0000856982-22-000013 | 10-K | XBRL Viewer | Merit Medical Systems INC

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CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 67,750	$ 56,916
Trade receivables - net of allowance for credit losses - 2021 - $6,767 and 2020 - $5,313	152,301	146,641
Other receivables	17,763	7,774
Inventories	221,922	198,019
Prepaid expenses and other current assets	16,149	13,120
Prepaid income taxes	3,550	3,688
Income tax refund receivables	2,777	3,549
Total current assets	482,212	429,707
Property and equipment:
Land and land improvements	25,287	28,400
Buildings	190,044	188,878
Manufacturing equipment	277,976	268,894
Furniture and fixtures	61,446	61,586
Leasehold improvements	46,341	48,800
Construction-in-progress	51,182	46,889
Total property and equipment	652,276	643,447
Less accumulated depreciation	(280,618)	(260,719)
Property and equipment - net	371,658	382,728
Other assets:
Goodwill	361,741	363,533
Deferred income tax assets	6,080	4,597
Right-of-use operating lease assets	65,913	78,240
Other assets	41,421	37,676
Total other assets	794,424	851,961
Total assets	1,648,294	1,664,396
Current liabilities:
Trade payables	55,624	49,837
Accrued expenses	159,014	111,944
Current portion of long-term debt	8,438	7,500
Short-term operating lease liabilities	10,668	12,903
Income taxes payable	2,536	2,820
Total current liabilities	236,280	185,004
Long-term debt	234,397	343,722
Deferred income tax liabilities	31,503	33,312
Long-term income taxes payable	347	347
Liabilities related to unrecognized tax benefits	932	1,016
Deferred compensation payable	18,111	16,808
Deferred credits	1,815	1,923
Long-term operating lease liabilities	61,526	70,941
Other long-term obligations	23,584	52,748
Total liabilities	608,495	705,821
Commitments and contingencies
Stockholders' equity:
Preferred stock - 5,000 shares authorized as of December 31, 2021 and December 31, 2020; no shares issued	0	0
Common stock, no par value; shares authorized - 2021 and 2020 - 100,000; issued and outstanding as of December 31, 2021 - 56,570 and December 31, 2020 - 55,623	641,533	606,224
Retained earnings	406,257	357,803
Accumulated other comprehensive loss	(7,991)	(5,452)
Total stockholders' equity	1,039,799	958,575
Total liabilities and stockholders' equity	1,648,294	1,664,396
Developed technology
Other assets:
Intangible assets	276,833	318,059
Other
Other assets:
Intangible assets	$ 42,436	$ 49,856

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Trade receivables, allowances	$ 6,767	$ 5,313
Stockholders' equity:
Preferred stock shares authorized (in shares)	5,000	5,000
Preferred stock shares issued (in shares)	0	0
Common stock shares authorized (in shares)	100,000	100,000
Common stock shares issued (in shares)	56,570	55,623
Common stock shares outstanding (in shares)	56,570	55,623
Developed technology
Other assets:
Intangibles, accumulated amortization	$ 234,016	$ 193,164
Other
Other assets:
Intangibles, accumulated amortization	$ 65,053	$ 56,943

CONSOLIDATED STATEMENTS OF INCOME (LOSS) - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Statement [Abstract]
Net sales	$ 1,074,751	$ 963,875	$ 994,852
Cost of sales	589,418	562,698	562,486
Gross profit	485,333	401,177	432,366
Operating expenses:
Selling, general and administrative	335,690	297,724	327,274
Research and development	71,247	57,537	65,615
Legal settlement	10,036	18,684
Impairment charges	4,283	36,504	23,750
Contingent consideration expense (benefit)	3,161	(7,960)	(232)
Acquired in-process research and development		250	525
Total operating expenses	424,417	402,739	416,932
Income (loss) from operations	60,916	(1,562)	15,434
Other income (expense):
Interest income	769	604	(291)
Interest expense	(5,261)	(9,994)	(12,413)
Other expense - net	(2,507)	(2,279)	(537)
Total other expense - net	(6,999)	(11,669)	(13,241)
Income (loss) before income taxes	53,917	(13,231)	2,193
Income tax expense (benefit)	5,463	(3,388)	(3,258)
Net income (loss)	$ 48,454	$ (9,843)	$ 5,451
Earnings (loss) per common share
Basic (in dollars per share)	$ 0.86	$ (0.18)	$ 0.10
Diluted (in dollars per share)	$ 0.84	$ (0.18)	$ 0.10
Weighted average shares outstanding
Basic (in shares)	56,145	55,434	55,075
Diluted (in shares)	57,359	55,434	56,235

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement of Comprehensive Income [Abstract]
Net income (loss)	$ 48,454	$ (9,843)	$ 5,451
Other comprehensive income (loss):
Cash flow hedges	5,965	(9,523)	(5,456)
Income tax benefit (expense)	(1,489)	2,365	1,404
Foreign currency translation adjustment	(7,704)	7,786	(18)
Income tax benefit (expense)	689	(786)	61
Total other comprehensive loss	(2,539)	(158)	(4,009)
Total comprehensive income (loss)	$ 45,915	$ (10,001)	$ 1,442

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income and other comprehensive income. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

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

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CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Thousands	Common Stock	Retained Earnings Reclassify upon adoption of ASU	Retained Earnings	Accumulated Other Comprehensive Income (Loss) Reclassify upon adoption of ASU	Accumulated Other Comprehensive Income (Loss)	Reclassify upon adoption of ASU	Total
Beginning balance (ASU 2016-02) at Dec. 31, 2018		$ 93				$ 93
Beginning balance (ASU 2018-02) at Dec. 31, 2018		(748)		$ 748
Beginning balance at Dec. 31, 2018	$ 571,383		$ 363,425		$ (2,033)		$ 932,775
Beginning balance (in shares) at Dec. 31, 2018	54,893
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)			5,451				5,451
Other comprehensive loss					(4,009)		(4,009)
Stock-based compensation expense	$ 9,382						9,382
Options exercised	$ 4,930						4,930
Options exercised (in shares)	288
Issuance of common stock under Employee Stock Purchase Plan	$ 1,415						1,415
Issuance of common stock under Employee Stock Purchase Plans (in shares)	35
Shares surrendered in exchange for exercise of stock options	$ (93)						$ (93)
Shares surrendered in exchange for exercise of stock options (in shares)	(3)						(3)
Ending balance (ASU 2016-13) at Dec. 31, 2019		$ (575)				$ (575)
Ending balance at Dec. 31, 2019	$ 587,017		368,221		(5,294)		$ 949,944
Ending balance (in shares) at Dec. 31, 2019	55,213
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)			(9,843)				(9,843)
Other comprehensive loss					(158)		(158)
Stock-based compensation expense	$ 13,433						13,433
Options exercised	$ 6,948						6,948
Options exercised (in shares)	442
Issuance of common stock under Employee Stock Purchase Plan	$ 1,159						1,159
Issuance of common stock under Employee Stock Purchase Plans (in shares)	30
Shares surrendered in exchange for payment of payroll tax liabilities	$ (866)						(866)
Shares surrendered in exchange for payment of payroll tax liabilities (in shares)	(23)
Shares surrendered in exchange for exercise of stock options	$ (1,467)						$ (1,467)
Shares surrendered in exchange for exercise of stock options (in shares)	(39)						(39)
Ending balance at Dec. 31, 2020	$ 606,224		357,803		(5,452)		$ 958,575
Ending balance (in shares) at Dec. 31, 2020	55,623						55,623
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)			48,454				$ 48,454
Other comprehensive loss					(2,539)		(2,539)
Stock-based compensation expense	$ 14,579						14,579
Options exercised	$ 20,374						$ 20,374
Options exercised (in shares)	883						883
Issuance of common stock under Employee Stock Purchase Plan	$ 1,112						$ 1,112
Issuance of common stock under Employee Stock Purchase Plans (in shares)	18
Shares issued from time-vested restricted stock units (in shares)	59
Shares surrendered in exchange for payment of payroll tax liabilities	$ (576)						(576)
Shares surrendered in exchange for payment of payroll tax liabilities (in shares)	(10)
Shares surrendered in exchange for exercise of stock options	$ (180)						$ (180)
Shares surrendered in exchange for exercise of stock options (in shares)	(3)						(3)
Ending balance at Dec. 31, 2021	$ 641,533		$ 406,257		$ (7,991)		$ 1,039,799
Ending balance (in shares) at Dec. 31, 2021	56,570						56,570

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income (loss)	$ 48,454	$ (9,843)	$ 5,451
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization	84,066	94,070	92,100
Gain on sale of business		(517)
Loss on sales and/or abandonment of property and equipment	1,303	2,159	115
Write-off of certain intangible assets and other long-term assets	4,412	36,609	25,563
Acquired in-process research and development		250	525
Amortization of right-of-use operating lease assets	11,718	12,746	12,256
Fair value adjustments to contingent consideration	3,161	(7,960)	(232)
Amortization of deferred credits	(108)	(130)	(139)
Amortization of long-term debt issuance costs	604	604	721
Deferred income taxes	(4,631)	(11,295)	(12,436)
Stock-based compensation expense	16,090	14,339	9,382
Changes in operating assets and liabilities, net of acquisitions and divestitures:
Trade receivables	(8,618)	10,425	(17,900)
Other receivables	(10,418)	1,668	1,787
Inventories	(25,183)	29,429	(27,044)
Prepaid expenses and other current assets	(3,555)	(446)	(1,239)
Prepaid income taxes	125	(162)	128
Income tax refund receivables	739	(339)	(2,247)
Other assets	(1,670)	(3,511)	(5,141)
Trade payables	6,050	333	(2,295)
Accrued expenses	36,462	4,603	4,719
Income taxes payable	(119)	(86)	(351)
Long-term income taxes payable			(45)
Liabilities related to unrecognized tax benefits	314	(576)	(794)
Deferred compensation payable	1,303	1,953	3,635
Operating lease liabilities	(12,410)	(12,659)	(11,970)
Other long-term obligations	(858)	3,606	3,264
Total adjustments	98,777	175,113	72,362
Net cash provided by operating activities	147,231	165,270	77,813
Capital expenditures for:
Property and equipment	(27,939)	(45,988)	(78,173)
Intangible assets	(2,834)	(3,288)	(3,324)
Proceeds from the sale of property and equipment	1,037	42	920
Proceeds from sale of business		1,285
Cash received for settlement of note receivable	2,000	250
Issuance of note receivable	(2,254)
Cash paid in acquisitions, net of cash acquired	(7,171)	(10,953)	(53,904)
Net cash used in investing activities	(37,161)	(58,652)	(134,481)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of common stock	21,306	6,635	6,252
Proceeds from issuance of long-term debt	98,421	68,625	246,659
Payments on long-term debt	(206,921)	(157,000)	(202,159)
Long-term debt issuance costs			(1,479)
Contingent payments related to acquisitions	(10,665)	(13,100)	(15,740)
Payment of taxes related to an exchange of common stock	(576)	(866)
Net cash provided by (used in) financing activities	(98,435)	(95,706)	33,533
Effect of exchange rates on cash	(801)	1,684	96
Net increase (decrease) in cash and cash equivalents	10,834	12,596	(23,039)
CASH AND CASH EQUIVALENTS:
Beginning of period	56,916	44,320	67,359
End of period	67,750	56,916	44,320
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Interest (net of capitalized interest of $480, $813 and $1,290, respectively)	5,261	10,077	12,434
Income taxes	8,828	8,918	12,069
SUPPLEMENTAL DISCLOSURES OF NON-CASH INVESTING AND FINANCING ACTIVITIES
Property and equipment purchases in accounts payable	2,558	2,180	7,952
Current note receivable converted to equity investment		899
Proceeds from sale of business in other receivables		321
Acquisition purchases in accrued expenses and other long-term obligations		4,358	10,541
Merit common stock surrendered (3, 39 and 3 shares, respectively) in exchange for exercise of stock options	180	1,467	93
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 1,524	$ 10,938	$ 10,637

CONSOLIDATED STATEMENTS OF CASH FLOWS (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement of Cash Flows [Abstract]
Net capitalized interest	$ 480	$ 813	$ 1,290
Shares surrendered in exchange for exercise of stock options (in shares)	3	39	3

Revenues

12 Months Ended

Dec. 31, 2021

Revenue from Contract with Customer [Abstract]

Revenues

2.REVENUES

Disaggregation of Revenue. Our revenue is disaggregated based on reporting segment, product category and geographical region.

We design, develop, manufacture and market medical products for interventional and diagnostic procedures. For financial reporting purposes, we report our operations in two operating segments: cardiovascular and endoscopy. Our cardiovascular segment consists of four product categories: peripheral intervention, cardiac intervention, custom procedural solutions, and OEM. Within these product categories, we sell a variety of products, including cardiology and radiology devices (which assist in diagnosing and treating coronary arterial disease, peripheral vascular disease and other non-vascular diseases), as well as embolotherapeutic, cardiac rhythm management, electrophysiology, critical care, breast cancer localization and guidance, biopsy, and interventional oncology and spine devices. Our endoscopy segment consists of gastroenterology and pulmonology devices which assist in the palliative treatment of expanding esophageal, tracheobronchial and biliary strictures caused by malignant tumors.

The following table presents sales by operating segment disaggregated based on product category and geographic region for the years ended December 31, 2021, 2020 and 2019 (in thousands).


	Year Ended						Year Ended						Year Ended
	December 31, 2021						December 31, 2020						December 31, 2019
	United States		International		Total		United States		International		Total		United States		International		Total
Cardiovascular
Peripheral Intervention	$	244,459	$	160,657	$	405,116	$	211,999	$	129,569	$	341,568	$	226,788	$	124,148	$	350,936
Cardiac Intervention		122,452		198,189		320,641		108,109		171,562		279,671		115,604		189,193		304,797
Custom Procedural Solutions		108,068		85,874		193,942		110,269		92,927		203,196		99,659		87,700		187,359
OEM		104,436		19,092		123,528		91,826		17,941		109,767		101,065		16,824		117,889
Total		579,415		463,812		1,043,227		522,203		411,999		934,202		543,116		417,865		960,981

Endoscopy
Endoscopy devices		29,463		2,061		31,524		27,858		1,815		29,673		32,595		1,276		33,871

Total	$	608,878	$	465,873	$	1,074,751	$	550,061	$	413,814	$	963,875	$	575,711	$	419,141	$	994,852

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130556-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 9
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130550-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-SubTopic 10
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-Paragraph 12
-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 15
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130558-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

+ Details

Acquisitions and Other Strategic Transactions

12 Months Ended

Dec. 31, 2021

Business Combinations [Abstract]

Acquisitions and Other Strategic Transactions

3.ACQUISITIONS AND OTHER STRATEGIC TRANSACTIONS

2021 Acquisitions

During September 2021, we paid $2.7 million to acquire series A preferred shares of Fluidx Medical Technology, Inc. ("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. We had previously purchased $2 million of participating preferred shares during 2019. Our investment 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 15.0% of the outstanding stock.

