interest expense. In order to mitigate a portion of this risk, we use a hedging strategy to reduce the variability of cash flows in the interest payments associated with a portion of the variable-rate debt outstanding under our Second Amended Credit Agreement that is solely due to changes in the benchmark interest rate.Balance Sheet Presentation of Derivative Instruments. As of March 31, 2019, and December 31, 2018, all derivative instruments, both those designated as hedging instruments and those that were not designated as hedging instruments, were recorded gross at fair value on our consolidated balance sheets. We are not subject to any master netting agreements. Foreign Currency Risk. We operate on a global basis and are exposed to the risk that our financial condition, results of operations, and cash flows could be adversely affected by changes in foreign currency exchange rates. To reduce the potential effects of foreign currency exchange rate movements on net earnings, we enter into derivative financial instruments in the form of foreign currency exchange forward contracts with major financial institutions. Our policy is to enter into foreign currency derivative contracts with maturities of up to two years. We are primarily exposed to foreign currency exchange rate risk with respect to transactions and balances denominated in Euros, British Pounds, Chinese Renminbi, Mexican Pesos, Brazilian Reals, Australian Dollars, Hong Kong Dollars, Swiss Francs, Swedish Krona, Canadian Dollars, Danish Krone, Japanese Yen, Korean Won, and Singapore Dollars. We do not use derivative financial instruments for trading or speculative purposes. We are not subject to any credit risk contingent features related to our derivative contracts, and counterparty risk is managed by allocating derivative contracts among several major financial institutions. Derivative Instruments Designated as Cash Flow Hedges We enter into forward contracts on various foreign currencies to manage the risk associated with forecasted exchange rates which impact revenues, cost of sales, and operating expenses in various international markets. The objective of the hedges is to reduce the variability of cash flows associated with the forecasted purchase or sale of the associated foreign currencies.

Inventories (Tables)

3 Months Ended

Mar. 31, 2019

Inventory Disclosure [Abstract]

Schedule of Inventory

Inventories at March 31, 2019 and December 31, 2018, consisted of the following (in thousands):



	March 31,		December 31,
	2019		2018
Finished goods	$	117,112	$	117,703
Work-in-process	20,192		14,380
Raw materials	61,618		65,453

Total Inventories	$	198,922	$	197,536

Stock-Based Compensation Expense (Tables)

3 Months Ended

Mar. 31, 2019

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs

The stock-based compensation expense before income tax expense for the three months ended March 31, 2019 and 2018, consisted of the following (in thousands):



	Three Months Ended March 31,
	2019		2018
Cost of sales	$	252	$	184
Research and development	192		124
Selling, general and administrative	1,322		948
Stock-based compensation expense before taxes	$	1,766	$	1,256

Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions

In applying the Black-Scholes methodology to the option grants, the fair value of our stock-based awards granted was estimated using the following assumptions for the periods indicated below:



	Three Months Ended March 31,
	2019	2018
Risk-free interest rate	2.42% - 2.56%	2.63%
Expected option term	3.0 - 5.0 years	5.0 years
Expected dividend yield	—	—
Expected price volatility	28.93% - 33.69%	34.32%

Earnings Per Common Share (EPS) (Tables)

3 Months Ended

Mar. 31, 2019

Earnings Per Share, Basic and Diluted [Abstract]

Schedule of Earnings Per Share, Basic and Diluted

The computation of weighted average shares outstanding and the basic and diluted earnings per common share for the following periods consisted of the following (in thousands, except per share amounts):



	Net Income		Shares	Per Share Amount
Three-month period ended March 31, 2019:
Basic EPS	$	6,195	54,917	$	0.11
Effect of dilutive stock options			1,573

Diluted EPS	$	6,195	56,490	$	0.11

Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive			976

Three-month period ended March 31, 2018:
Basic EPS	$	5,269	50,277	$	0.10
Effect of dilutive stock options			1,633

Diluted EPS	$	5,269	51,910	$	0.10

Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive			184

Acquisitions (Tables)

3 Months Ended

Mar. 31, 2019

Business Combinations [Abstract]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table summarizes the preliminary purchase price allocated to the net assets acquired from Cianna Medical (in thousands):



Assets Acquired
Trade receivables	$	6,151
Inventories	5,803
Prepaid expenses and other current assets	315
Property and equipment	1,047
Other long-term assets	14
Intangibles
Developed technology	134,510
Customer lists	3,330
Trademarks	7,080
Goodwill	65,802
Total assets acquired	224,052

Liabilities Assumed
Trade payables	(1,497		)
Accrued expenses	(2,384		)
Other long-term liabilities	(1,527		)
Deferred income tax liabilities	(30,363		)
Total liabilities assumed	(35,771		)

Total net assets acquired	$	188,281

The purchase price was preliminarily allocated as follows (in thousands):



Inventories	$	971
Intangibles
Developed technology	4,840
Customer list	120
Trademarks	400
Goodwill	938

Total net assets acquired	$	7,269

The following table summarizes the purchase price allocated to the assets acquired from BD (in thousands):



Inventories	$	5,804
Property and equipment	748
Intangibles
Developed technology	74,000
Customer list	4,200
Trademarks	4,900
In-process technology	2,500
Goodwill	9,728

Total net assets acquired	$	101,880

The purchase price was preliminarily allocated as follows (in thousands):



Inventories	$	1,353
Intangibles
Developed technology	32,750
Customer list	840
Trademarks	1,410
Goodwill	21,847

Total net assets acquired	$	58,200

Business Acquisition, Pro Forma Information



	Three Months Ended
	March 31, 2018
	As Reported		Pro Forma
Net sales	$	203,035	$	222,440
Net income	5,269		(2,050		)
Earnings per common share:
Basic	$	0.10	$	(0.04	)
Diluted	$	0.10	$	(0.04	)

Revenue from Contracts with Customers (Tables)

3 Months Ended

Mar. 31, 2019

Revenue from Contract with Customer [Abstract]