2020 Acquisitions

On November 6, 2020, we entered into a unit purchase agreement to acquire KA Medical, LLC (“KA Medical”). Subject to the terms and conditions of the unit purchase agreement, we paid $14.6 million in cash, net of cash acquired, including adjustments for working capital and deferred payments of $4 million. KA Medical developed the Micro Plug Set, a self-expanding nitinol vascular occlusion device, which is FDA-cleared and CE marked. We accounted for this acquisition as a business combination. 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 for the years ended December 31, 2021 and 2020. Acquisition-related costs associated with the KA Medical acquisition, which were included in selling, general and administrative expenses, were not material. During the fourth quarter of 2021, certain immaterial measurement period adjustments were recorded to our purchase price allocation. The purchase price was allocated as follows (in thousands):


Assets Acquired
Trade receivables	$	24
Other receivables		13
Inventories		211
Property and equipment		298
Other long-term assets		10
Intangible assets
Developed technology		6,000
Goodwill		8,570
Total assets acquired		15,126

Liabilities Assumed
Trade payables		(31)
Accrued expenses		(507)
Total liabilities assumed		(538)

Total net assets acquired	$	14,588

We are amortizing the developed technology intangible asset acquired from KA Medical over 17 years. The goodwill consists largely of the synergies expected from combining operations and is expected to be deductible for income tax purposes. We do not deem the pro forma effects to our consolidated results of operations of the KA Medical acquisition to be material.

2019 Acquisitions

On October 11, 2019, we entered into a subscription and shareholders’ agreement to acquire 3,900 ordinary shares and 1,365 C ordinary shares of Selio Medical Limited ("Selio"), an option to purchase all ordinary shares in Selio throughout a 45-day period commencing from the date Selio receives FDA Section 510(k) approval of a medical device it is currently developing, and an option to purchase all remaining shares on the third anniversary date of the agreement if we elect to purchase all ordinary shares. The shares of stock we acquired, which represent an ownership interest of 19.5%, have been recorded as an equity investment accounted for at cost because we are not able to exercise significant influence over the operations of Selio. The investment and purchase option of $2.6 million are reflected within other assets in the accompanying consolidated balance sheets. In addition, we have loans to Selio of $2.5 million, reflected within other assets, including funding of an additional loan commitment of €2 million during the year ended December 31, 2021. Amounts outstanding under the loans accrue interest at a rate of 5% per annum. All amounts outstanding under the loans become due and payable at the first anniversary of the expiration of our option to purchase all ordinary shares.

On August 1, 2019, we entered into a share purchase agreement to acquire Fibrovein Holdings Limited, which is the owner of 100% of the capital stock of STD Pharmaceutical Products Limited, a UK private company engaged in the manufacture, distribution and sale of pharmaceutical sclerotherapy products (“STD Pharmaceutical”). The purchase consideration consisted of an upfront payment of $13.7 million, net of cash acquired. We also recorded a contingent consideration

liability of $934,000 related to royalties potentially payable pursuant to the terms of the share purchase agreement. We accounted for this acquisition as a business combination.

On June 14, 2019, we consummated an acquisition transaction contemplated by a merger agreement to acquire Brightwater Medical, Inc. ("Brightwater"). The purchase consideration consisted of an upfront payment of $35 million plus an immaterial working capital adjustment, net of cash acquired, with potential earn-out payments of up to an additional $5 million for achievement of CE certification with respect to the ConvertX®, a single-use device used to replace a series of devices and procedures used to treat severe obstructions of the ureter, and up to an additional $10 million for the achievement of sales milestones specified in the merger agreement. The ConvertX device is designed to be implanted once and converted from a nephroureteral catheter to a nephroureteral stent without requiring sedation or local anesthesia. Brightwater recently received FDA clearance for the ConvertX biliary stent device. We accounted for this acquisition as a business combination.

The following table summarizes the purchase price allocation and other disclosures for acquisitions accounted for as business combinations during the year ended December 31, 2019 (in thousands). During the year ended December 31, 2020, certain non-significant measurement period adjustments were recorded to our purchase price allocation for the assets acquired from Brightwater, including reassessment of tax assets and liabilities.


	STD Pharmaceutical		Brightwater
Assets Acquired
Trade receivables	$	277	$	55
Inventories		843		349
Prepaid expenses and other current assets		49		—
Property and equipment		—		409
Other long-term assets		—		30
Intangible assets
Developed technology		10,428		31,960
Customer lists		—		83
Trademarks		—		250
Goodwill		4,975		17,607
Total assets acquired		16,572		50,743

Liabilities Assumed
Trade payables		(53)		(58)
Accrued expenses		(29)		(261)
Other long-term obligations		—		(1,522)
Deferred income tax liabilities		(1,890)		(4,263)
Total liabilities assumed		(1,972)		(6,104)

Total net assets acquired	$	14,600	$	44,639

Amortization Period of Intangible Assets
Developed technology		12 years		13 years
Customer lists (on an accelerated basis)		—		1 year
Trademarks		—		5 years
Weighted Average		12 years		12.9 years

The sales and results of operations related to the STD Pharmaceutical and Brightwater acquisitions have been included in our cardiovascular segment and were not material for the years ended December 31, 2021, 2020 and 2019. It is not practical to separately report earnings related to these acquisitions, as we cannot split out sales costs related solely to the products acquired, principally because our sales representatives sell multiple products within our cardiovascular business segment. Acquisition costs related to the STD Pharmaceutical and Brightwater acquisitions, which were included in selling, general and administrative expenses, were not material. Goodwill related to these acquisitions arises principally from synergies and economies of scale anticipated upon consolidation of operations and is not expected to be deductible for income tax

purposes. We do not deem the pro forma effects to our consolidated results of operations of the STD Pharmaceutical and Brightwater acquisitions to be material.

Inventories

12 Months Ended

Dec. 31, 2021

Inventory Disclosure [Abstract]

Inventories

4.INVENTORIES

Inventories at December 31, 2021 and 2020, consisted of the following (in thousands):


	2021		2020
Finished goods	$	132,403	$	110,933
Work-in-process		22,160		19,308
Raw materials		67,359		67,778
Total inventories	$	221,922	$	198,019

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

5.GOODWILL AND INTANGIBLE ASSETS

The changes in the carrying amount of goodwill for the years ended December 31, 2021 and 2020, are as follows (in thousands):


	2021		2020
Goodwill balance at January 1	$	363,533	$	353,193
Effect of foreign exchange		(2,078)		1,941
Additions and adjustments as the result of acquisitions		286		8,399
Goodwill balance at December 31	$	361,741	$	363,533

Total accumulated goodwill impairment losses aggregated to $8.3 million as of December 31, 2021 and 2020. We did not have any goodwill impairments for the years ended December 31, 2021, 2020 and 2019. The total goodwill balance as of December 31, 2021 and 2020 is related to our cardiovascular segment.

Other intangible assets at December 31, 2021 and 2020, consisted of the following (in thousands):


	December 31, 2021
	Gross Carrying		Accumulated		Net Carrying
	Amount		Amortization		Amount
Patents	$	26,349	$	(8,315)	$	18,034
Distribution agreements		3,250		(2,519)		731
License agreements		12,663		(7,768)		4,895
Trademarks		30,242		(15,256)		14,986
Customer lists		34,985		(31,195)		3,790
Total	$	107,489	$	(65,053)	$	42,436


	December 31, 2020
	Gross Carrying		Accumulated		Net Carrying
	Amount		Amortization		Amount
Patents	$	23,669	$	(6,460)	$	17,209
Distribution agreements		3,250		(2,319)		931
License agreements		14,453		(6,647)		7,806
Trademarks		30,273		(12,414)		17,859
Customer lists		35,154		(29,103)		6,051
Total	$	106,799	$	(56,943)	$	49,856

Aggregate amortization expense for the years ended December 31, 2021, 2020 and 2019 was $49.6 million, $58.6 million and $60.7 million, respectively.

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of December 31, 2021 (in thousands):


Year Ending December 31,	Estimated Amortization Expense
2022	$	48,195
2023		47,101
2024		44,165
2025		42,396
2026		31,843

During the years ended December 31, 2021, 2020 and 2019, we identified indicators of impairment associated with certain acquired intangible assets based on our qualitative assessment that carrying amounts may not be recoverable, which required us to then complete a quantitative impairment assessment. The primary indicators of impairment were planned closure and restructuring activities and uncertainty about future product development and commercialization associated with certain acquired technologies, due in part to the economic impacts of the COVID-19 pandemic in 2021 and 2020.

During the year ended December 31, 2021, we recorded total impairment charges related to our intangible assets of $1.6 million for the remaining carrying value of ArraVasc license agreements.

During the year ended December 31, 2020, we recorded total impairment charges related to our intangible assets of $28.7 million which included a partial impairment charge of $8.2 million of intangible assets from our acquisition of STD Pharmaceutical, a partial impairment charge of $8.0 million of intangible assets from our acquisition of certain assets from Laurane Medical S.A.S, a partial impairment charge of $4.8 million related to our license agreements with ArraVasc Limited, and other intangible asset impairments charges of $7.7 million related to intangible assets from our acquisition of certain assets from DirectACCESS Medical, LLC, in-process technology intangible assets of Sontina Medical LLC acquired in connection with our acquisition of certain divested assets from Becton, Dickinson and Company, and a customer list intangible asset from our acquisition of ITL Healthcare Pty Ltd (“ITL”).

During the year ended December 31, 2019, we recorded impairment charges related to our amortizing intangible assets from our acquisitions of certain assets from Distal Access, LLC, Lazarus Medical Technologies, LLC, and Pleuratech ApS for a total of $3.3 million. The impairment charges recorded in 2021, 2020, and 2019 all pertained to our cardiovascular segment and are reflected within impairment charges in our consolidated statements of income (loss).

Income Taxes

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Income Taxes

6.INCOME TAXES

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) was signed into law. The $2.2 trillion economic stimulus bill contains numerous tax law changes. We evaluated the tax changes to determine what provisions would apply to us. As permitted by the CARES Act, we have deferred payment of the employer’s portion of social security payroll tax payments and made a payment equal to one half of the deferred amount during the year ended December 31, 2021.

For the years ended December 31, 2021, 2020 and 2019, income (loss) before income taxes is broken out between U.S. and foreign-sourced operations and consisted of the following (in thousands):


	2021		2020		2019
Domestic	$	21,328	$	(32,216)	$	(37,277)
Foreign		32,589		18,985		39,470
Total	$	53,917	$	(13,231)	$	2,193

The components of the provision for income taxes for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Current expense (benefit):
Federal	$	808	$	(937)	$	479
State		806		437		662
Foreign		8,480		8,407		8,037
Total current expense (benefit)		10,094		7,907		9,178

Deferred expense (benefit):
Federal		(468)		(2,688)		(8,111)
State		(1,845)		(4,524)		(3,523)
Foreign		(2,318)		(4,083)		(802)
Total deferred expense (benefit)		(4,631)		(11,295)		(12,436)

Total income tax expense (benefit)	$	5,463	$	(3,388)	$	(3,258)

The difference between the income tax expense (benefit) reported and amounts computed by applying the statutory federal rate of 21.0% to pretax income (loss) for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020⁽¹⁾		2019⁽¹⁾
Computed federal income tax expense (benefit) at applicable statutory rate of 21%	$	11,323	$	(2,778)	$	461
State income tax benefit		(283)		(1,448)		(2,241)
Tax credits		(2,507)		(2,391)		(1,064)
Tax effect of international items		(281)		4,705		1,325
Uncertain tax positions		401		(455)		(574)
Deferred compensation insurance assets		(413)		(290)		(493)
Stock-based compensation		(5,571)		(1,822)		(1,659)
Valuation allowance		—		1,257		—
DOJ settlement		—		1,890		—
Remeasurement of state deferred taxes		(526)		(1,765)		—
Non-deductible expenses		2,455		1,077		1,320
Remeasurement of contingent consideration liabilities		733		(1,185)		(87)
Other — including the effect of graduated rates		132		(183)		(246)
Total income tax expense (benefit)	$	5,463	$	(3,388)	$	(3,258)

(1) Amounts for the years ended December 31, 2020 and 2019 in the table above have been updated for presentation and comparative purposes

Deferred income tax assets and liabilities at December 31, 2021 and 2020, consisted of the following temporary differences and carry-forward items (in thousands):


	2021		2020 ⁽¹⁾
Deferred income tax assets:
Allowance for credit losses on trade receivables	$	1,494	$	1,198
Accrued compensation expense		11,063		9,694
Inventory differences		4,887		3,161
Net operating loss carryforwards		14,833		18,622
Stock-based compensation expense		6,388		7,360
Operating lease assets		13,431		15,182
Federal R&D tax credit		5,003		3,607
UT R&D Credit		4,126		3,484
Other		9,939		11,126
Total deferred income tax assets		71,164		73,434

Deferred income tax liabilities:
Prepaid expenses		(1,047)		(1,078)
Property and equipment		(20,797)		(20,671)
Intangible assets		(42,888)		(47,178)
Foreign withholding tax		(5,575)		(5,358)
Operating lease liabilities		(11,938)		(13,855)
Other		(3,556)		(3,796)
Total deferred income tax liabilities		(85,801)		(91,936)
Valuation allowance		(10,786)		(10,213)
Net deferred income tax liabilities	$	(25,423)	$	(28,715)

Reported as:
Deferred income tax assets	$	6,080	$	4,597
Deferred income tax liabilities		(31,503)		(33,312)
Net deferred income tax liabilities	$	(25,423)	$	(28,715)

(1)

Amounts for the year ended December 31, 2020 in the table above have been updated for presentation and comparative purposes

Deferred tax assets and liabilities are netted on the balance sheet by separate tax jurisdictions. Deferred income tax balances reflect the temporary differences between the carrying amounts of assets and liabilities and their tax basis and are stated at enacted tax rates expected to be in effect when taxes are actually paid or recovered. The valuation allowance is primarily related to state credit carryforwards, non-US net operating loss carryforwards, and capital loss carryforwards for which we believe it is more likely than not that the deferred tax assets will not be realized. The valuation allowance increased by $573,000 during the year ended December 31, 2021, increased by $5.6 million during the year ended December 31, 2020, and decreased by $345,000 during the year ended December 31, 2019.

As of December 31, 2021, we had U.S federal net operating loss carryforwards of $45.6 million, which were generated by Cianna Medical, Vascular Access Technologies, Inc., DFINE Inc., Biosphere Medical, Inc., and Brightwater prior to our acquisition of these companies. These net operating loss carryforwards are subject to annual limitations under Internal Revenue Code Section 382. If unused $34.5 million of the NOLs will expire between 2025 and 2037. Of the NOLs incurred post-2017, $11.1 million can be carried forward indefinitely. We anticipate that we will utilize all current net operating loss carryforwards prior to their expiration dates over the next 14 years. We utilized a total of $21.3 million in U.S. federal net operating loss carryforwards during the year ended December 31, 2021.

As of December 31, 2021, we had $22.8 million of non-U.S. net operating loss carryforwards, of which $21.9 million have no expiration date and $879,000 expire at various dates through 2030. Non-U.S. net operating loss carryforwards utilized during the year ended December 31, 2021 were not material.

We do not consider our foreign earnings to be permanently reinvested. Consequently, we have recorded tax expense of $288,000, $228,000 and $638,000 for foreign withholding taxes on unremitted foreign earnings during the years ended December 31, 2021, 2020 and 2019, respectively.

We are subject to income taxes in the U.S. and numerous foreign jurisdictions. Significant judgment is required in determining our worldwide provision for income taxes and recording the related assets and liabilities. In the ordinary course of our business, there are many transactions and calculations where the ultimate tax determination is uncertain. In our opinion, we have made adequate provisions for income taxes for all years subject to audit. We are no longer subject to U.S. federal, state, and local income tax examinations by tax authorities for years before 2018. In foreign jurisdictions, we are no longer subject to income tax examinations for years before 2015.