Schedule of Disaggregation of Revenue

The following tables present revenue from contracts with customers for the three months ended March 31, 2019 and 2018 (in thousands):



	Three Months Ended March 31, 2019						Three Months Ended March 31, 2018
	United States		International		Total		United States		International		Total
Cardiovascular
Stand-alone devices	$	53,400	$	42,027	$	95,427	$	44,010	$	39,236	$	83,246
Cianna Medical	12,849		—		12,849		—		—		—
Custom kits and procedure trays	22,055		10,888		32,943		22,318		10,954		33,272
Inflation devices	7,972		14,045		22,017		7,668		14,751		22,419
Catheters	19,412		23,627		43,039		15,270		18,595		33,865
Embolization devices	4,706		7,121		11,827		5,033		7,554		12,587
CRM/EP	10,098		2,280		12,378		8,838		1,628		10,466
Total	130,492		99,988		230,480		103,137		92,718		195,855

Endoscopy
Endoscopy devices	7,568		301		7,869		6,918		262		7,180

Total	$	138,060	$	100,289	$	238,349	$	110,055	$	92,980	$	203,035

Segment Reporting (Tables)

3 Months Ended

Mar. 31, 2019

Segment Reporting [Abstract]

Schedule of Segment Reporting Information, by Segment



	Three Months Ended March 31,
	2019			2018
Net Sales
Cardiovascular	$	230,480		$	195,855
Endoscopy	7,869			7,180
Total net sales	$	238,349		$	203,035

Operating Income
Cardiovascular	7,619			6,397
Endoscopy	1,904			2,384
Total operating income	9,523			8,781

Total other expense - net	(2,677		)	(2,422		)

Income tax expense	651			1,090

Net income	$	6,195		$	5,269

Revolving Credit Facility and Long-Term Debt (Tables)

3 Months Ended

Mar. 31, 2019

Debt Disclosure [Abstract]

Schedule of Long-term Debt Instruments

Principal balances outstanding under our long-term debt obligations as of March 31, 2019 and December 31, 2018, consisted of the following (in thousands):



	March 31, 2019			December 31, 2018
2016 Term loan	$	68,750		$	72,500
2016 Revolving credit loans	308,750			316,000
Collateralized debt facility	7,000			7,000
Less unamortized debt issuance costs	(313		)	(348		)
Total long-term debt	384,187			395,152
Less current portion	22,000			22,000
Long-term portion	$	362,187		$	373,152

Schedule of Long-term Debt Covenants

The Second Amended Credit Agreement requires that we maintain certain financial covenants, as follows:



		Covenant Requirement
Consolidated Total Leverage Ratio ⁽¹⁾
	January 1, 2018 and thereafter	3.5 to 1.0
Consolidated EBITDA ⁽²⁾		1.25 to 1.0
Consolidated Net Income ⁽³⁾		$0
Facility Capital Expenditures ⁽⁴⁾		$30 million

⁽¹⁾	Maximum Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) as of any fiscal quarter end.
⁽²⁾	Minimum ratio of Consolidated EBITDA (as defined in the Second Amended Credit Agreement and adjusted for certain expenditures) to Consolidated Fixed Charges (as defined in the Second Amended Credit Agreement) for any period of four consecutive fiscal quarters.
⁽³⁾	Minimum level of Consolidated Net Income (as defined in the Second Amended Credit Agreement) for certain periods, and subject to certain adjustments.
⁽⁴⁾	Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Second Amended Credit Agreement) in any fiscal year.

Schedule of Maturities of Long-term Debt

Future minimum principal payments on our long-term debt as of March 31, 2019, are as follows (in thousands):



Years Ending	Future Minimum
December 31	Principal Payments
Remaining 2019	$	18,250
2020	17,500
2021	348,750
Total future minimum principal payments	$	384,500

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

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+ Details

Derivatives (Tables)

3 Months Ended

Mar. 31, 2019

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Notional Amounts of Outstanding Derivative Positions

We enter into approximately 150 cash flow foreign currency hedges every month. As of March 31, 2019, we had entered into foreign currency forward contracts, which qualified as cash flow hedges, with the following notional amounts (in thousands and in local currencies):



Currency	Symbol	Forward Notional Amount
Australian Dollar	AUD	3,100
Canadian Dollar	CAD	3,850
Swiss Franc	CHF	2,125
Chinese Renminbi	CNY	238,000
Danish Krone	DKK	15,725
Euro	EUR	18,065
British Pound	GBP	4,915
Japanese Yen	JPY	1,305,000
Korean Won	KRW	3,750,000
Mexican Peso	MXN	215,500
Swedish Krona	SEK	25,180



Currency	Symbol	Forward Notional Amount
Australian Dollar	AUD	11,400
Brazilian Real	BRL	9,000
Canadian Dollar	CAD	1,136
Swiss Franc	CHF	500
Chinese Renminbi	CNY	50,920
Danish Krone	DKK	4,550
Euro	EUR	7,293
British Pound	GBP	3,350
Hong Kong Dollar	HKD	11,000
Japanese Yen	JPY	265,000
Korean Won	KRW	5,500,000
Mexican Peso	MXN	18,000
Swedish Krona	SEK	12,000
Singapore Dollar	SGD	8,500

Schedule of Derivative Instruments in Statement of Financial Position, Fair Value

The fair value of derivative instruments on a gross basis was as follows on the dates indicated (in thousands):



		Fair Value
	Balance Sheet Location	March 31, 2019			December 31, 2018
Derivative instruments designated as hedging instruments
Assets
Interest rate swap	Other assets (long-term)	$	4,321		$	5,772
Foreign currency forward contracts	Prepaid expenses and other assets	636			613
Foreign currency forward contracts	Other assets (long-term)	162			151

Liabilities
Foreign currency forward contracts	Accrued expenses	(1,458		)	(711		)
Foreign currency forward contracts	Other long-term obligations	(194		)	(101		)