Although we believe our estimates are reasonable, the final outcomes of these matters may be different from those which we have reflected in our historical income tax provisions and accruals. Such differences could have a material effect on our income tax provision and operating results in the period in which we make such determination.

The total liability for unrecognized tax benefits at December 31, 2021, including interest and penalties, was $2.0 million, of which $2.0 million would favorably impact our effective tax rate if recognized. At December 31, 2021, $1.0 million of the total liability was presented as a reduction to non-current deferred income tax assets on our consolidated balance sheet. The total liability for unrecognized tax benefits at December 31, 2020, including interest and penalties, was $2.0 million, of which $1.6 million would favorably impact our effective tax rate if recognized. At December 31,2020, $627,000 of the total liability was presented as a reduction to non-current deferred income tax assets on our consolidated balance sheet. As of December 31, 2021 and 2020, we had accrued $322,000 and $276,000 respectively, in total interest and penalties related to unrecognized tax benefits. We account for interest and penalties for unrecognized tax benefits as part of our income tax provision. During the years ended December 31, 2021, 2020 and 2019, our liability for unrecognized tax benefit was increased (decreased) for interest and penalties by $46,000, ($90,000), and ($7,000), respectively. It is reasonably possible that within the next 12 months the total liability for unrecognized tax benefits may change, net of potential decreases due to the expiration of statutes of limitation, up to $86,000.

A reconciliation of the beginning and ending amount of liabilities associated with uncertain tax benefits for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Unrecognized tax benefits, opening balance	$	1,674	$	2,161	$	2,947
Gross increases (decreases) in tax positions taken in a prior year		82		115		(244)
Gross increases in tax positions taken in the current year		316		283		229
Lapse of applicable statute of limitations		(437)		(885)		(771)
Unrecognized tax benefits, ending balance	$	1,635	$	1,674	$	2,161

The tabular roll-forward ending balance does not include interest and penalties related to unrecognized tax benefits.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

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+ Details

Accrued Expenses

12 Months Ended

Dec. 31, 2021

Payables and Accruals [Abstract]

Accrued Expenses

7.ACCRUED EXPENSES

Accrued expenses at December 31, 2021 and 2020, consisted of the following (in thousands):


	2021		2020
Payroll and related liabilities	$	59,435	$	41,023
Current portion of contingent liabilities		34,735		18,833
Advances from employees		201		259
Accrued rebates payable		11,271		9,532
Accrued legal settlement		18,250		—
Other accrued expenses		35,122		42,297

Total	$	159,014	$	111,944

Revolving Credit Facility and Long-Term Debt

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Revolving Credit Facility and Long-Term Debt

8.REVOLVING CREDIT FACILITY AND LONG-TERM DEBT

Principal balances outstanding under our long-term debt obligations as of December 31, 2021 and 2020, consisted of the following (in thousands):


	2021		2020
Term loans	$	133,125	$	140,625
Revolving credit loans		110,000		211,000
Less unamortized debt issuance costs		(290)		(403)
Total long-term debt		242,835		351,222
Less current portion		8,438		7,500
Long-term portion	$	234,397	$	343,722

Third Amended and Restated Credit Agreement

On July 31, 2019, we entered into a Third Amended and Restated Credit Agreement (the "Third Amended Credit Agreement"). The Third Amended Credit Agreement is a syndicated loan agreement with Wells Fargo Bank, National Association and other parties. The Third Amended Credit Agreement amends and restates in its entirety our previously outstanding Second Amended and Restated Credit Agreement and all amendments thereto. The Third Amended Credit Agreement provides for a term loan of $150 million and a revolving credit commitment up to an aggregate amount of $600 million, inclusive of sub-facilities for multicurrency borrowings, standby letters of credit and swingline loans. On July 31, 2024, all principal, interest and other amounts outstanding under the Third Amended Credit Agreement are payable in full. At any time prior to the maturity date, we may repay any amounts owing under all term loans and revolving credit loans in whole or in part, without premium or penalty, other than breakage fees (as defined in the Third Amended Credit Agreement).

Revolving credit loans denominated in dollars and term loans made under the Third Amended Credit Agreement bear interest, at our election, at either the Base Rate or the Eurocurrency Rate (as such terms are defined in the Third Amended Credit Agreement) plus the Applicable Margin (as defined in the Third Amended Credit Agreement). Revolving credit loans denominated in an Alternative Currency (as defined in the Third 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 (as defined in the Third Amended Credit Agreement). Interest on each loan featuring the Base Rate is due and payable on the last business day of each calendar quarter; interest on each loan featuring the Eurocurrency Rate is due and payable on the last day of each interest period applicable thereto, and if such interest period extends over three months, at the end of each three-month interval during such interest period.

The Third Amended Credit Agreement is collateralized by substantially all of our assets. The Third Amended Credit Agreement contains affirmative and negative covenants, representations and warranties, events of default and other terms

customary for loans of this nature. In particular, the Third Amended Credit Agreement requires that we maintain certain financial covenants, as follows:


	Covenant Requirement
Consolidated Total Leverage Ratio ⁽¹⁾		4.0 to 1.0
Consolidated Interest Coverage Ratio ⁽²⁾		3.0 to 1.0
Facility Capital Expenditures ⁽³⁾		$50 million

(1)	Maximum Consolidated Total Net Leverage Ratio (as defined in the Third Amended Credit Agreement) as of any fiscal quarter end.

(2)	Minimum ratio of Consolidated EBITDA (as defined in the Third Amended Credit Agreement and adjusted for certain expenditures) to Consolidated interest expense (as defined in the Third Amended Credit Agreement) for any period of four consecutive fiscal quarters.

(3)	Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Third Amended Credit Agreement) in any fiscal year.

As of December 31, 2021, we believe we were in compliance with all covenants set forth in the Third Amended Credit Agreement.

As of December 31, 2021, we had outstanding borrowings of $243.1 million and issued letter of credit guarantees of $3.5 million under the Third Amended Credit Agreement, with additional available borrowings of approximately $490 million, based on the leverage ratio required pursuant to the Third Amended Credit Agreement. Our interest rate as of December 31, 2021 was a fixed rate of 2.71% on $75 million as a result of an interest rate swap (see Note 9) and a variable floating rate of 1.10% on $168.1 million. Our interest rate as of December 31, 2020 was a fixed rate of 2.37% on $175 million as a result of an interest rate swap and a variable floating rate of 1.40% on $176.6 million. The foregoing fixed rates are exclusive of potential future changes in the applicable margin.

Certain of the interest rates applicable to our Third Amended Credit Agreement, and applicable to hedging instruments we have purchased to offset interest rate risk under our Third Amended Credit Agreement, are LIBOR-based. We anticipate replacement rates will be identified, as provided for in our Third Amended Credit Agreement, as LIBOR-based rates become unavailable.

Future Payments

Future minimum principal payments on our long-term debt as of December 31, 2021, are as follows (in thousands):


Years Ending	Future Minimum
December 31,	Principal Payments
2022	$	8,438
2023		11,250
2024		223,437
Total future minimum principal payments	$	243,125

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

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+ Details

Derivatives

12 Months Ended

Dec. 31, 2021

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Derivatives

9.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 programs 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. For qualifying hedges, the change in fair value is deferred in accumulated other comprehensive income (loss) (“AOCI”), a component of stockholders’ equity in the accompanying consolidated balance sheets, and recognized in earnings at the same time the hedged item 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. 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 Third Amended Credit Agreement that is solely due to changes in the benchmark interest rate.

Derivatives 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 Bank to fix the one-month LIBOR rate at 1.12%. The variable portion of the interest rate swap was tied to the one-month LIBOR rate (the benchmark interest rate). The interest rate swap expired on July 6, 2021.

On December 23, 2019, we entered into a pay-fixed, receive-variable interest rate swap with a notional amount of $75 million with Wells Fargo Bank to fix the one-month LIBOR rate at 1.71% for the period from July 6, 2021 to July 31, 2024. 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.

At December 31, 2021 and 2020, our interest rate swaps qualified as cash flow hedges. The fair value of our interest rate swap at December 31, 2021 was a liability of $1.4 million, partially offset by $0.4 million in deferred taxes. The fair value of our interest rate swaps at December 31, 2020 was a liability of $4.4 million, partially offset by $1.1 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 exposed to foreign currency exchange rate risk with respect to transactions and balances denominated in Chinese Renminbi, Euros, British Pounds, Mexican Pesos, Brazilian Reals, Australian Dollars, Hong Kong Dollars, Swiss Francs, Swedish Krona, Canadian Dollars, Danish Krone, Japanese Yen, and South Korean Won, among others. 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.

Derivatives Designated as Cash Flow Hedges

For derivative instruments that are designated and qualify as cash flow hedges, the gain or loss on the derivative instrument is temporarily reported as a component of other comprehensive income (loss) and then 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. We entered 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 foreign currencies.

We enter into approximately 100 cash flow foreign currency hedges every month. As of December 31, 2021 and 2020, we had entered into foreign currency forward contracts, which qualified as cash flow hedges, with aggregate notional amounts of $123.0 million and $168.2 million, respectively.

Derivatives 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 50 foreign currency fair value hedges every month. As of December 31, 2021 and 2020, we had entered into foreign currency forward contracts related to those balance sheet accounts with aggregate notional amounts of $86.0 million and $74.8 million, respectively.

Balance Sheet Presentation of Derivatives. As of December 31, 2021 and 2020, all derivatives, 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 is as follows (in thousands):



Fair Value of Derivative Instruments Designated as Hedging Instruments	Balance Sheet Location	December 31, 2021		December 31, 2020
Assets
Foreign currency forward contracts	Prepaid expenses and other assets	$	1,326	$	1,777
Foreign currency forward contracts	Other assets (long-term)		179		424

(Liabilities)
Interest rate swaps	Accrued expenses		—		(896)
Interest rate swaps	Other long-term obligations		(1,447)		(3,462)
Foreign currency forward contracts	Accrued expenses		(2,288)		(5,281)
Foreign currency forward contracts	Other long-term obligations		(502)		(866)

Fair Value of Derivative Instruments Not Designated as Hedging Instruments	Balance Sheet Location	December 31, 2021		December 31, 2020
Assets
Foreign currency forward contracts	Prepaid expenses and other assets	$	736	$	877

(Liabilities)
Foreign currency forward contracts	Accrued expenses		(856)		(2,120)

Income Statement Presentation of Derivatives

Derivatives Designated as Cash Flow Hedges

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


	Amount of Gain/(Loss)
	Recognized in OCI
	Year Ended December 31,
Derivative instrument	2021		2020		2019
Interest rate swaps	$	1,402	$	(6,131)	$	(2,830)
Foreign currency forward contracts		(1,521)		(5,516)		(587)

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


	Consolidated Statements						Amount of Gain/(Loss)
	of Income (Loss)						reclassified from AOCI
	Year Ended December 31,						Year ended December 31,
Location in statements of income	2021			2020	2019		2021		2020		2019
Interest expense	$	(5,261)	$	(9,994)	$	(12,413)	$	(1,509)	$	(872)	$	2,040
Revenue		1,074,751		963,875		994,852		(5,592)		36		577
Cost of sales		(589,418)		(562,698)		(562,486)		1,017		(1,288)		(578)

All other amounts included in earnings related to designated cash flow hedges are immaterial.

As of December 31, 2021, ($1.4) million or ($1.0) million after taxes, was expected to be reclassified from AOCI to earnings in revenue and cost of sales over the succeeding twelve months. As of December 31, 2021, ($1.0) million, or ($0.7) million after taxes, was expected to be reclassified from AOCI to earnings in interest expense over the succeeding twelve months.

Derivatives Not Designated as Hedging Instruments

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


		Year ended December 31,
Derivative Instrument	Location in statements of income (loss)	2021		2020		2019
Foreign currency forward contracts	Other income (expense)	$	(1,598)	$	(2,190)	$	(307)

See Note 15 for additional information about our derivatives.

Commitments and Contingencies

12 Months Ended

Dec. 31, 2021

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

10.COMMITMENTS AND CONTINGENCIES

We are obligated under non-terminable operating leases for manufacturing facilities, finished good distribution centers, office space, equipment, vehicles, and land. See Note 17 for disclosures regarding these operating leases.

Royalties. As of December 31, 2021, we had entered into a number of agreements to license or acquire rights to certain intellectual property which require us to make royalty payments during the term of the agreements generally based on a percentage of sales. During the years ended December 31, 2021, 2020 and 2019, total royalty expense approximated $7.6 million, $7.1 million and $6.7 million, respectively. Minimum contractual commitments under royalty agreements to be paid within twelve months of December 31, 2021 were not significant. See Note 15 for discussion of future royalty commitments related to acquisitions.

Litigation. In the ordinary course of business, we are involved in various claims and litigation matters. These proceedings, actions and claims may involve product liability, intellectual property, contract disputes, employment, governmental inquiries or other matters, including those more fully described below. The outcomes of these matters will generally not be known for prolonged periods of time. In certain proceedings, the claimants may seek damages as well as other compensatory and equitable relief that could result in the payment of significant claims and settlements and/or the imposition of injunctions or other equitable relief. For legal matters for which our management had sufficient information to reasonably estimate our future obligations, a liability representing management’s best estimate of the probable loss, or the minimum of the range of probable losses when a best estimate within the range is not known, is recorded. The estimates are based on consultation with legal counsel, previous settlement experience and settlement strategies. If actual outcomes are less favorable than those estimated by management, additional expense may be incurred, which could unfavorably affect our financial position, results of operations and cash flows. The ultimate cost to us with respect to actions and claims

could be materially different than the amount of the current estimates and accruals and could have a material adverse effect on our financial position, results of operations and cash flows.

Securities Litigation

On December 5, 2019, the Bucks County Employees Retirement Fund filed a complaint against Merit, our Chief Executive Officer and our Chief Financial Officer in the United States District Court for the Central District of California (the “California Central District Court”), individually and on behalf of all purchasers of our common stock between February 26, 2019 and October 30, 2019. On February 24, 2020, the court appointed the City of Atlanta Police Pension Fund, the Atlanta Firefighters’ Pension Fund, and the Employees’ Retirement System of the City of Baton Rouge and Parish of East Baton Rouge as Lead Plaintiffs. This action is now captioned In re Merit Medical Systems, Inc. Securities Litigation (Master File No. 8:19-cv-02326-DOC-ADS). On June 30, 2020, Lead Plaintiffs filed a consolidated class action complaint for violations of federal securities laws against Merit, our Chief Executive Officer and our Chief Financial Officer in the California Central District Court, individually and on behalf of all purchasers of our common stock between February 26, 2019 and October 30, 2019. The consolidated class action complaint alleges that defendants violated Sections 10(b) and 20(a) of the Exchange Act and Rule 10b-5 promulgated thereunder, and seeks unspecified damages, costs and attorneys’ fees, and equitable relief.

In November 2021 we entered into an agreement in principle to settle the consolidated securities class action lawsuit. The proposed settlement calls for a payment of $18.25 million in resolution of all claims asserted against Merit and all other defendants. Approximately $8.2 million of the settlement payment is expected to be satisfied with proceeds of available insurance. The terms of the proposed settlement provide for a full release of all claims against all defendants, including Merit and its officers, and contain no admission of liability, wrongdoing or responsibility by any of the defendants. On January 3, 2022, the California Central District Court entered an Order Preliminarily Approving Settlement and Providing for Notice of the Settlement. The California Central District Court has scheduled a further settlement hearing for April 13, 2022, for the purpose of addressing objections raised to the settlement, if any. The settlement remains subject to final approval by the California Central District Court and is subject to the satisfaction of customary conditions. There can be no assurance that the final settlement agreement will be approved by the California Central District Court. A final, non-appealable closure of the litigation could take several months. It is possible that the ultimate resolution of the foregoing matter, 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.