Derivative instruments not designated as hedging instruments
Assets
Foreign currency forward contracts	Prepaid expenses and other assets	$	633		$	814
Liabilities
Foreign currency forward contracts	Accrued expenses	(405		)	(796		)

Schedule of Cash Flow Hedges Included in Accumulated Other Comprehensive Income (Loss)



	Amount of Gain/(Loss) recognized in OCI						Consolidated Statements of Income						Amount of Gain/(Loss) reclassified from AOCI
	Three Months Ended March 31,						Three Months Ended March 31,						Three Months Ended March 31,
	2019			2018			2019			2018			2019			2018
Derivative instrument						Location in statements of income
Interest rate swaps	$	(857	)	$	2,120	Interest expense	$	(2,764	)	$	(2,398	)	$	595		$	213
Foreign currency forward contracts	(1,013		)	174		Revenue	238,349			203,035			194			(151		)
						Cost of sales	(133,713		)	(114,979		)	(82		)	241

Derivative Instruments, Gain (Loss)

The following gains/(losses) from these derivative instruments were recognized in our consolidated statements of income for the periods presented (in thousands):



		Three Months Ended March 31,
Derivative Instrument	Location in statements of income	2019			2018
Foreign currency forward contracts	Other expense	$	(266	)	$	(1,115	)

Fair Value Measurements (Tables)

3 Months Ended

Mar. 31, 2019

Fair Value Disclosures [Abstract]

Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis

Our financial assets and (liabilities) carried at fair value measured on a recurring basis as of March 31, 2019 and December 31, 2018, consisted of the following (in thousands):



				Fair Value Measurements Using
	Total Fair			Quoted prices in		Significant other			Significant
	Value at			active markets		observable inputs			unobservable inputs
Description	March 31, 2019			(Level 1)		(Level 2)			(Level 3)
Interest rate contracts ⁽¹⁾	$	4,321		$	—	$	4,321		$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	1,431		$	—	$	1,431		$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(2,057	)	$	—	$	(2,057	)	$	—
Contingent receivable asset	$	627		$	—	$	—		$	627
Contingent consideration liabilities	$	(82,457	)	$	—	$	—		$	(82,457	)

				Fair Value Measurements Using
	Total Fair			Quoted prices in		Significant other			Significant
	Value at			active markets		observable inputs			unobservable inputs
Description	December 31, 2018			(Level 1)		(Level 2)			(Level 3)
Interest rate contracts ⁽¹⁾	$	5,772		$	—	$	5,772		$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	1,578		$	—	$	1,578		$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(1,608	)	$	—	$	(1,608	)	$	—
Contingent receivable asset	$	607		$	—	$	—		$	607
Contingent consideration liabilities	$	(82,236	)	$	—	$	—		$	(82,236	)

(1) The fair value of the interest rate contracts is determined using Level 2 fair value inputs and is recorded as other assets or other long-term obligations in the consolidated balance sheets.

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

Changes in the fair value of our contingent consideration liability during the three-month periods ended March 31, 2019 and 2018, consisted of the following (in thousands):



	Three Months Ended March 31,
	2019			2018
Beginning balance	$	82,236		$	10,956
Fair value adjustments recorded to income during the period	775			(13		)
Contingent payments made	(554		)	(15		)
Ending balance	$	82,457		$	10,928

Fair Value Inputs, Liabilities, Quantitative Information



Contingent consideration asset or liability	Fair value at March 31, 2019		Valuation technique	Unobservable inputs	Range
Revenue-based royalty	$	9,966	Discounted cash flow	Discount rate	14% - 25%
payments contingent liability			Discounted cash flow	Projected year of payments	2019-2034

Supply chain milestone	$	14,100	Discounted cash flow	Discount rate	3.9%
contingent liability			Discounted cash flow	Probability of milestone payment	95%
				Projected year of payments	2019

Revenue milestones	$	58,391	Discounted cash flow	Discount rate	3.1% - 15%
contingent liability			Discounted cash flow	Projected year of payments	2019-2023

Contingent receivable	$	627	Discounted cash flow	Discount rate	10%
asset			Discounted cash flow	Probability of milestone payment	68%
				Projected year of payments	2019

Contingent consideration asset or liability	Fair value at December 31, 2018		Valuation technique	Unobservable inputs	Range
Revenue-based royalty	$	10,661	Discounted cash flow	Discount rate	9.9% - 25%
payments contingent liability			Discounted cash flow	Projected year of payments	2018-2037

Supply chain milestone	$	13,593	Discounted cash flow	Discount rate	5.3%
contingent liability			Discounted cash flow	Probability of milestone payment	95%
				Projected year of payments	2019

Revenue milestones	$	57,982	Discounted cash flow	Discount rate	3.3% - 13%
contingent liability			Discounted cash flow	Projected year of payments	2019-2023

Contingent receivable	$	607	Discounted cash flow	Discount rate	10%
asset			Discounted cash flow	Probability of milestone payment	67%
				Projected year of payments	2019

Goodwill and Intangible Assets (Tables)

3 Months Ended

Mar. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Changes in carrying amount of goodwill

The changes in the carrying amount of goodwill for the three-month period ended March 31, 2019 were as follows (in thousands):



	2019
Goodwill balance at January 1	$	335,433
Effect of foreign exchange	(413		)
Purchase price adjustments as the result of acquisitions	(69		)
Goodwill balance at March 31	$	334,951

Other intangible assets

Other intangible assets at March 31, 2019 and December 31, 2018, consisted of the following (in thousands):



	March 31, 2019
	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount
Patents	$	20,231	$	(5,467	)	$	14,764
Distribution agreements	8,012		(6,023		)	1,989
License agreements	26,926		(7,941		)	18,985
Trademarks	29,991		(7,298		)	22,693
Covenants not to compete	1,028		(1,008		)	20
Customer lists	39,965		(24,732		)	15,233
In-process technology	3,420		—			3,420

Total	$	129,573	$	(52,469	)	$	77,104



	December 31, 2018
	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount
Patents	$	19,378	$	(5,012	)	$	14,366
Distribution agreements	8,012		(5,766		)	2,246
License agreements	26,930		(7,411		)	19,519
Trademarks	29,998		(6,586		)	23,412
Covenants not to compete	1,028		(1,000		)	28
Customer lists	39,936		(23,361		)	16,575
In-process technology	3,420		—			3,420

Total	$	128,702	$	(49,136	)	$	79,566

Estimated amortization expense

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of March 31, 2019 (in thousands):



Year Ending December 31
Remaining 2019	$	44,351
2020	56,238
2021	48,864
2022	47,398
2023	46,136

Leases (Tables)

3 Months Ended

Mar. 31, 2019

Leases [Abstract]

Schedule of Consolidated Balance Sheet Information and Supplemental Information

The following was included in our consolidated balance sheet as of March 31, 2019 (in thousands):



Leases	As of March 31, 2019
Assets
ROU operating lease assets	$	80,453

Liabilities
Short-term operating lease liabilities	11,825
Long-term operating lease liabilities	72,243
Total operating lease liabilities	$	84,068

As of March 31, 2019, the following disclosures for remaining lease term and incremental borrowing rates were applicable:



Supplemental disclosure		March 31, 2019
Weighted average remaining lease term		12 years
Weighted average discount rate		3.3%

Components of Lease Costs

We recognize lease expense on a straight-line basis over the term of the lease. The components of lease costs for the three months ended March 31, 2019 are as follows, in thousands:



		Three months ended
Lease Cost	Classification	March 31, 2019
Operating lease cost (a)	Selling, general and administrative expenses	$	3,827
Sublease (income) (b)	Selling, general and administrative expenses	(146		)
Net lease cost		$	3,681

(a) Includes expense related to short-term leases and variable payments, which were insignificant.

(b) Does not include rental revenue from leases of NinePoint consoles, which was insignificant.

Supplemental cash flow information for the three months ended March 31, 2019 is as follows:



	Three Months Ended
	March 31, 2019
Cash paid for amounts included in the measurement of lease liabilities	$	3,713
Right-of-use assets obtained in exchange for lease obligations	$	1,162

Maturities of Operating Lease Liabilities

As of March 31, 2019, maturities of operating lease liabilities were the following, in thousands:



Year ended December 31,	Amounts under Operating Leases
Remaining 2019	$	10,380
2020	12,251
2021	11,109
2022	8,822
2023	7,026
Thereafter	53,203
Total lease payments	102,791
Less: Imputed interest	(18,723		)
Total	$	84,068

Schedule of Minimum Payments Under Operating Lease Agreements

As previously disclosed in our 2018 Form 10-K under the prior guidance of ASC 840, minimum payments under operating lease agreements as of December 31, 2018 were as follows, in thousands:



Year ended December 31,	Operating Leases
2019	$	13,421
2020	11,319
2021	9,995
2022	8,053
2023	6,953
Thereafter	52,754
Total	$	102,495

Inventories (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Finished goods	$ 117,112	$ 117,703
Work-in-process	20,192	14,380
Raw materials	61,618	65,453
Total Inventories	$ 198,922	$ 197,536

Stock-Based Compensation Expense - Allocation of Recognized Period Costs (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	$ 1,766	$ 1,256
Cost of sales
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	252	184
Research and development
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	192	124
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	$ 1,322	$ 948

Stock-Based Compensation Expense - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Compensation cost not yet recognized	$ 32.8
Compensation cost not yet recognized, period of recognition	3 years 5 months 23 days
Options granted in period (in shares)	909,603	492,002

Stock-Based Compensation Expense - Fair Value Calculation Assumptions (Details)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate		2.63%
Risk-free interest rate		5 years
Expected option term	0.00%	0.00%
Expected price volatility		34.32%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	2.42%
Risk-free interest rate	3 years
Expected price volatility	28.93%
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	2.56%
Risk-free interest rate	5 years
Expected price volatility	33.69%

Earnings Per Common Share (EPS) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Earnings Per Share, Basic and Diluted [Abstract]
Net income, Basic EPS	$ 6,195	$ 5,269
Basic EPS (in shares)	54,917	50,277
Basic EPS (in dollars per share)	$ 0.11	$ 0.10
Effect of dilutive stock options (in shares)	1,573	1,633
Net income, Diluted EPS	$ 6,195	$ 5,269
Diluted EPS (in shares)	56,490	51,910
Diluted EPS (in dollars per share)	$ 0.11	$ 0.10
Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive (in shares)	976	184

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

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- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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+ Details

Acquisitions - Narrative (Details) - USD ($) $ in Millions						3 Months Ended		12 Months Ended
Acquisitions - Narrative (Details) - USD ($) $ in Millions	Mar. 28, 2019	Dec. 14, 2018	Nov. 13, 2018	May 23, 2018	Feb. 14, 2018	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Vascular Insights
Business Acquisition [Line Items]
Purchase consideration, upfront payment		$ 40.0
Contingent liability		$ 20.0
Net sales related to acquisition						$ 1.5
Weighted average useful life		11 years 9 months 18 days
Vascular Insights \| Developed technology
Business Acquisition [Line Items]
Useful life		12 years
Vascular Insights \| Trademarks
Business Acquisition [Line Items]
Useful life		9 years
Vascular Insights \| Customer Lists
Business Acquisition [Line Items]
Useful life		8 years
Cianna Medical
Business Acquisition [Line Items]
Purchase consideration, upfront payment			$ 135.0
Net sales related to acquisition						12.8
Weighted average useful life			10 years 8 months 12 days
Working capital adjustment			$ 1.2
Acquisition-related costs								$ 3.5
Cianna Medical \| Achievement of Supply Chain and Scalability Metrics
Business Acquisition [Line Items]
Earn-out payments			15.0
Cianna Medical \| Annual Net Sales Milestone
Business Acquisition [Line Items]
Earn-out payments			$ 50.0
Cianna Medical \| Developed technology
Business Acquisition [Line Items]
Useful life			11 years
Cianna Medical \| Trademarks
Business Acquisition [Line Items]
Useful life			10 years
Cianna Medical \| Customer Lists
Business Acquisition [Line Items]
Useful life			8 years
DirectACCESS Medical, LLC
Business Acquisition [Line Items]
Weighted average useful life				9 years 10 months 24 days
Total purchase price				$ 7.3
DirectACCESS Medical, LLC \| Developed technology
Business Acquisition [Line Items]
Useful life				10 years
DirectACCESS Medical, LLC \| Trademarks
Business Acquisition [Line Items]
Useful life				10 years
DirectACCESS Medical, LLC \| Customer Lists
Business Acquisition [Line Items]
Useful life				5 years
Becton, Dickinson and Company
Business Acquisition [Line Items]
Net sales related to acquisition						$ 11.6	$ 6.3
Weighted average useful life					8 years
Acquisition-related costs								$ 1.8
Total purchase price					$ 100.3
Becton, Dickinson and Company \| Developed technology
Business Acquisition [Line Items]
Useful life					8 years
Becton, Dickinson and Company \| Trademarks
Business Acquisition [Line Items]
Useful life					9 years
Becton, Dickinson and Company \| Customer Lists
Business Acquisition [Line Items]
Useful life					7 years
Fluidx
Business Acquisition [Line Items]
Payments to acquire shares	$ 2.0
Ownership percentage						12.70%