Shareholder Derivative Action

On June 3, 2021, Steffen Maute filed a complaint, derivatively on behalf of Merit, against Merit (as a nominal defendant), our Chief Executive Officer, our Chief Financial Officer, our former President of Europe, Middle East and Africa (“EMEA,”) and certain of our directors in the United States District Court for the District of Utah (Case No. 2:21-cv-00346-DBP). The derivative complaint alleges that the individual defendants violated their fiduciary duties owed to Merit and were unjustly enriched at the expense of and to the detriment of Merit between February 2019 and October 2019, and seeks unspecified damages, costs, and professional fees. We intend to vigorously defend against the lawsuit. The proceeding was stayed until February 19, 2022, subject to the right of either party to seek to lift or extend the stay. We have not received an indication of plaintiff’s intentions subsequent to the expiration of the stay, although the parties have engaged in mediation in an attempt to resolve the dispute. We have not recorded an expense related to this matter because any potential loss is not reasonably estimable. Additionally, we cannot presently estimate the range of loss, if any, that may result from the matter. It is possible that the ultimate resolution of the foregoing matter, 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.

DOJ Settlement

In addition to the foregoing matters, on October 13, 2020, we entered into a Settlement Agreement with the United States Department of Justice (“DOJ”) to resolve the DOJ’s investigation into past marketing and promotional practices of the Company. Under the Settlement Agreement, we agreed to pay settlement payments in the aggregate of $18 million plus interest and enter into a Corporate Integrity Agreement with the U.S. Office of Inspector General. In total, we paid $18.7

million in settlement payments, interest and additional expenses associated with the Settlement Agreement, including fees paid to settle claims of the relator’s counsel. Our failure to comply with the obligations of the Settlement Agreement or Corporate Integrity Agreement could result in monetary penalties and our exclusion from federal health care programs. In the event of unexpected further developments, it is possible that the ultimate outcome 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.

Earnings Per Common Share (EPS)

12 Months Ended

Dec. 31, 2021

Earnings Per Share, Basic and Diluted [Abstract]

Earnings Per Common Share (EPS)

11.EARNINGS PER COMMON SHARE (EPS)

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




	2021		2020		2019
Net income (loss)	$	48,454	$	(9,843)	$	5,451
Average common shares outstanding		56,145		55,434		55,075
Basic EPS	$	0.86	$	(0.18)	$	0.10

Average common shares outstanding		56,145		55,434		55,075
Effect of dilutive stock awards		1,214		—		1,160
Total potential shares outstanding		57,359		55,434		56,235
Diluted EPS	$	0.84	$	(0.18)	$	0.10

Equity awards excluded as the impact was anti-dilutive ⁽¹⁾		799		4,216		1,750

(1)	Does not reflect the impact of incremental repurchases under the treasury stock method.

Employee Stock Purchase Plan, Stock Options and Warrants

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [Abstract]

Employee Stock Purchase Plan, Stock Options and Warrants

12.EMPLOYEE STOCK PURCHASE PLAN, STOCK OPTIONS AND WARRANTS.

Our stock-based compensation primarily consists of the following plans:

2018 Long-Term Incentive Plan. In June 2018, our Board of Directors adopted and our shareholders approved, the Merit Medical Systems, Inc. 2018 Long-Term Incentive Plan, which was subsequently amended effective December 14, 2018 (the “2018 Incentive Plan”) to supplement the Merit Medical Systems, Inc. 2006 Long-Term Incentive plan (the "2006 Incentive Plan"). The 2018 Incentive Plan provides for the granting of stock options, stock appreciation rights, restricted stock, stock units (including restricted stock units) and performance awards (including performance stock units). Options may be granted to directors, officers, outside consultants and key employees and may be granted upon such terms and such conditions as the Compensation Committee of our Board of Directors determines. Options typically vest on an annual basis over a three to five-year life with a contractual life of seven years. At our annual meeting, held June 17, 2021, our shareholders approved the addition of 3,000,000 shares to the 2018 Incentive Plan. As of December 31, 2021, a total of 3,205,529 shares remained available to be issued under the 2018 Incentive Plan.

2006 Long-Term Incentive Plan. In May 2006, our Board of Directors adopted, and our shareholders approved, the 2006 Incentive Plan. As of December 31, 2021, the 2006 Incentive Plan was no longer being used for new equity award grants. However, as of December 31, 2021, options granted under this plan were still outstanding, vesting, and being exercised and will continue to be outstanding until the vesting periods end and the terms of the equity awards expire.

Employee Stock Purchase Plan. We have a non-qualified Employee Stock Purchase Plan (“ESPP”), which has an expiration date of June 30, 2026. At our annual meeting, held June 17, 2021, our shareholders approved the addition of 100,000 shares to our ESPP. As of December 31, 2021, the total number of shares of common stock that remained available

to be issued under our non-qualified plan was 121,959 shares. ESPP participants purchase shares on a quarterly basis at a price equal to 95% of the market price of the common stock at the end of the applicable offering period.

Stock-Based Compensation Expense. The stock-based compensation expense before income tax expense for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Cost of sales
Nonqualified stock options	$	1,476	$	1,357	$	1,289
Research and development
Nonqualified stock options		1,343		1,157		961
Selling, general and administrative
Nonqualified stock options		6,678		7,332		7,132
Performance-based restricted stock units		3,525		2,829		—
Restricted stock units		1,557		758		—
Cash-settled performance-based share-based awards ("Liability Awards")		1,511		906		—
Total selling, general and administrative		13,271		11,825		7,132

Stock-based compensation expense before taxes	$	16,090	$	14,339	$	9,382

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.

Nonqualified Stock Options

As of December 31, 2021, the total remaining unrecognized compensation cost related to non-vested stock options, net of expected forfeitures, was $26.5 million and is expected to be recognized over a weighted average period of 2.5 years.

In applying the Black-Scholes methodology to the option grants, the fair value of our stock-based awards granted were estimated using the following assumptions for the years ended December 31, 2021, 2020 and 2019:


	2021	2020	2019
Risk-free interest rate	0.5% - 1.1%	0.3% - 1.7%	1.4% - 2.6%
Expected option term	4.0 years	4.0 - 5.0 years	3.0 - 5.0 years
Expected dividend yield	—	—	—
Expected price volatility	46.1% - 46.7%	38.7% - 45.1%	28.7% - 39.4%

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 option. We determine the expected term of the stock options using the historical exercise behavior of employees. The expected price volatility was determined based upon the historical volatility for our stock. We recognize compensation expense for options on a straight-line basis over the service period, which corresponds to the vesting period. During the years ended December 31, 2021, 2020 and 2019, approximately 716,000, 329,000 and 1.2 million nonqualified stock option grants were made, respectively, for a total fair value of $17.5 million, $4.5 million and $20.9 million.

The table below presents information related to stock option activity for the years ended December 31, 2021, 2020 and 2019 (in thousands):


	2021		2020		2019
Total intrinsic value of stock options exercised	$	36,086	$	11,733	$	9,910
Cash received from stock option exercises		20,194		5,481		4,837
Excess tax benefit from the exercise of stock options		5,571		1,815		1,654

Changes in stock options for the year ended December 31, 2021, consisted of the following (shares and intrinsic value in thousands):


	Number	Weighted Average		Remaining Contractual	Intrinsic
	of Shares	Exercise Price		Term (in years)	Value
Beginning balance	3,942	$	35.98
Granted	716		66.60
Exercised	(883)		23.08
Forfeited/expired	(135)		47.60
Outstanding at December 31	3,640		44.70	3.90	$	67,868
Exercisable	1,762		35.86	2.80		46,601
Ending vested and expected to vest	3,537		44.32	3.85		67,063

The weighted average grant-date fair value of options granted during the years ended December 31, 2021, 2020 and 2019 was $24.38, $13.70 and $16.78, respectively.

Stock-Settled Performance-Based Restricted Stock Units (“PSUs”) and Time-Vested Restricted Stock Units (“RSUs”)

Since 2020 we have granted PSUs to certain of our executive officers. Conversion of PSUs occurs at the end of one, two and three-year performance periods, or one year after the agreement date, whichever is later. The conversion ratio is based upon attaining targeted levels of free cash flow (“FCF”) and relative shareholder return as compared to the Russell 2000 Index (“rTSR”), as defined in the award agreements. In 2020, our Board of Directors amended PSUs granted in 2020 with a one-year performance period to adjust the performance targets and reduce the maximum FCF multiplier to 100% for the one-year awards, which lowered the potential shares of our common stock to be granted pursuant to the one-year awards by 25,415 shares. We accounted for this amendment in accordance with ASC 718 as a “Type I” modification.

The payout for each PSU is equal to one share of common stock multiplied by a FCF multiplier (between 0% and 100% in the case of the 2020 one-year awards, as amended, or 0% and 200% in the case of all other PSU awards) and a rTSR multiplier (between 75% and 125%). PSUs convey no shareholder rights unless and until shares are issued in settlement of the award. We use Monte-Carlo simulations to estimate the grant-date fair value of the PSUs linked to total shareholder return. Compensation expense is recognized using the grant-date fair value for the number of shares that are probable of being awarded based on the performance conditions. Each reporting period, this probability assessment is updated, and cumulative catchups are recorded based on the level of FCF that is expected to be achieved. At the end of the performance period, cumulative expense is calculated based on the actual level of FCF achieved.

We grant RSUs to our non-employee directors, which are subject to continued service through the vesting date, which is one year from the date of grant. The expense recognized for RSUs is equal to the closing stock price on the date of grant, which is recognized over the vesting period.

Changes in PSUs and RSUs for the year ended December 31, 2021, consisted of the following:


	PSUs				RSUs
			Weighted Average			Weighted Average
	Stock Units		Grant Date		Stock Units	Grant Date
	(In Thousands)	⁽¹⁾	Fair Value		(In Thousands)	Fair Value
Beginning nonvested balance	102		$	43.63	34	$	42.98
Granted	103			61.39	26		61.77
rTSR adjustment	5	⁽²⁾		43.43	—		—
Vested	(26)			43.43	(34)		42.98
Forfeited	(21)			52.56	—		—
Nonvested balance at December 31	163			53.71	26		61.77

(1)

Based on the maximum payout, excluding the impact of the rTSR multiplier. The actual number of shares which vest is determined based on the satisfaction of performance conditions and the application of an rTSR multiplier between 75% and 125%.

(2)

Represents the application of an rTSR multiplier of 125% to awards vested in 2021 based on the performance of our common stock and the terms of the awards.

The following table summarizes PSUs and RSUs granted during the years ended December 31, 2021, 2020 and 2019 (units and shares in thousands):


	2021		2020			2019
PSUs
Target units granted		52		61			—
Maximum units granted ⁽¹⁾		103		102	⁽³⁾		—
Maximum potential shares⁽¹⁾⁽²⁾		129		127	⁽³⁾		—
Weighted average grant date fair value	$	61.39	$	43.63			N/A
RSUs
Units granted		26		34			—
Weighted average grant date fair value	$	61.77	$	42.98			N/A

(1)

Based on the maximum payout, excluding the impact of the rTSR multiplier.

(2)

Includes the impact of the maximum potential rTSR multiplier of 125%.

(3)

Includes the impact of the 2020 amendment which reduced the maximum FCF multiplier for one-year awards from 200% to 100%.

During the year ended December 31, 2021, there were approximately 26,000 shares that vested under PSUs, prior to the reduction of shares withheld to satisfy tax withholding obligations. Vested shares were calculated based upon achievement of the maximum performance multiplier, as amended, of 100% and an rTSR multiplier of 125%. There were no shares that vested under PSUs during the years ended December 31, 2020 and 2019. During the year ended December 31, 2021 there were approximately 34,000 shares that vested under RSUs. There were no shares that vested under RSUs during the years ended December 31, 2020 and 2019.

The fair value of each PSU was estimated as of the grant date using the following assumptions for awards granted in the years ended December 31, 2021 and 2020:


	2021	2020
Risk-free interest rate	0.1% - 0.3%	1.1% - 1.3%
Performance period	1.8 - 2.8 years	0.8 - 2.8 years
Expected dividend yield	—	—
Expected price volatility	43.7% - 49.3%	40.2% - 56.1%

The risk-free interest rate of return was determined using the U.S. Treasury rate at the time of grant with a remaining term equal to the expected term of the award. The expected volatility was based on a weighted average volatility of our stock

price and the average volatility of our compensation peer group's volatilities. The expected dividend yield was assumed to be zero because, at the time of the grant, we had no plans to declare a dividend.

As of December 31, 2021, the total remaining unrecognized compensation cost related to stock-settled performance stock units and restricted stock units, net of expected forfeitures, was $4.4 million and $0.7 million, respectively, which is expected to be recognized over a weighted average period of 1.5 years and 0.5 years, respectively.

Cash-Settled Performance-Based Share-Based Awards (“Liability Awards”)

During the years ended December 31, 2021 and 2020, we granted liability awards to our Chief Executive Officer. These awards entitle him to cash payments equal to a total target cash incentive of $1.0 million and $1.0 million, respectively, multiplied by rTSR and FCF multipliers, as defined in the award agreements. In 2020, our Board of Directors amended the liability awards with a one-year performance period. The potential maximum payout of these liability awards is 125% of the target cash incentive for the 2020 one-year award, as amended, and 250% of the target cash incentive for all other liability awards, resulting in a total potential maximum payout of $2.5 million and $2.1 million for liability awards granted during the years ended December 31, 2021 and 2020, respectively. Settlement generally occurs at the end of one, two and three-year performance periods based upon the same performance metrics and vesting period as our performance stock units.

These awards are classified as liabilities and reported in accrued expenses and other long-term liabilities within our consolidated balance sheet. The fair value of these awards is remeasured at each reporting period until the awards are settled. As of December 31, 2021, our recorded liabilities associated with these awards was $2.0 million, and we had remaining unrecognized compensation cost related to cash-settled performance-based share-based awards of $1.7 million, which is expected to be recognized over a weighted average period of 1.6 years. During 2021, we paid $417,000 in connection with liability awards, and no awards were forfeited. There were no liability awards vested or forfeited in the years ended December 31, 2020 or 2019.

Segment Reporting and Foreign Operations

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Segment Reporting and Foreign Operations

13.SEGMENT REPORTING AND FOREIGN OPERATIONS

We report our operations in two operating segments: cardiovascular and endoscopy. Our cardiovascular segment consists of four product categories: peripheral intervention, cardiac intervention, custom procedural solutions, and OEM. Within these product categories, we sell a variety of products, including cardiology and radiology devices (which assist in diagnosing and treating coronary arterial disease, peripheral vascular disease and other non-vascular diseases), as well as embolotherapeutic, cardiac rhythm management, electrophysiology, critical care, breast cancer localization and guidance, biopsy, and interventional oncology and spine devices. Our endoscopy segment consists of gastroenterology and pulmonology devices which assist in the palliative treatment of expanding esophageal, tracheobronchial and biliary strictures caused by malignant tumors. We evaluate the performance of our operating segments based on net sales and operating income (loss). See Note 2 for a detailed breakout of our sales by operating segment and product category, disaggregated between domestic and international sales.

During the years ended December 31, 2021, 2020 and 2019, we had international sales of $465.9 million, $413.8 million and $419.1 million, respectively, or 43%, 43% and 42%, respectively, of net sales. Our largest international markets include China, Japan, Germany, France and the United Kingdom, with China representing our most significant international sales market with sales of $138.2 million, $113.2 million, and $113.3 million for the years ended December 31, 2021, 2020 and 2019, respectively. International sales are attributed based on location of the customer receiving the product.

Our long-lived assets (which are comprised of our net property and equipment) by geographic area at December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
United States	$	275,311	$	277,643	$	273,816
Ireland		39,863		42,951		44,912
Other foreign countries		56,484		62,134		60,057
Total	$	371,658	$	382,728	$	378,785

Financial information relating to our reportable operating segments and reconciliations to the consolidated totals for the years ended December 31, 2021, 2020 and 2019, are as follows (in thousands):




	2021		2020		2019
Net Sales
Cardiovascular	$	1,043,227	$	934,202	$	960,981
Endoscopy		31,524		29,673		33,871
Total net sales		1,074,751		963,875		994,852

Operating Income (Loss)
Cardiovascular		53,415		(7,042)		25,780
Endoscopy		7,501		5,480		(10,346)
Total operating income (loss)		60,916		(1,562)		15,434

Total other expense - net		(6,999)		(11,669)		(13,241)
Income tax expense (benefit)		5,463		(3,388)		(3,258)

Net income (loss)	$	48,454	$	(9,843)	$	5,451

Total assets by operating segment at December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Cardiovascular	$	1,635,676	$	1,654,866	$	1,745,057
Endoscopy		12,618		9,530		12,264
Total	$	1,648,294	$	1,664,396	$	1,757,321

Total depreciation and amortization by operating segment for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Cardiovascular	$	83,000	$	93,160	$	91,151
Endoscopy		1,066		910		949
Total	$	84,066	$	94,070	$	92,100

Total capital expenditures for property and equipment by operating segment for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Cardiovascular	$	27,557	$	45,803	$	77,631
Endoscopy		382		185		542
Total	$	27,939	$	45,988	$	78,173

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

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+ Details

Employee Benefit Plans

12 Months Ended

Dec. 31, 2021

Defined Contribution Plan [Abstract]

Employee Benefit Plans

14.EMPLOYEE BENEFIT PLANS

We have defined contribution plans covering all U.S. full-time adult employees and certain of our foreign employees. Our contributions to these plans are discretionary in certain countries, including the U.S. In September 2019, we ceased discretionary contributions to certain of our defined contribution plans and subsequently reinstated those contributions in May 2021. Total expense for contributions made to these plans for the years ended December 31, 2021, 2020 and 2019 was $6.5 million, $3.9 million and $6.6 million, respectively.

Fair Value Measurements

12 Months Ended

Dec. 31, 2021

Fair Value Disclosures [Abstract]

Fair Value Measurements

15.FAIR VALUE MEASUREMENTS

Assets (Liabilities) Measured at Fair Value on a Recurring Basis

Our financial assets and (liabilities) carried at fair value measured on a recurring basis as of December 31, 2021 and 2020, 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
	December 31, 2021		(Level 1)		(Level 2)		(Level 3)
Interest rate contract liabilities, long-term ⁽¹⁾	$	(1,447)	$	—	$	(1,447)	$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	2,241	$	—	$	2,241	$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(3,646)	$	—	$	(3,646)	$	—
Contingent consideration liabilities	$	(48,234)	$	—	$	—	$	(48,234)


			Fair Value Measurements Using
	Total Fair		Quoted prices in		Significant other		Significant
	Value at		active markets		observable inputs		unobservable inputs
	December 31, 2020		(Level 1)		(Level 2)		(Level 3)
Interest rate contract liabilities, current and long-term ⁽¹⁾	$	(4,358)	$	—	$	(4,358)	$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	3,078	$	—	$	3,078	$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(8,267)	$	—	$	(8,267)	$	—
Contingent consideration liabilities	$	(55,750)	$	—	$	—	$	(55,750)

(1)	The fair value of the interest rate contracts is determined using Level 2 fair value inputs and is recorded as accrued expenses 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 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 or other milestones. Contingent consideration liabilities are re-measured to fair value at each reporting period, with the change in fair value recognized within operating expenses in the accompanying consolidated statements of income (loss). 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 liabilities during the years ended December 31, 2021 and 2020, consisted of the following (in thousands):


	2021		2020
Beginning balance	$	55,750	$	76,709
Contingent consideration expense (benefit)		3,161		(7,960)
Contingent payments made		(10,665)		(13,100)
Effect of foreign exchange		(12)		101
Ending balance	$	48,234	$	55,750

As of December 31, 2021, $13.5 million was included in other long-term obligations and approximately $34.7 million was included in accrued expenses in our consolidated balance sheet related to contingent liabilities. As of December 31, 2020, $36.9 million was included in other long-term obligations and $18.8 was included in accrued expenses in our consolidated balance sheet related to contingent liabilities. Cash paid to settle contingent consideration liabilities recognized at fair value as of the acquisition date has been reflected as a cash outflow from financing activities in the accompanying consolidated statements of cash flows.

The recurring Level 3 measurement of our contingent consideration liabilities includes the following significant unobservable inputs at December 31, 2021 and 2020 (amounts in thousands):


	Fair value at
	December 31,		Valuation			Weighted
Contingent consideration liability	2021		technique	Unobservable inputs	Range	Average⁽¹⁾
Revenue-based royalty payments contingent liability	$	2,870	Discounted cash flow	Discount rate	13% - 16%	14.7%
				Projected year of payments	2022-2034	2026

Revenue milestones contingent liability	$	41,671	Monte Carlo simulation	Discount rate	7.5% - 12.5%	8.2%
				Projected year of payments	2022-2031	2022

Regulatory approval contingent liability	$	3,693	Scenario-based method	Discount rate	2.6%
				Probability of milestone payment	80%
				Projected year of payment	2024-2025	2025

(1)	Unobservable inputs were weighted by the relative fair value of the instruments. No weighted average is reported for contingent consideration liabilities without a range of unobservable inputs.


	Fair value at
	December 31,		Valuation			Weighted
Contingent consideration liability	2020		technique	Unobservable inputs	Range	Average⁽¹⁾
Revenue-based royalty payments contingent liability	$	4,545	Discounted cash flow	Discount rate	12% - 15%	13.5%
				Projected year of payments	2021-2034	2026

Revenue milestones contingent liability	$	46,305	Monte Carlo simulation	Discount rate	7.5% - 12%	9.0%
				Projected year of payments	2021-2030	2022

Regulatory approval contingent liability	$	4,900	Scenario-based method	Discount rate	1%
				Probability of milestone payment	100%
				Projected year of payment	2021-2024	2022

(1)	Unobservable inputs were weighted by the relative fair value of the instruments. No weighted average is reported for contingent consideration liabilities without a range of unobservable inputs.

The contingent consideration liabilities 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 (increase) in the probability of any milestone payment may result in lower (higher) fair value measurements. Our determination of the fair value of contingent consideration liabilities 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 (loss).

Contingent Payments to Related Parties. During the years ended December 31, 2020 and 2019, we made contingent payments of approximately $800,000 and $1.0 million to a current director of Merit and former shareholder of Cianna Medical which we acquired in 2018. We made no such payments in 2021. In 2022, the Company expects to make additional payments consistent with prior years. The terms of the acquisition, including contingent consideration payments, were determined prior to the appointment of the former Cianna Medical shareholder as a director of Merit. As a former shareholder of Cianna Medical, the Merit director may be eligible for additional payments for the achievement of sales milestones specified in our merger agreement with Cianna Medical.

Fair Value of Other Financial Instruments

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.

Impairment Charges

We recognize or disclose the fair value of certain assets, such as non-financial assets, primarily property and equipment, intangible assets and goodwill in connection with impairment evaluations. All of our nonrecurring valuations use significant unobservable inputs and therefore fall under Level 3 of the fair value hierarchy.

Intangible Assets. During the years ended December 31, 2021, 2020 and 2019, we had losses of $1.6 million, $28.7 million and $3.3 million, respectively, related to certain acquired intangible assets (see Note 5).

Right of Use Operating Lease Assets. During the years ended December 31, 2021 and 2020, we identified changes in events and circumstances relating to certain right-of-use (“ROU”) operating lease assets. We compared the anticipated undiscounted cash flows generated by a sublease to the carrying value of the ROU operating lease and related long-lived assets and determined that the carrying values were not recoverable. Consequently, we recorded impairment losses during the years ended December 31, 2021 and 2020 of $1.4 million and $1.5 million, respectively, which is equal to the excess of the carrying value of the assets over their estimated fair value. The impairment losses in both periods were driven primarily by site consolidation decisions and changes in our projected cash flows for the ROU operating lease asset and related long-lived assets, due to changes in the real estate market as a result of the COVID-19 pandemic. These changes include an increase in the anticipated time to identify a lessee, an increase in anticipated lease concessions, and a decrease in the expected lease rates for the property. The ROU operating lease asset impairment losses in both 2021 and 2020 pertained to our cardiovascular segment.

Property and Equipment. During the year ended December 31, 2021, we had losses of $1.3 million related to the measurement of property and equipment at fair value based on the planned discontinuance of the Advocate™ Peripheral Angioplasty Balloon product line, sold under our license agreements with ArraVasc, which pertained to our cardiovascular segment. During the year ended December 31, 2020, we had losses of $359,000 related to the measurement of certain property and equipment measured at fair value based on restructuring activities associated with the suspension of our distribution agreement with NinePoint, which pertained to our endoscopy segment.

Equity Investments, Purchase Options and Notes Receivable. During the year ended December 31, 2020, we recognized $2.5 million of impairment expense related to our equity method investment in the 19.5 percent ownership in preferred shares of Fusion Medical, Inc. (“Fusion”) due to uncertainty about future product development and commercialization associated with the technologies and a charge of $3.5 million related to Bluegrass Vascular due to our decision not to exercise our option to purchase the company. Our equity investments in privately held companies, including options to acquire these companies, were $14.7 million and $12.0 million at December 31, 2021 and 2020, respectively, which are included within other long-term assets in our consolidated balance sheets. We analyze our investments in privately held companies to determine if they should be accounted for using the equity method based on our ability to exercise significant influence over operating and financial policies of the investment. Investments not accounted for under the equity method of accounting are accounted for at cost minus impairment, if applicable, plus or minus changes in valuation resulting from observable transactions for identical or similar investments.

Prior to the adoption of ASU 2016-13 on January 1, 2020, we assessed the credit support available for notes receivable and the value of any underlying collateral to determine if there were any other-than temporary impairments. Credit losses represent the difference between the present value of cash flows expected to be collected on these notes receivable and the amortized cost basis. For the year ended December 31, 2019, we recorded impairment charges of $20.5 million due to our write-off of our NinePoint note receivable and purchase option due to our assessment of the collectability of the note receivable and management’s decision not to exercise our option to purchase this business. We also wrote off $1.6 million of accrued interest related to the note receivable reported in interest income in the consolidated statements of income (loss) for the year ended December 31, 2019. We recorded interest income of $0.4 million and $0.3 million during the years ended December 31, 2021 and 2020, respectively, for partial recoveries of this interest.

Current Expected Credit Losses

Our outstanding long-term notes receivable, including accrued interest and our allowance for current expected credit losses, were $2.3 million and $2.2 million, as of December 31, 2021 and 2020, respectively. As of December 31, 2021 and 2020, we had an allowance for current expected credit losses of $199,000 and $730,000, respectively, associated with these notes receivable and in 2020 our contractual obligation to extend credit to Selio, which they exercised during the year ended December 31, 2021. We assess the allowance for current expected credit losses on an individual security basis, due to the limited number of securities, using a probability of default model, which is based on relevant information about past events, including historical experience, current conditions and reasonable and supportable forecasts that affect the expected collectability of securities. During the year ended December 31, 2021, we collected $2.8 million from Bluegrass Vascular which represents the entire principal balance and all accrued interest.

The table below presents a rollforward of the allowance for current expected credit losses on our notes receivable for the years ended December 31, 2021 and 2020 (in thousands):


	2021		2020
Beginning balance	$	730	$	—
Cumulative effect adjustment upon adoption of ASU 2016-13, Credit Losses		—		575
Provision for credit loss - expense (benefit)		(531)		155
Ending balance	$	199	$	730

- 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

Accumulated Other Comprehensive Income (Loss)

12 Months Ended

Dec. 31, 2021

Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]

Accumulated Other Comprehensive Income (Loss)

16.ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS)

The changes in each component of Accumulated Other Comprehensive Income (Loss) for the years ended December 31, 2021, 2020 and 2019 were as follows (in thousands):


	Cash Flow Hedges		Foreign Currency Translation		Total
January 1, 2019	$	3,522		(5,555)		(2,033)

Other comprehensive income (loss)		(3,417)		(18)		(3,435)
Income taxes		1,404		61		1,465
Reclassifications to:
Revenue		(577)				(577)
Cost of sales		578				578
Interest expense		(2,040)				(2,040)
Net other comprehensive income (loss)		(4,052)		43		(4,009)

Reclassification of stranded tax effects ¹		748				748

December 31, 2019		218		(5,512)		(5,294)

Other comprehensive income (loss)		(11,647)		7,786		(3,861)
Income taxes		2,365		(786)		1,579
Reclassifications to:
Revenue		(36)				(36)
Cost of sales		1,288				1,288
Interest expense		872				872
Net other comprehensive income (loss)		(7,158)		7,000		(158)

December 31, 2020		(6,940)		1,488		(5,452)

Other comprehensive income (loss)		(119)		(7,704)		(7,823)
Income taxes		(1,489)		689		(800)
Reclassifications to:
Revenue		5,592				5,592
Cost of sales		(1,017)				(1,017)
Interest expense		1,509				1,509
Net other comprehensive income (loss)		4,476		(7,015)		(2,539)

December 31, 2021	$	(2,464)	$	(5,527)	$	(7,991)

(1)	Amounts reclassified to retained earnings as a result of the adoption of ASU 2018-02.

Leases

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Leases

17.LEASES

We have operating leases for facilities used for manufacturing, research and development, sales and distribution, and office space, as well as leases for manufacturing and office equipment, vehicles, and land. Our leases have remaining terms ranging from less than one year to approximately 28 years. A number of our lease agreements contain options to renew at our discretion for periods of up to 15 years and options to terminate the leases within one year. The lease term used to calculate 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 December 31, 2021 recorded on our consolidated balance sheet are related to our cardiovascular segment.

From time to time, we enter into agreements to sublease a portion of our facilities to third parties. Such sublease income is not material. We also lease certain hardware consoles to customers and record rental revenue as a component of net sales. Rental revenue under such console leasing arrangements for the years ended December 31, 2021, 2020 and 2019 was not significant.

The following was included in our consolidated balance sheet as of December 31, 2021 and 2020 (in thousands):


	2021		2020
Assets
ROU operating lease assets	$	65,913	$	78,240

Liabilities
Short-term operating lease liabilities	$	10,668	$	12,903
Long-term operating lease liabilities		61,526		70,941
Total operating lease liabilities	$	72,194	$	83,844

During the year ended December 31, 2015, we entered into sale and leaseback transactions to finance certain production equipment for $2.0 million. At that time, we deferred the gain from the sale and leaseback transaction, of which $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 as of January 1, 2019.