Acquisitions - Purchase Price Allocation (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018	Dec. 14, 2018	Nov. 13, 2018	May 23, 2018	Feb. 14, 2018
Assets Acquired
Goodwill	$ 334,951	$ 335,433
Vascular Insights
Assets Acquired
Inventories			$ 1,353
Goodwill			21,847
Total assets acquired			58,200
Vascular Insights \| Developed technology
Assets Acquired
Intangibles			32,750
Vascular Insights \| Customer lists
Assets Acquired
Intangibles			840
Vascular Insights \| Trademarks
Assets Acquired
Intangibles			$ 1,410
Cianna Medical
Assets Acquired
Trade receivables				$ 6,151
Inventories				5,803
Prepaid expenses and other assets				315
Property and equipment				1,047
Other long-term assets				14
Goodwill				65,802
Total assets acquired				224,052
Liabilities Assumed
Trade payables				(1,497)
Accrued expenses				(2,384)
Other long-term liabilities				(1,527)
Deferred income tax liabilities				(30,363)
Total liabilities assumed				(35,771)
Total net assets acquired				188,281
Cianna Medical \| Developed technology
Assets Acquired
Intangibles				134,510
Cianna Medical \| Customer lists
Assets Acquired
Intangibles				3,330
Cianna Medical \| Trademarks
Assets Acquired
Intangibles				$ 7,080
DirectACCESS Medical, LLC
Assets Acquired
Inventories					$ 971
Goodwill					938
Total assets acquired					7,269
DirectACCESS Medical, LLC \| Developed technology
Assets Acquired
Intangibles					4,840
DirectACCESS Medical, LLC \| Customer lists
Assets Acquired
Intangibles					120
DirectACCESS Medical, LLC \| Trademarks
Assets Acquired
Intangibles					$ 400
Becton, Dickinson and Company
Assets Acquired
Inventories						$ 5,804
Property and equipment						748
Goodwill						9,728
Total assets acquired						101,880
Becton, Dickinson and Company \| Developed technology
Assets Acquired
Intangibles						74,000
Becton, Dickinson and Company \| Customer lists
Assets Acquired
Intangibles						4,200
Becton, Dickinson and Company \| Trademarks
Assets Acquired
Intangibles						4,900
Becton, Dickinson and Company \| In-process technology
Assets Acquired
Intangibles						$ 2,500

Acquisitions - Summary of Unaudited Consolidated Results of Operations, Including Proforma Results (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
As Reported
Net sales	$ 238,349	$ 203,035
Net income	$ 6,195	$ 5,269
Basic (in dollars per share)	$ 0.11	$ 0.10
Diluted (in dollars per share)	$ 0.11	$ 0.10
Pro Forma
Net sales		$ 222,440
Net income		$ (2,050)
Basic, Pro Forma (in dollars per share)		$ (0.04)
Diluted, Pro Forma (in dollars per share)		$ (0.04)

Revenue from Contracts with Customers - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Disaggregation of Revenue [Line Items]
Net sales	$ 238,349	$ 203,035
United States
Disaggregation of Revenue [Line Items]
Net sales	138,060	110,055
International
Disaggregation of Revenue [Line Items]
Net sales	100,289	92,980
Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	230,480	195,855
Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	130,492	103,137
Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	99,988	92,718
Endoscopy
Disaggregation of Revenue [Line Items]
Net sales	7,869	7,180
Stand-alone devices \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	95,427	83,246
Stand-alone devices \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	53,400	44,010
Stand-alone devices \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	42,027	39,236
Cianna Medical \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	12,849	0
Cianna Medical \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	12,849	0
Cianna Medical \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	0	0
Custom kits and procedure trays \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	32,943	33,272
Custom kits and procedure trays \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	22,055	22,318
Custom kits and procedure trays \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	10,888	10,954
Inflation devices \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	22,017	22,419
Inflation devices \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	7,972	7,668
Inflation devices \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	14,045	14,751
Catheters \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	43,039	33,865
Catheters \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	19,412	15,270
Catheters \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	23,627	18,595
Embolization devices \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	11,827	12,587
Embolization devices \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	4,706	5,033
Embolization devices \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	7,121	7,554
CRM/EP \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	12,378	10,466
CRM/EP \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	10,098	8,838
CRM/EP \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	2,280	1,628
Endoscopy devices \| Endoscopy
Disaggregation of Revenue [Line Items]
Net sales	7,869	7,180
Endoscopy devices \| Endoscopy \| United States
Disaggregation of Revenue [Line Items]
Net sales	7,568	6,918
Endoscopy devices \| Endoscopy \| International
Disaggregation of Revenue [Line Items]
Net sales	$ 301	$ 262