We recognize lease expense for operating leases on a straight-line basis over the term of the lease. Net lease cost for the years ended December 31, 2021, 2020 and 2019 was $15.9 million, $16.7 million, and $16.5 million, respectively. The components of lease costs for the years ended December 31, 2021, 2020 and 2019 were as follows, in thousands:



Lease Cost	Classification	2021		2020		2019
Operating lease cost (a)	Selling, general and administrative expenses	$	16,013	$	16,735	$	16,828
Sublease (income) (b)	Selling, general and administrative expenses		(75)		(15)		(361)
Net lease cost		$	15,938	$	16,720	$	16,467


(a)	Includes expense related to short-term leases and variable payments, which were not significant.

(b)		Does not include rental revenue from leases of hardware consoles to customers, which was not significant.

Supplemental cash flow information for the years ended December 31, 2021, 2020 and 2019 was as follows, in thousands:


	2021		2020		2019
Cash paid for amounts included in the measurement of lease liabilities	$	14,970		15,059		14,646
Right-of-use assets obtained in exchange for lease obligations	$	1,524		10,938		10,637

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 December 31, 2021, 2020 and 2019, our lease agreements had the following remaining lease term and discount rates:


	2021	2020	2019
Weighted average remaining lease term	11.4 years	11.5 years	12.3 years
Weighted average discount rate	3.4%	3.3%	3.2%

As of December 31, 2021, maturities of operating lease liabilities were as follows, in thousands:


Year ended December 31,	Amounts due under operating leases
2022	$	12,405
2023		9,794
2024		8,847
2025		7,130
2026		6,378
Thereafter		43,306
Total lease payments		87,860
Less: Imputed interest		(15,666)
Total	$	72,194

As of December 31, 2021, we had additional operating leases for office space that had not yet commenced. These leases will commence during 2022 and are not deemed material.

Schedule II - Valuation and qualifying accounts

12 Months Ended

Dec. 31, 2021

SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]

Schedule II - Valuation and qualifying accounts

(2) Financial Statement Schedules.

—

Schedule II - Valuation and qualifying accounts

Years Ended December 31, 2021, 2020 and 2019

(In thousands)


		Balance at		Additions Charged to				Balance at
Allowance for Credit Losses:		Beginning of Year		Costs and Expenses (a)		Deduction (b)		End of Year
2019 (c)	$	(2,355)	$	(1,163)	$	410	$	(3,108)
2020	$	(3,108)	$	(3,115)	$	910	$	(5,313)
2021	$	(5,313)	$	(2,678)	$	1,224	$	(6,767)

(a)

We record a bad debt provision based upon historical bad debt experience, current economic conditions, expectations of future economic conditions, and management’s evaluation of our ability to collect individual outstanding balances.

(b)

When an individual customer balance becomes impaired and is deemed uncollectible, a deduction is made against the allowance for uncollectible accounts.

(c)

In 2019, our “Allowance for Credit Losses” was referred to as an “Allowance for Uncollectible Accounts” in our consolidated balances sheet.

Years Ended December 31, 2021, 2020 and 2019

(In thousands)


		Balance at		Additions Charged to				Balance at
Tax Valuation Allowance:		Beginning of Year		Costs and Expenses (a)		Deduction		End of Year
2019	$	(4,989)	$	-	$	345	$	(4,644)
2020	$	(4,644)	$	(5,569)	$	-	$	(10,213)
2021	$	(10,213)	$	(573)	$	-	$	(10,786)

(a)

We record a valuation allowance against a deferred tax asset when it is determined that it is more likely than not that the deferred tax asset will not be realized.

(b)

Exhibits:

Organization and Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Use of Estimates in Preparing Financial Statements

Use of Estimates in Preparing Financial Statements. The preparation of financial statements in conformity with accounting principles generally accepted in the United States ("U.S. GAAP") requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

Principles of Consolidation

Principles of Consolidation. The consolidated financial statements include our wholly owned subsidiaries. Intercompany balances and transactions have been eliminated. Amounts presented in this report are rounded, while percentages and earnings per share amounts presented are calculated from the underlying amounts.

Cash and Cash Equivalents

Cash and Cash Equivalents. We consider interest-bearing deposits with an original maturity date of three months or less to be cash equivalents. As of December 31, 2021, approximately $1.9 million of our cash and cash equivalents represents restricted cash for the payment of certain import and other taxes for our subsidiary in China. There was no restricted cash for the year ended December 31, 2020.

Receivables

Receivables. Trade accounts receivable are recorded at the net invoice value and are not interest-bearing. An allowance for credit losses on trade receivables is recorded based on our expectation of credit losses and is based upon our historical bad debt experience, current economic conditions, expectations of future economic conditions and management’s evaluation of our ability to collect individual outstanding balances. Once collection efforts have been exhausted and a receivable is deemed to be uncollectible, such balance is charged against the allowance for credit losses.

Inventories

Inventories. We value our inventories at the lower of cost, at approximate costs determined on a first-in, first-out method, or net realizable value. Net realizable value is the estimated selling price in the ordinary course of business, less reasonably predictable costs of completion, disposal, and transportation. Inventory costs include material, labor and manufacturing overhead. We review inventories on hand at least quarterly and record provisions for estimated excess, slow moving and obsolete inventory, as well as inventory with a carrying value in excess of net realizable value. The regular and systematic inventory valuation reviews include a current assessment of future product demand, historical experience and product expiration.

Goodwill and Intangible Assets

Goodwill and Intangible Assets. We test goodwill balances for impairment on an annual basis as of July 1 or whenever impairment indicators arise. When impairment indicators are identified, we may elect to perform an optional qualitative assessment to determine whether it is more likely than not that the fair value of our reporting units has fallen below their

carrying value. During our annual impairment test, we utilize four reporting units in evaluating goodwill for impairment using a quantitative assessment, which uses a combination of a guideline public company market-based approach and a discounted cash flow income-based approach. The quantitative assessment considers whether the carrying amount of a reporting unit exceeds its fair value, in which case an impairment charge is recorded to the extent the reporting unit’s carrying value exceeds its fair value.

Finite-lived intangible assets including developed technology, customer lists, distribution agreements, license agreements, trademarks and patents are subject to amortization. Intangible assets are amortized over their estimated useful life on a straight-line basis, except for customer lists, which are generally amortized on an accelerated basis. Estimated useful lives are determined considering the period the assets are expected to contribute to future cash flows. We evaluate long-lived assets, including amortizing intangible assets, for impairment whenever events or changes in circumstances indicate that their carrying amounts may not be recoverable. We perform the impairment analysis at the asset group for which the lowest level of identifiable cash flows are largely independent of the cash flows of other assets and liabilities. We compare the carrying value of the asset group to the undiscounted cash flows expected to result from the asset group and determine whether the carrying amount is recoverable. We determine the fair value of each asset group based on estimated future cash flows discounted back to their present value using a discount rate that reflects the risk profiles of the underlying activities.

In-process technology intangible assets, which are not subject to amortization until projects reach commercialization, are assessed for impairment at least annually and more frequently if events occur that would indicate a potential reduction in the fair value of the assets below their carrying value. An impairment charge would be recognized to the extent the carrying amount of the in-process technology exceeded its fair value.

Long-Lived Assets

Long-Lived Assets. We periodically review the carrying amount of our depreciable long-lived assets for impairment. An asset is considered impaired when estimated future cash flows are less than the carrying amount of the asset. In the event the carrying amount of such asset is not considered recoverable, the asset is adjusted to its fair value. Fair value is generally determined based on discounted future cash flow.

Property and Equipment

Property and Equipment. Property and equipment is stated at the historical cost of construction or purchase. Construction costs include interest costs capitalized during construction. Maintenance and repairs of property and equipment are charged to operations as incurred. Leasehold improvements are amortized over the lesser of the base term of the lease or estimated life of the leasehold improvements. Construction-in-process consists of new buildings and various production equipment being constructed internally and externally. Assets in construction-in-process will commence depreciating once the asset has been placed in service. Depreciation is computed using the straight-line method over estimated useful lives as follows:


Buildings		40 years
Manufacturing equipment		4 - 20 years
Furniture and fixtures		3 - 20 years
Land improvements		10 - 20 years
Leasehold improvements		4 - 25 years

Depreciation expense related to property and equipment for the years ended December 31, 2021, 2020 and 2019 was $34.5 million, $35.4 million, and $31.4 million, respectively.

Deferred Compensation

Deferred Compensation. We have a deferred compensation plan that permits certain management employees to defer a portion of their salary until the future. We established a Rabbi trust to finance obligations under the plan with corporate-owned variable life insurance contracts. The cash surrender value totaled $19.1 million and $17.1 million at December 31, 2021 and 2020, respectively, which is included in other assets in our consolidated balance sheets. We have recorded a deferred compensation payable of $18.1 million and $16.8 million at December 31, 2021 and 2020, respectively, to reflect the liability to our employees under this plan.

Other Assets

Other Assets. Other assets as of December 31, 2021 and 2020 consisted of the following (in thousands):


	2021		2020
Deferred compensation plan assets	$	19,126	$	17,074
Investments in privately held companies		14,711		12,043
Long-term notes receivable		2,345		2,196
Other		5,239		6,363
Total	$	41,421	$	37,676

We analyze our investments in privately held companies to determine if they should be accounted for using the equity method based on our ability to exercise significant influence over operating and financial policies of the investment. Our share of earnings associated with equity method investments is reported within other income (expense) in our consolidated statements of income (loss). Investments not accounted for under the equity method of accounting are accounted for at cost minus impairment, if applicable, plus or minus changes in valuation resulting from observable transactions for identical or similar investments.

Other Long-term Obligations

Other Long-term Obligations. Other long-term obligations as of December 31, 2021 and 2020 consisted of the following (in thousands):


	2021		2020
Contingent consideration liabilities	$	13,500	$	36,917
Other long-term obligations		10,084		15,831
Total	$	23,584	$	52,748

In connection with a business combination, any contingent consideration is recorded at fair value on the acquisition date based upon the consideration expected to be transferred in the future. We re-measure the estimated liability each quarter based upon changes in revenue estimates, changes in the probability of achieving relevant milestones and changes in the discount rate or expected period of payment. Changes in the estimated fair value are recorded through operating expense in our consolidated statements of income (loss).

Revenue Recognition/Shipping and Handling/Cost of Sales

Revenue Recognition. We sell our medical products through a direct sales force in the U.S. and through OEM relationships, custom procedure tray manufacturers and a combination of direct sales force and independent distributors in international markets. Revenue is recognized when a customer obtains control of promised goods based on the consideration we expect to receive in exchange for these goods. This core principle is achieved through the following steps:

Identify the contract with the customer. A contract with a customer exists when (i) we enter into an enforceable contract with a customer that defines each party’s rights regarding the goods to be transferred and identifies the payment terms related to these goods, (ii) the contract has commercial substance and (iii) we determine that collection of substantially all consideration for services that are transferred is probable based on the customer’s intent and ability to pay the promised consideration. We do not have significant costs to obtain contracts with customers. For commissions on product sales, we have elected the practical expedient to expense the costs as incurred if the amortization period would have been one year or less.

Identify the performance obligations in the contract. Generally, our contracts with customers do not include multiple performance obligations to be completed over a period of time. Our performance obligations generally relate to delivering single-use medical products to a customer, subject to the shipping terms of the contract. Limited warranties are provided, under which we typically accept returns and provide either replacement parts or refunds. We do not have significant returns. We do not typically offer extended warranty or service plans, except in limited cases which are not material.

Determine the transaction price. Payment by the customer is due under customary fixed payment terms, and we evaluate if collectability is reasonably assured. Our contracts do not typically contain a financing component. Revenue is recorded at the net sales price, which includes estimates of variable consideration such as product returns, rebates, discounts, and other adjustments. The estimates of variable consideration are based on historical payment experience, historical and

projected sales data, and current contract terms. Variable consideration is included in revenue only to the extent that it is probable that a significant reversal of the revenue recognized will not occur when the uncertainty associated with the variable consideration is subsequently resolved. Taxes collected from customers relating to product sales and remitted to governmental authorities are excluded from revenues.

Allocate the transaction price to performance obligations in the contract. We typically do not have multiple performance obligations in our contracts with customers. As such, we generally recognize revenue upon transfer of the product to the customer’s control at contractually stated pricing.

Recognize revenue when or as we satisfy a performance obligation. We generally satisfy performance obligations at a point in time upon either shipment or delivery of goods, in accordance with the terms of each contract with the customer. We do not have significant service revenue. Contract assets are recognized for the future right to invoice customers, and contract liabilities are recognized for unearned revenue if payment is received prior to our fulfillment of performance obligations. We do not have material contract assets or contract liabilities.

Reserves are recorded as a reduction in net sales and are not considered material to our consolidated statements of income (loss) for the years ended December 31, 2021, 2020 and 2019. In addition, we invoice our customers for taxes assessed by governmental authorities, such as sales tax and value-added taxes. We present these taxes on a net basis.

Shipping and Handling. When billed to our customers, shipping and handling charges are included in net sales for the applicable period, and the corresponding shipping and handling expense is reported in cost of sales.

Cost of Sales. We include product costs (i.e. material, direct labor and overhead costs), shipping and handling expense, product royalty expense, developed technology amortization expense, production-related depreciation expense and product license agreement expense in cost of sales.

Research and Development

Research and Development. Research and development costs, including new product development, clinical trials, and regulatory compliance, are expensed as incurred.

Income Taxes

Income Taxes. Under our accounting policies, we initially recognize a tax position in our financial statements when it becomes more likely than not that the position will be sustained upon examination by the tax authorities. Such tax positions are initially and subsequently measured as the largest amount of tax positions that has a greater than 50% likelihood of being realized upon ultimate settlement with the tax authorities assuming full knowledge of the position and all relevant facts. Although we believe our provisions for unrecognized tax positions are reasonable, we can make no assurance that the final tax outcome of these matters will not be different from that which we have reflected in our income tax provisions and accruals. The tax law is subject to varied interpretations, and we have taken positions related to certain matters where the law is subject to interpretation. Such differences could have a material impact on our income tax provisions and operating results in the period(s) in which we make such determination.

Earnings per Common Share

Earnings per Common Share. Net income (loss) per common share is computed by both the basic method, which uses the weighted average number of our common shares outstanding, and the diluted method, which includes the dilutive common shares from stock options and restricted stock units as calculated using the treasury stock method. Performance stock units are considered contingently issuable awards and are excluded from the weighted average basic share calculation. These awards are included in the weighted average dilutive share calculation, to the extent they are dilutive, based on the number of shares, if any, that would be issuable as of the end of the reporting period assuming the end of the reporting period is also the end of the performance period.

Fair Value Measurements

Fair Value Measurements. The fair value of a financial instrument is the amount that could be received upon the sale of an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Financial assets are marked to bid prices and financial liabilities are marked to offer prices. Fair value measurements do not include transaction costs. A fair value hierarchy is used to prioritize the quality and reliability of the information

used to determine fair values. Categorization within the fair value hierarchy is based on the lowest level of input that is significant to the fair value measurement. The fair value hierarchy is defined in the following three categories:

Level 1: Quoted market prices in active markets for identical assets or liabilities.

Level 2: Observable market-based inputs or inputs that are corroborated by market data.