Segment Reporting - Operating Income (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Segment Reporting Information [Line Items]
Net sales	$ 238,349	$ 203,035
Operating income	9,523	8,781
Nonoperating Income (Expense)	(2,677)	(2,422)
Income tax expense	651	1,090
Net income	6,195	5,269
Cardiovascular
Segment Reporting Information [Line Items]
Net sales	230,480	195,855
Operating income	7,619	6,397
Endoscopy
Segment Reporting Information [Line Items]
Net sales	7,869	7,180
Operating income	$ 1,904	$ 2,384

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
Income Taxes - Narrative (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Mar. 31, 2018
Income Tax Disclosure [Abstract]
Income tax expense	$ 651	$ 1,090
Effective tax rate	9.50%	17.10%

Revolving Credit Facility and Long-Term Debt - Principal Balances under Long-term Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Jan. 11, 2019	Dec. 31, 2018
Line of Credit Facility [Line Items]
Total long-term debt	$ 384,187		$ 395,152
Collateralized debt facility	7,000	$ 7,000	7,000
Less unamortized debt issuance costs	(313)		(348)
Less current portion	22,000		22,000
Long-term portion	362,187		373,152
Term Loan
Line of Credit Facility [Line Items]
Total long-term debt	68,750		72,500
Revolving Credit Facility
Line of Credit Facility [Line Items]
Total long-term debt	$ 308,750		$ 316,000

Revolving Credit Facility and Long-Term Debt - Narrative (Details) - USD ($)		3 Months Ended
	Jan. 11, 2019	Mar. 31, 2019	Dec. 31, 2018	Dec. 13, 2017	Jul. 06, 2016
Line of Credit Facility [Line Items]
Outstanding borrowings		$ 384,500,000
Collateralized debt facility	$ 7,000,000.0	$ 7,000,000	$ 7,000,000
Variable rate on loan		3.43%
LIBOR
Line of Credit Facility [Line Items]
Debt instrument, basis spread on variable rate	1.00%
Credit Agreement
Line of Credit Facility [Line Items]
Outstanding borrowings		$ 377,500,000
Remaining borrowing capacity on line of credit		$ 65,500,000
Fixed interest rate percent			2.12%
Debt subject to fixed interest rate			$ 175,000,000
Credit Agreement \| Variable Rate 1
Line of Credit Facility [Line Items]
Variable interest rate percent		4.00%	3.52%
Debt subject to variable interest rate		$ 202,500,000	$ 213,500,000
Credit Agreement \| Interest Rate Swap 2
Line of Credit Facility [Line Items]
Fixed interest rate percent		2.62%
Debt subject to fixed interest rate		$ 175,000,000
Credit Agreement \| Revolving Credit Facility
Line of Credit Facility [Line Items]
Increase to revolving credit commitment				$ 100,000,000
Maximum borrowing capacity				$ 375,000,000
Interest rate increase if in event of default		2.00%
Credit Agreement \| Revolving Credit Facility \| Minimum
Line of Credit Facility [Line Items]
Commitment fee percentage		0.15%
Credit Agreement \| Revolving Credit Facility \| Maximum
Line of Credit Facility [Line Items]
Commitment fee percentage		0.40%
Credit Agreement \| Term Loan
Line of Credit Facility [Line Items]
Debt instrument, face amount					$ 150,000,000
Credit Agreement \| Bridge Loan
Line of Credit Facility [Line Items]
Maximum borrowing capacity					$ 25,000,000

Revolving Credit Facility and Long-Term Debt - Financial Covenants (Details) - Credit Agreement	3 Months Ended
	Mar. 31, 2019 USD ($)
Debt Instrument [Line Items]
Consolidated EBITDA	1.25
Consolidated Net Income	$ 0
Facility Capital Expenditures	$ 30,000,000
January 1, 2018 and thereafter
Debt Instrument [Line Items]
Consolidated Total Leverage Ratio	3.5

Revolving Credit Facility and Long-Term Debt - Future Minimum Payments on Long-term Debt (Details) $ in Thousands	Mar. 31, 2019 USD ($)
Debt Disclosure [Abstract]
Remaining 2019	$ 18,250
2020	17,500
2021	348,750
Total future minimum principal payments	$ 384,500

Derivatives - Narrative (Details) € in Thousands, ₩ in Thousands, ¥ in Thousands, ¥ in Thousands, £ in Thousands, kr in Thousands, kr in Thousands, SFr in Thousands, R$ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019 USD ($)	Mar. 31, 2019 DKK (kr) derivative_instrument	Mar. 31, 2019 MXN ($) derivative_instrument	Mar. 31, 2019 CNY (¥) derivative_instrument	Mar. 31, 2019 KRW (₩) derivative_instrument	Mar. 31, 2019 GBP (£) derivative_instrument	Mar. 31, 2019 CAD ($) derivative_instrument	Mar. 31, 2019 JPY (¥) derivative_instrument	Mar. 31, 2019 SGD ($) derivative_instrument	Mar. 31, 2019 SEK (kr) derivative_instrument	Mar. 31, 2019 CHF (SFr) derivative_instrument	Mar. 31, 2019 HKD ($) derivative_instrument	Mar. 31, 2019 BRL (R$) derivative_instrument	Mar. 31, 2019 USD ($) derivative_instrument	Mar. 31, 2019 EUR (€) derivative_instrument	Mar. 31, 2019 AUD ($) derivative_instrument	Dec. 31, 2018 USD ($)	Aug. 05, 2016 USD ($)
Derivative [Line Items]
Deferred taxes used to offset fair value of interest rate swap														$ 1,100			$ 1,500
Maturity of derivative contract (up to)	2 years
Revenue and cost of sales
Derivative [Line Items]
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, gross	$ 1,100
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, net of tax	800
Interest expense
Derivative [Line Items]
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, gross	2,200
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, net of tax	$ 1,700
Interest rate swap
Derivative [Line Items]
Notional amount of derivative																		$ 175,000
Fixed rate																		1.12%
Foreign currency forward contracts \| Designated as hedging instrument
Derivative [Line Items]
Average number of contracts entered into per month \| derivative_instrument		150	150	150	150	150	150	150	150	150	150	150	150	150	150	150
Foreign currency forward contracts \| Not designated as hedging instrument
Derivative [Line Items]
Notional amount of derivative		kr 4,550	$ 18,000	¥ 50,920	₩ 5,500,000	£ 3,350	$ 1,136	¥ 265,000	$ 8,500	kr 12,000	SFr 500	$ 11,000	R$ 9,000		€ 7,293	$ 11,400
Average number of contracts entered into per month \| derivative_instrument		20	20	20	20	20	20	20	20	20	20	20	20	20	20	20
Other assets (long-term) \| Interest rate swap \| Designated as hedging instrument
Derivative [Line Items]
Total Asset Derivatives														$ 4,321			5,772
Other assets (long-term) \| Foreign currency forward contracts \| Designated as hedging instrument
Derivative [Line Items]
Total Asset Derivatives														$ 162			$ 151