Level 3: Unobservable inputs that are not corroborated by market data.

Stock-Based Compensation

Stock-Based Compensation. We recognize the fair value compensation cost relating to stock-based payment transactions in accordance with Accounting Standards Codification (“ASC”) 718, Compensation — Stock Compensation. Under the provisions of ASC 718, stock-based compensation cost is measured at the grant date, based on the fair value of the award, and is recognized over the employee’s requisite service period, which is generally the vesting period. The fair value of our stock options is estimated using a Black-Scholes option valuation model. The fair value of our performance stock units linked to total shareholder return is estimated using Monte-Carlo simulations. Compensation expense is adjusted each period based on the grant-date fair value and the number of shares that are probable of being awarded based on the performance conditions of the awards. Restricted stock units are valued based on the closing stock price on the date of grant. Cash-settled share-based awards, or liability awards, are remeasured at fair value each reporting period until the awards are settled. Stock-based compensation expense for the years ended December 31, 2021, 2020 and 2019 was $16.1 million, $14.3 million and $9.4 million, respectively (see Note 12).

Concentration of Credit Risk

Concentration of Credit Risk. Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash and cash equivalents and accounts receivable. We provide credit, in the normal course of business, primarily to hospitals and independent third-party custom procedure tray manufacturers and distributors. We perform ongoing credit evaluations of our customers and maintain allowances for potential credit losses. Due to the diversified nature and number of our customers, concentrations of credit risk with respect to accounts receivable are limited.

Foreign Currency

Foreign Currency. The financial statements of our foreign subsidiaries are measured using local currencies as the functional currency, with the exception of our manufacturing subsidiaries in Ireland and Mexico, which each use the U.S. Dollar as its functional currency. Assets and liabilities are translated into U.S. Dollars at year-end rates of exchange and results of operations are translated at average rates for the year. Gains and losses resulting from these translations are included in accumulated other comprehensive income (loss) as a separate component of stockholders’ equity. Transactional exchange gains or losses are included in other income (expense) in determining net income (loss) for the period.

Derivatives

Derivatives. We use forward contracts to mitigate our exposure to volatility in foreign exchange rates, and we use interest rate swaps to hedge changes in the benchmark interest rate related to our Third Amended Credit Agreement described in Note 8. All derivatives are recognized in the consolidated balance sheets at fair value. Classification of each hedging instrument is based upon whether the maturity of the instrument is less than or greater than 12 months. We do not purchase or hold derivative financial instruments for speculative or trading purposes (see Note 9).

Organization and Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Property and Equipment

Depreciation is computed using the straight-line method over estimated useful lives as follows:


Buildings		40 years
Manufacturing equipment		4 - 20 years
Furniture and fixtures		3 - 20 years
Land improvements		10 - 20 years
Leasehold improvements		4 - 25 years

Other assets

Other assets as of December 31, 2021 and 2020 consisted of the following (in thousands):


	2021		2020
Deferred compensation plan assets	$	19,126	$	17,074
Investments in privately held companies		14,711		12,043
Long-term notes receivable		2,345		2,196
Other		5,239		6,363
Total	$	41,421	$	37,676

Other Long-term Obligations

Other long-term obligations as of December 31, 2021 and 2020 consisted of the following (in thousands):


	2021		2020
Contingent consideration liabilities	$	13,500	$	36,917
Other long-term obligations		10,084		15,831
Total	$	23,584	$	52,748

Revenues (Tables)

12 Months Ended

Dec. 31, 2021

Revenue from Contract with Customer [Abstract]

Schedule of Disaggregation of Revenue

The following table presents sales by operating segment disaggregated based on product category and geographic region for the years ended December 31, 2021, 2020 and 2019 (in thousands).


	Year Ended						Year Ended						Year Ended
	December 31, 2021						December 31, 2020						December 31, 2019
	United States		International		Total		United States		International		Total		United States		International		Total
Cardiovascular
Peripheral Intervention	$	244,459	$	160,657	$	405,116	$	211,999	$	129,569	$	341,568	$	226,788	$	124,148	$	350,936
Cardiac Intervention		122,452		198,189		320,641		108,109		171,562		279,671		115,604		189,193		304,797
Custom Procedural Solutions		108,068		85,874		193,942		110,269		92,927		203,196		99,659		87,700		187,359
OEM		104,436		19,092		123,528		91,826		17,941		109,767		101,065		16,824		117,889
Total		579,415		463,812		1,043,227		522,203		411,999		934,202		543,116		417,865		960,981

Endoscopy
Endoscopy devices		29,463		2,061		31,524		27,858		1,815		29,673		32,595		1,276		33,871

Total	$	608,878	$	465,873	$	1,074,751	$	550,061	$	413,814	$	963,875	$	575,711	$	419,141	$	994,852

Acquisitions and Other Strategic Transactions (Tables)

12 Months Ended

Dec. 31, 2021

KA Medical

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

During the fourth quarter of 2021, certain immaterial measurement period adjustments were recorded to our purchase price allocation. The purchase price was allocated as follows (in thousands):


Assets Acquired
Trade receivables	$	24
Other receivables		13
Inventories		211
Property and equipment		298
Other long-term assets		10
Intangible assets
Developed technology		6,000
Goodwill		8,570
Total assets acquired		15,126

Liabilities Assumed
Trade payables		(31)
Accrued expenses		(507)
Total liabilities assumed		(538)

Total net assets acquired	$	14,588

Business Acquisitions 2019

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed


	STD Pharmaceutical		Brightwater
Assets Acquired
Trade receivables	$	277	$	55
Inventories		843		349
Prepaid expenses and other current assets		49		—
Property and equipment		—		409
Other long-term assets		—		30
Intangible assets
Developed technology		10,428		31,960
Customer lists		—		83
Trademarks		—		250
Goodwill		4,975		17,607
Total assets acquired		16,572		50,743

Liabilities Assumed
Trade payables		(53)		(58)
Accrued expenses		(29)		(261)
Other long-term obligations		—		(1,522)
Deferred income tax liabilities		(1,890)		(4,263)
Total liabilities assumed		(1,972)		(6,104)

Total net assets acquired	$	14,600	$	44,639

Amortization Period of Intangible Assets
Developed technology		12 years		13 years
Customer lists (on an accelerated basis)		—		1 year
Trademarks		—		5 years
Weighted Average		12 years		12.9 years

Inventories (Tables)

12 Months Ended

Dec. 31, 2021

Inventory Disclosure [Abstract]

Schedule of Inventory

Inventories at December 31, 2021 and 2020, consisted of the following (in thousands):


	2021		2020
Finished goods	$	132,403	$	110,933
Work-in-process		22,160		19,308
Raw materials		67,359		67,778
Total inventories	$	221,922	$	198,019

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Changes in carrying amount of goodwill

The changes in the carrying amount of goodwill for the years ended December 31, 2021 and 2020, are as follows (in thousands):


	2021		2020
Goodwill balance at January 1	$	363,533	$	353,193
Effect of foreign exchange		(2,078)		1,941
Additions and adjustments as the result of acquisitions		286		8,399
Goodwill balance at December 31	$	361,741	$	363,533

Other intangible assets

Other intangible assets at December 31, 2021 and 2020, consisted of the following (in thousands):


	December 31, 2021
	Gross Carrying		Accumulated		Net Carrying
	Amount		Amortization		Amount
Patents	$	26,349	$	(8,315)	$	18,034
Distribution agreements		3,250		(2,519)		731
License agreements		12,663		(7,768)		4,895
Trademarks		30,242		(15,256)		14,986
Customer lists		34,985		(31,195)		3,790
Total	$	107,489	$	(65,053)	$	42,436


	December 31, 2020
	Gross Carrying		Accumulated		Net Carrying
	Amount		Amortization		Amount
Patents	$	23,669	$	(6,460)	$	17,209
Distribution agreements		3,250		(2,319)		931
License agreements		14,453		(6,647)		7,806
Trademarks		30,273		(12,414)		17,859
Customer lists		35,154		(29,103)		6,051
Total	$	106,799	$	(56,943)	$	49,856

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 December 31, 2021 (in thousands):


Year Ending December 31,	Estimated Amortization Expense
2022	$	48,195
2023		47,101
2024		44,165
2025		42,396
2026		31,843

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Schedule of Income before Income Tax, Domestic and Foreign

For the years ended December 31, 2021, 2020 and 2019, income (loss) before income taxes is broken out between U.S. and foreign-sourced operations and consisted of the following (in thousands):


	2021		2020		2019
Domestic	$	21,328	$	(32,216)	$	(37,277)
Foreign		32,589		18,985		39,470
Total	$	53,917	$	(13,231)	$	2,193

Schedule of Components of Income Tax Expense (Benefit)

The components of the provision for income taxes for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Current expense (benefit):
Federal	$	808	$	(937)	$	479
State		806		437		662
Foreign		8,480		8,407		8,037
Total current expense (benefit)		10,094		7,907		9,178

Deferred expense (benefit):
Federal		(468)		(2,688)		(8,111)
State		(1,845)		(4,524)		(3,523)
Foreign		(2,318)		(4,083)		(802)
Total deferred expense (benefit)		(4,631)		(11,295)		(12,436)

Total income tax expense (benefit)	$	5,463	$	(3,388)	$	(3,258)

Schedule of Effective Income Tax Rate Reconciliation


	2021		2020⁽¹⁾		2019⁽¹⁾
Computed federal income tax expense (benefit) at applicable statutory rate of 21%	$	11,323	$	(2,778)	$	461
State income tax benefit		(283)		(1,448)		(2,241)
Tax credits		(2,507)		(2,391)		(1,064)
Tax effect of international items		(281)		4,705		1,325
Uncertain tax positions		401		(455)		(574)
Deferred compensation insurance assets		(413)		(290)		(493)
Stock-based compensation		(5,571)		(1,822)		(1,659)
Valuation allowance		—		1,257		—
DOJ settlement		—		1,890		—
Remeasurement of state deferred taxes		(526)		(1,765)		—
Non-deductible expenses		2,455		1,077		1,320
Remeasurement of contingent consideration liabilities		733		(1,185)		(87)
Other — including the effect of graduated rates		132		(183)		(246)
Total income tax expense (benefit)	$	5,463	$	(3,388)	$	(3,258)

(1) Amounts for the years ended December 31, 2020 and 2019 in the table above have been updated for presentation and comparative purposes

Schedule of Deferred Tax Assets and Liabilities

Deferred income tax assets and liabilities at December 31, 2021 and 2020, consisted of the following temporary differences and carry-forward items (in thousands):


	2021		2020 ⁽¹⁾
Deferred income tax assets:
Allowance for credit losses on trade receivables	$	1,494	$	1,198
Accrued compensation expense		11,063		9,694
Inventory differences		4,887		3,161
Net operating loss carryforwards		14,833		18,622
Stock-based compensation expense		6,388		7,360
Operating lease assets		13,431		15,182
Federal R&D tax credit		5,003		3,607
UT R&D Credit		4,126		3,484
Other		9,939		11,126
Total deferred income tax assets		71,164		73,434

Deferred income tax liabilities:
Prepaid expenses		(1,047)		(1,078)
Property and equipment		(20,797)		(20,671)
Intangible assets		(42,888)		(47,178)
Foreign withholding tax		(5,575)		(5,358)
Operating lease liabilities		(11,938)		(13,855)
Other		(3,556)		(3,796)
Total deferred income tax liabilities		(85,801)		(91,936)
Valuation allowance		(10,786)		(10,213)
Net deferred income tax liabilities	$	(25,423)	$	(28,715)

Reported as:
Deferred income tax assets	$	6,080	$	4,597
Deferred income tax liabilities		(31,503)		(33,312)
Net deferred income tax liabilities	$	(25,423)	$	(28,715)

(1)

Amounts for the year ended December 31, 2020 in the table above have been updated for presentation and comparative purposes

Summary of Income Tax Contingencies


	2021		2020		2019
Unrecognized tax benefits, opening balance	$	1,674	$	2,161	$	2,947
Gross increases (decreases) in tax positions taken in a prior year		82		115		(244)
Gross increases in tax positions taken in the current year		316		283		229
Lapse of applicable statute of limitations		(437)		(885)		(771)
Unrecognized tax benefits, ending balance	$	1,635	$	1,674	$	2,161

Accrued Expenses (Tables)

12 Months Ended

Dec. 31, 2021

Payables and Accruals [Abstract]

Schedule of Accrued Liabilities

Accrued expenses at December 31, 2021 and 2020, consisted of the following (in thousands):


	2021		2020
Payroll and related liabilities	$	59,435	$	41,023
Current portion of contingent liabilities		34,735		18,833
Advances from employees		201		259
Accrued rebates payable		11,271		9,532
Accrued legal settlement		18,250		—
Other accrued expenses		35,122		42,297

Total	$	159,014	$	111,944

Revolving Credit Facility and Long-Term Debt (Tables)

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Schedule of Long-term Debt Instruments

Principal balances outstanding under our long-term debt obligations as of December 31, 2021 and 2020, consisted of the following (in thousands):


	2021		2020
Term loans	$	133,125	$	140,625
Revolving credit loans		110,000		211,000
Less unamortized debt issuance costs		(290)		(403)
Total long-term debt		242,835		351,222
Less current portion		8,438		7,500
Long-term portion	$	234,397	$	343,722

Schedule of Long-term Debt Covenants

customary for loans of this nature. In particular, the Third Amended Credit Agreement requires that we maintain certain financial covenants, as follows:


	Covenant Requirement
Consolidated Total Leverage Ratio ⁽¹⁾		4.0 to 1.0
Consolidated Interest Coverage Ratio ⁽²⁾		3.0 to 1.0
Facility Capital Expenditures ⁽³⁾		$50 million

(1)	Maximum Consolidated Total Net Leverage Ratio (as defined in the Third Amended Credit Agreement) as of any fiscal quarter end.

(2)	Minimum ratio of Consolidated EBITDA (as defined in the Third Amended Credit Agreement and adjusted for certain expenditures) to Consolidated interest expense (as defined in the Third Amended Credit Agreement) for any period of four consecutive fiscal quarters.