Derivatives - Forward Notional Contracts (Details) - Mar. 31, 2019 - Foreign currency forward contracts € in Thousands, ₩ in Thousands, ¥ in Thousands, ¥ in Thousands, £ in Thousands, kr in Thousands, kr in Thousands, SFr in Thousands, R$ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands	DKK (kr)	MXN ($)	CNY (¥)	KRW (₩)	GBP (£)	CAD ($)	JPY (¥)	SGD ($)	SEK (kr)	CHF (SFr)	HKD ($)	BRL (R$)	EUR (€)	AUD ($)
Designated as hedging instrument \| Derivatives designated as cash flow hedges
Derivative [Line Items]
Notional amount of derivative	kr 15,725	$ 215,500	¥ 238,000	₩ 3,750,000	£ 4,915	$ 3,850	¥ 1,305,000		kr 25,180	SFr 2,125			€ 18,065	$ 3,100
Not designated as hedging instrument
Derivative [Line Items]
Notional amount of derivative	kr 4,550	$ 18,000	¥ 50,920	₩ 5,500,000	£ 3,350	$ 1,136	¥ 265,000	$ 8,500	kr 12,000	SFr 500	$ 11,000	R$ 9,000	€ 7,293	$ 11,400

Derivatives - Fair Value of Derivative Instruments (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Designated as hedging instrument \| Interest rate swap \| Other assets (long-term)
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	$ 4,321	$ 5,772
Designated as hedging instrument \| Foreign currency forward contracts \| Other assets (long-term)
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	162	151
Designated as hedging instrument \| Foreign currency forward contracts \| Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	636	613
Designated as hedging instrument \| Foreign currency forward contracts \| Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(1,458)	(711)
Designated as hedging instrument \| Foreign currency forward contracts \| Other long-term obligations
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(194)	(101)
Not designated as hedging instrument \| Foreign currency forward contracts \| Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	633	814
Not designated as hedging instrument \| Foreign currency forward contracts \| Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	$ (405)	$ (796)

Derivatives - Amount of Gain (Loss) Recognized in OCI and Income Statement (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	$ (2,577)	$ 1,992
Derivatives designated as cash flow hedges \| Interest rate swap
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	(857)
Amount of Gain/(Loss) recognized in OCI		2,120
Derivatives designated as cash flow hedges \| Interest rate swap \| Interest expense
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in income	(2,764)	(2,398)
Amount of Gain/(Loss) reclassified from AOCI	595
Amount of Gain/(Loss) reclassified from AOCI		213
Derivatives designated as cash flow hedges \| Foreign currency forward contracts
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	(1,013)
Amount of Gain/(Loss) recognized in OCI		174
Derivatives designated as cash flow hedges \| Foreign currency forward contracts \| Revenue
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in income	238,349	203,035
Amount of Gain/(Loss) reclassified from AOCI	194
Amount of Gain/(Loss) reclassified from AOCI		(151)
Derivatives designated as cash flow hedges \| Foreign currency forward contracts \| Cost of sales
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in income	(133,713)	(114,979)
Amount of Gain/(Loss) reclassified from AOCI	$ (82)
Amount of Gain/(Loss) reclassified from AOCI		$ 241

Derivatives - Gain (Loss) in the Consolidated Statements of Income (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Not designated as hedging instrument \| Foreign currency forward contracts \| Other expense
Derivative [Line Items]
Gain (loss) on derivative	$ (266)	$ (1,115)

Fair Value Measurements - Financial Assets and (Liabilities) Carried at Fair Value (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Fair Value, Inputs, Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	$ 0	$ 0
Foreign currency contract liabilities, current and long-term	0	0
Foreign currency contract liabilities, current and long-term	0	0
Contingent receivable asset	0	0
Contingent consideration liabilities	0	0
Fair Value, Inputs, Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	4,321	5,772
Foreign currency contract liabilities, current and long-term	1,431	1,578
Foreign currency contract liabilities, current and long-term	(2,057)	(1,608)
Contingent receivable asset	0	0
Contingent consideration liabilities	0	0
Fair Value, Inputs, Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	0	0
Foreign currency contract liabilities, current and long-term	0	0
Foreign currency contract liabilities, current and long-term	0	0
Contingent receivable asset	627	607
Contingent consideration liabilities	(82,457)	(82,236)
Estimate of Fair Value, Fair Value Disclosure
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	4,321	5,772
Foreign currency contract liabilities, current and long-term	1,431	1,578
Foreign currency contract liabilities, current and long-term	(2,057)	(1,608)
Contingent receivable asset	627	607
Contingent consideration liabilities	$ (82,457)	$ (82,236)

Fair Value Measurements - Liability Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - Contingent Consideration - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 82,236	$ 10,956
Fair value adjustments recorded to income during the period	775	(13)
Contingent payments made	(554)	(15)
Ending balance	$ 82,457	$ 10,928

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment of other assets	$ 211	$ 57
Contingent Receivable \| Contingent Consideration
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Gain (loss) on contingent receivable	20	(53)
Payment received on contingent receivable		$ 153
Other long-term obligations
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liability, noncurrent	59,200		$ 58,500
Accrued expenses
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liability, current	$ 23,300		$ 23,800

Fair Value Measurements - Fair Value Inputs, Liabilities, Quantitative Information (Details) - Fair Value, Inputs, Level 3 $ in Thousands	Mar. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)
Revenue-based royalty
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	$ 9,966	$ 10,661
Supply chain milestone
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	14,100	13,593
Revenue milestones
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	58,391	57,982
Contingent receivable
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration asset	$ 627	$ 607
Discount rate \| Revenue-based royalty \| Minimum \| Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.140	0.099
Discount rate \| Revenue-based royalty \| Maximum \| Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.25	0.25
Discount rate \| Supply chain milestone \| Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.039	0.053
Discount rate \| Revenue milestones \| Minimum \| Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.031	0.033
Discount rate \| Revenue milestones \| Maximum \| Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.15	0.13
Discount rate \| Contingent receivable \| Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent receivable asset	0.10	0.10
Probability of milestone payment \| Supply chain milestone \| Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.95	0.95
Probability of milestone payment \| Contingent receivable \| Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent receivable asset	0.68	0.67

Goodwill and Intangible Assets - Goodwill (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019 USD ($)
Goodwill [Roll Forward]
Goodwill balance at January 1	$ 335,433
Effect of foreign exchange	(413)
Purchase price adjustments as the result of acquisitions	(69)
Goodwill balance at March 31	$ 334,951

Goodwill and Intangible Assets - Other Intangible Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 129,573	$ 128,702
Accumulated Amortization	(52,469)	(49,136)
Net Carrying Amount	77,104	79,566
Other
Finite-Lived Intangible Assets [Line Items]
Accumulated Amortization	(52,469)	(49,136)
Net Carrying Amount	77,104	79,566
Patents
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	20,231	19,378
Accumulated Amortization	(5,467)	(5,012)
Net Carrying Amount	14,764	14,366
Distribution agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	8,012	8,012
Accumulated Amortization	(6,023)	(5,766)
Net Carrying Amount	1,989	2,246
License agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	26,926	26,930
Accumulated Amortization	(7,941)	(7,411)
Net Carrying Amount	18,985	19,519
Trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	29,991	29,998
Accumulated Amortization	(7,298)	(6,586)
Net Carrying Amount	22,693	23,412
Covenants not to compete
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	1,028	1,028
Accumulated Amortization	(1,008)	(1,000)
Net Carrying Amount	20	28
Customer lists
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	39,965	39,936
Accumulated Amortization	(24,732)	(23,361)
Net Carrying Amount	15,233	16,575
In-process technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	3,420	3,420
Accumulated Amortization	0	0
Net Carrying Amount	$ 3,420	$ 3,420

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Accumulated impairment loss	$ 8.3		$ 8.3
Aggregate amortization expense	$ 14.8	$ 8.5

Goodwill and Intangible Assets - Future Amortization Expense (Details) $ in Thousands	Mar. 31, 2019 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remaining 2019	$ 44,351
2020	56,238
2021	48,864
2022	47,398
2023	$ 46,136

Leases - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
Leases - Narrative (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018	Dec. 31, 2015
Lessee, Lease, Description [Line Items]
Renewal term (up to)	30 years
Termination option (within)	1 year
Sale and leaseback transaction			$ 2,000
Deferred gain from sale and leaseback transaction		$ 93
Minimum
Lessee, Lease, Description [Line Items]
Remaining lease term	1 year
Maximum
Lessee, Lease, Description [Line Items]
Remaining lease term	19 years

Leases - Schedule of Consolidated Balance Sheet Information (Details) $ in Thousands	Mar. 31, 2019 USD ($)
Leases [Abstract]
ROU operating lease assets	$ 80,453
Short-term operating lease liabilities	11,825
Long-term operating lease liabilities	72,243
Total operating lease liabilities	$ 84,068

Leases - Components of Lease Cost (Details) $ in Thousands	3 Months Ended
Leases - Components of Lease Cost (Details) $ in Thousands	Mar. 31, 2019 USD ($)
Leases [Abstract]
Operating lease cost	$ 3,827
Sublease (income)	(146)
Net lease cost	$ 3,681

Leases - Supplemental Cash Flow Information (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019 USD ($)
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 3,713
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 1,162

Leases - Supplemental Disclosure (Details)	Mar. 31, 2019
Leases [Abstract]
Weighted average remaining lease term	12 years
Weighted average discount rate	3.30%

Leases - Maturities of Operating Lease Liabilities (Details) $ in Thousands	Mar. 31, 2019 USD ($)
Leases [Abstract]
Remaining 2019	$ 10,380
2020	12,251
2021	11,109
2022	8,822
2023	7,026
Thereafter	53,203
Total lease payments	102,791
Less: Imputed interest	(18,723)
Less: Imputed interest	$ 84,068

Leases - Schedule of Minimum Payments Under Operating Lease Agreements (Details) $ in Thousands	Dec. 31, 2018 USD ($)
Leases [Abstract]
2019	$ 13,421
2020	11,319
2021	9,995
2022	8,053
2023	6,953
Thereafter	52,754
Total	$ 102,495

Commitments and Contingencies (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
U.S. Department of Justice Matter
Loss Contingencies [Line Items]
Legal expenses	$ 1.7	$ 1.7

Segment Reporting - Narrative (Details)	3 Months Ended
Segment Reporting - Narrative (Details)	Mar. 31, 2019 segment
Segment Reporting [Abstract]
Number of operating segments	2

CONSOLIDATED STATEMENTS OF CASH FLOWS (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement of Cash Flows [Abstract]
Net capitalized interest	$ 241	$ 146

Label	Element	Value
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 93,000
Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 93,000