(3)	Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Third 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 December 31, 2021, are as follows (in thousands):


Years Ending	Future Minimum
December 31,	Principal Payments
2022	$	8,438
2023		11,250
2024		223,437
Total future minimum principal payments	$	243,125

- 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)

12 Months Ended

Dec. 31, 2021

Derivative Instruments and Hedging Activities Disclosure [Abstract]

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

The fair value of derivative instruments on a gross basis is as follows (in thousands):



Fair Value of Derivative Instruments Designated as Hedging Instruments	Balance Sheet Location	December 31, 2021		December 31, 2020
Assets
Foreign currency forward contracts	Prepaid expenses and other assets	$	1,326	$	1,777
Foreign currency forward contracts	Other assets (long-term)		179		424

(Liabilities)
Interest rate swaps	Accrued expenses		—		(896)
Interest rate swaps	Other long-term obligations		(1,447)		(3,462)
Foreign currency forward contracts	Accrued expenses		(2,288)		(5,281)
Foreign currency forward contracts	Other long-term obligations		(502)		(866)

Fair Value of Derivative Instruments Not Designated as Hedging Instruments	Balance Sheet Location	December 31, 2021		December 31, 2020
Assets
Foreign currency forward contracts	Prepaid expenses and other assets	$	736	$	877

(Liabilities)
Foreign currency forward contracts	Accrued expenses		(856)		(2,120)

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


	Amount of Gain/(Loss)
	Recognized in OCI
	Year Ended December 31,
Derivative instrument	2021		2020		2019
Interest rate swaps	$	1,402	$	(6,131)	$	(2,830)
Foreign currency forward contracts		(1,521)		(5,516)		(587)


	Consolidated Statements						Amount of Gain/(Loss)
	of Income (Loss)						reclassified from AOCI
	Year Ended December 31,						Year ended December 31,
Location in statements of income	2021			2020	2019		2021		2020		2019
Interest expense	$	(5,261)	$	(9,994)	$	(12,413)	$	(1,509)	$	(872)	$	2,040
Revenue		1,074,751		963,875		994,852		(5,592)		36		577
Cost of sales		(589,418)		(562,698)		(562,486)		1,017		(1,288)		(578)

Derivative Instruments, Gain (Loss)

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


		Year ended December 31,
Derivative Instrument	Location in statements of income (loss)	2021		2020		2019
Foreign currency forward contracts	Other income (expense)	$	(1,598)	$	(2,190)	$	(307)

Earnings Per Common Share (EPS) (Tables)

12 Months Ended

Dec. 31, 2021

Earnings Per Share, Basic and Diluted [Abstract]

Schedule of Earnings (Loss) Per Share, Basic and Diluted




	2021		2020		2019
Net income (loss)	$	48,454	$	(9,843)	$	5,451
Average common shares outstanding		56,145		55,434		55,075
Basic EPS	$	0.86	$	(0.18)	$	0.10

Average common shares outstanding		56,145		55,434		55,075
Effect of dilutive stock awards		1,214		—		1,160
Total potential shares outstanding		57,359		55,434		56,235
Diluted EPS	$	0.84	$	(0.18)	$	0.10

Equity awards excluded as the impact was anti-dilutive ⁽¹⁾		799		4,216		1,750

(1)	Does not reflect the impact of incremental repurchases under the treasury stock method.

Employee Stock Purchase Plan, Stock Options and Warrants (Tables)

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [Abstract]

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

The stock-based compensation expense before income tax expense for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Cost of sales
Nonqualified stock options	$	1,476	$	1,357	$	1,289
Research and development
Nonqualified stock options		1,343		1,157		961
Selling, general and administrative
Nonqualified stock options		6,678		7,332		7,132
Performance-based restricted stock units		3,525		2,829		—
Restricted stock units		1,557		758		—
Cash-settled performance-based share-based awards ("Liability Awards")		1,511		906		—
Total selling, general and administrative		13,271		11,825		7,132

Stock-based compensation expense before taxes	$	16,090	$	14,339	$	9,382

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


	2021	2020	2019
Risk-free interest rate	0.5% - 1.1%	0.3% - 1.7%	1.4% - 2.6%
Expected option term	4.0 years	4.0 - 5.0 years	3.0 - 5.0 years
Expected dividend yield	—	—	—
Expected price volatility	46.1% - 46.7%	38.7% - 45.1%	28.7% - 39.4%

Schedule of Share-based Compensation, Stock Option Activity

The table below presents information related to stock option activity for the years ended December 31, 2021, 2020 and 2019 (in thousands):


	2021		2020		2019
Total intrinsic value of stock options exercised	$	36,086	$	11,733	$	9,910
Cash received from stock option exercises		20,194		5,481		4,837
Excess tax benefit from the exercise of stock options		5,571		1,815		1,654

Share-based Compensation Arrangement by Share-based Payment Award, Options, Vested and Expected to Vest, Outstanding and Exercisable

Changes in stock options for the year ended December 31, 2021, consisted of the following (shares and intrinsic value in thousands):


	Number	Weighted Average		Remaining Contractual	Intrinsic
	of Shares	Exercise Price		Term (in years)	Value
Beginning balance	3,942	$	35.98
Granted	716		66.60
Exercised	(883)		23.08
Forfeited/expired	(135)		47.60
Outstanding at December 31	3,640		44.70	3.90	$	67,868
Exercisable	1,762		35.86	2.80		46,601
Ending vested and expected to vest	3,537		44.32	3.85		67,063

Schedule of Share-based Compensation, PSUs and RSUs, Activity

Changes in PSUs and RSUs for the year ended December 31, 2021, consisted of the following:


	PSUs				RSUs
			Weighted Average			Weighted Average
	Stock Units		Grant Date		Stock Units	Grant Date
	(In Thousands)	⁽¹⁾	Fair Value		(In Thousands)	Fair Value
Beginning nonvested balance	102		$	43.63	34	$	42.98
Granted	103			61.39	26		61.77
rTSR adjustment	5	⁽²⁾		43.43	—		—
Vested	(26)			43.43	(34)		42.98
Forfeited	(21)			52.56	—		—
Nonvested balance at December 31	163			53.71	26		61.77

(1)

(2)

Represents the application of an rTSR multiplier of 125% to awards vested in 2021 based on the performance of our common stock and the terms of the awards.

Schedule of Share-based Compensation, PSUs and RSUs Granted

The following table summarizes PSUs and RSUs granted during the years ended December 31, 2021, 2020 and 2019 (units and shares in thousands):


	2021		2020			2019
PSUs
Target units granted		52		61			—
Maximum units granted ⁽¹⁾		103		102	⁽³⁾		—
Maximum potential shares⁽¹⁾⁽²⁾		129		127	⁽³⁾		—
Weighted average grant date fair value	$	61.39	$	43.63			N/A
RSUs
Units granted		26		34			—
Weighted average grant date fair value	$	61.77	$	42.98			N/A

(1)

Based on the maximum payout, excluding the impact of the rTSR multiplier.

(2)

Includes the impact of the maximum potential rTSR multiplier of 125%.

(3)

Includes the impact of the 2020 amendment which reduced the maximum FCF multiplier for one-year awards from 200% to 100%.

Schedule of Share-based Payment Award, PSUs, Valuation Assumptions

The fair value of each PSU was estimated as of the grant date using the following assumptions for awards granted in the years ended December 31, 2021 and 2020:


	2021	2020
Risk-free interest rate	0.1% - 0.3%	1.1% - 1.3%
Performance period	1.8 - 2.8 years	0.8 - 2.8 years
Expected dividend yield	—	—
Expected price volatility	43.7% - 49.3%	40.2% - 56.1%

Segment Reporting (Tables)

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Schedule of Long-lived Assets by Geographic Area

Our long-lived assets (which are comprised of our net property and equipment) by geographic area at December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
United States	$	275,311	$	277,643	$	273,816
Ireland		39,863		42,951		44,912
Other foreign countries		56,484		62,134		60,057
Total	$	371,658	$	382,728	$	378,785

Schedule of Segment Reporting Information, by Segment

Financial information relating to our reportable operating segments and reconciliations to the consolidated totals for the years ended December 31, 2021, 2020 and 2019, are as follows (in thousands):




	2021		2020		2019
Net Sales
Cardiovascular	$	1,043,227	$	934,202	$	960,981
Endoscopy		31,524		29,673		33,871
Total net sales		1,074,751		963,875		994,852

Operating Income (Loss)
Cardiovascular		53,415		(7,042)		25,780
Endoscopy		7,501		5,480		(10,346)
Total operating income (loss)		60,916		(1,562)		15,434

Total other expense - net		(6,999)		(11,669)		(13,241)
Income tax expense (benefit)		5,463		(3,388)		(3,258)

Net income (loss)	$	48,454	$	(9,843)	$	5,451

Total depreciation and amortization by operating segment for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Cardiovascular	$	83,000	$	93,160	$	91,151
Endoscopy		1,066		910		949
Total	$	84,066	$	94,070	$	92,100

Total capital expenditures for property and equipment by operating segment for the years ended December 31, 2021, 2020 and 2019, consisted of the following (in thousands):


	2021		2020		2019
Cardiovascular	$	27,557	$	45,803	$	77,631
Endoscopy		382		185		542
Total	$	27,939	$	45,988	$	78,173

Reconciliation of Assets from Segment to Consolidated




	2021		2020		2019
Net Sales
Cardiovascular	$	1,043,227	$	934,202	$	960,981
Endoscopy		31,524		29,673		33,871
Total net sales		1,074,751		963,875		994,852

Operating Income (Loss)
Cardiovascular		53,415		(7,042)		25,780
Endoscopy		7,501		5,480		(10,346)
Total operating income (loss)		60,916		(1,562)		15,434

Total other expense - net		(6,999)		(11,669)		(13,241)
Income tax expense (benefit)		5,463		(3,388)		(3,258)

Net income (loss)	$	48,454	$	(9,843)	$	5,451

Fair Value Measurements (Tables)

12 Months Ended

Dec. 31, 2021

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 December 31, 2021 and 2020, 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
	December 31, 2021		(Level 1)		(Level 2)		(Level 3)
Interest rate contract liabilities, long-term ⁽¹⁾	$	(1,447)	$	—	$	(1,447)	$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	2,241	$	—	$	2,241	$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(3,646)	$	—	$	(3,646)	$	—
Contingent consideration liabilities	$	(48,234)	$	—	$	—	$	(48,234)


			Fair Value Measurements Using
	Total Fair		Quoted prices in		Significant other		Significant
	Value at		active markets		observable inputs		unobservable inputs
	December 31, 2020		(Level 1)		(Level 2)		(Level 3)
Interest rate contract liabilities, current and long-term ⁽¹⁾	$	(4,358)	$	—	$	(4,358)	$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	3,078	$	—	$	3,078	$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(8,267)	$	—	$	(8,267)	$	—
Contingent consideration liabilities	$	(55,750)	$	—	$	—	$	(55,750)

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

(2)

(3)

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

Changes in the fair value of our contingent consideration liabilities during the years ended December 31, 2021 and 2020, consisted of the following (in thousands):


	2021		2020
Beginning balance	$	55,750	$	76,709
Contingent consideration expense (benefit)		3,161		(7,960)
Contingent payments made		(10,665)		(13,100)
Effect of foreign exchange		(12)		101
Ending balance	$	48,234	$	55,750

Fair Value Inputs, Liabilities, Quantitative Information

The recurring Level 3 measurement of our contingent consideration liabilities includes the following significant unobservable inputs at December 31, 2021 and 2020 (amounts in thousands):


	Fair value at
	December 31,		Valuation			Weighted
Contingent consideration liability	2021		technique	Unobservable inputs	Range	Average⁽¹⁾
Revenue-based royalty payments contingent liability	$	2,870	Discounted cash flow	Discount rate	13% - 16%	14.7%
				Projected year of payments	2022-2034	2026

Revenue milestones contingent liability	$	41,671	Monte Carlo simulation	Discount rate	7.5% - 12.5%	8.2%
				Projected year of payments	2022-2031	2022

Regulatory approval contingent liability	$	3,693	Scenario-based method	Discount rate	2.6%
				Probability of milestone payment	80%
				Projected year of payment	2024-2025	2025

(1)	Unobservable inputs were weighted by the relative fair value of the instruments. No weighted average is reported for contingent consideration liabilities without a range of unobservable inputs.


	Fair value at
	December 31,		Valuation			Weighted
Contingent consideration liability	2020		technique	Unobservable inputs	Range	Average⁽¹⁾
Revenue-based royalty payments contingent liability	$	4,545	Discounted cash flow	Discount rate	12% - 15%	13.5%
				Projected year of payments	2021-2034	2026

Revenue milestones contingent liability	$	46,305	Monte Carlo simulation	Discount rate	7.5% - 12%	9.0%
				Projected year of payments	2021-2030	2022

Regulatory approval contingent liability	$	4,900	Scenario-based method	Discount rate	1%
				Probability of milestone payment	100%
				Projected year of payment	2021-2024	2022

(1)	Unobservable inputs were weighted by the relative fair value of the instruments. No weighted average is reported for contingent consideration liabilities without a range of unobservable inputs.

Schedule of Rollforward of Allowance for Credit Losses

The table below presents a rollforward of the allowance for current expected credit losses on our notes receivable for the years ended December 31, 2021 and 2020 (in thousands):


	2021		2020
Beginning balance	$	730	$	—
Cumulative effect adjustment upon adoption of ASU 2016-13, Credit Losses		—		575
Provision for credit loss - expense (benefit)		(531)		155
Ending balance	$	199	$	730

Accumulated Other Comprehensive Income (Loss) (Tables)

12 Months Ended

Dec. 31, 2021

Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]

Schedule of Components of Accumulated Other Comprehensive Income (Loss)

16.ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS)

The changes in each component of Accumulated Other Comprehensive Income (Loss) for the years ended December 31, 2021, 2020 and 2019 were as follows (in thousands):


	Cash Flow Hedges		Foreign Currency Translation		Total
January 1, 2019	$	3,522		(5,555)		(2,033)

Other comprehensive income (loss)		(3,417)		(18)		(3,435)
Income taxes		1,404		61		1,465
Reclassifications to:
Revenue		(577)				(577)
Cost of sales		578				578
Interest expense		(2,040)				(2,040)
Net other comprehensive income (loss)		(4,052)		43		(4,009)

Reclassification of stranded tax effects ¹		748				748

December 31, 2019		218		(5,512)		(5,294)

Other comprehensive income (loss)		(11,647)		7,786		(3,861)
Income taxes		2,365		(786)		1,579
Reclassifications to:
Revenue		(36)				(36)
Cost of sales		1,288				1,288
Interest expense		872				872
Net other comprehensive income (loss)		(7,158)		7,000		(158)

December 31, 2020		(6,940)		1,488		(5,452)

Other comprehensive income (loss)		(119)		(7,704)		(7,823)
Income taxes		(1,489)		689		(800)
Reclassifications to:
Revenue		5,592				5,592
Cost of sales		(1,017)				(1,017)
Interest expense		1,509				1,509
Net other comprehensive income (loss)		4,476		(7,015)		(2,539)

December 31, 2021	$	(2,464)	$	(5,527)	$	(7,991)

(1)	Amounts reclassified to retained earnings as a result of the adoption of ASU 2018-02.

Leases (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Schedule of Consolidated Balance Sheet Information and Supplemental Information

The following was included in our consolidated balance sheet as of December 31, 2021 and 2020 (in thousands):


	2021		2020
Assets
ROU operating lease assets	$	65,913	$	78,240

Liabilities
Short-term operating lease liabilities	$	10,668	$	12,903
Long-term operating lease liabilities		61,526		70,941
Total operating lease liabilities	$	72,194	$	83,844

Components of Lease Costs



Lease Cost	Classification	2021		2020		2019
Operating lease cost (a)	Selling, general and administrative expenses	$	16,013	$	16,735	$	16,828
Sublease (income) (b)	Selling, general and administrative expenses		(75)		(15)		(361)
Net lease cost		$	15,938	$	16,720	$	16,467


(a)	Includes expense related to short-term leases and variable payments, which were not significant.

(b)		Does not include rental revenue from leases of hardware consoles to customers, which was not significant.

Supplemental cash flow information for the years ended December 31, 2021, 2020 and 2019 was as follows, in thousands:


	2021		2020		2019
Cash paid for amounts included in the measurement of lease liabilities	$	14,970		15,059		14,646
Right-of-use assets obtained in exchange for lease obligations	$	1,524		10,938		10,637


	2021	2020	2019
Weighted average remaining lease term	11.4 years	11.5 years	12.3 years
Weighted average discount rate	3.4%	3.3%	3.2%

Maturities of Operating Lease Liabilities

As of December 31, 2021, maturities of operating lease liabilities were as follows, in thousands:


Year ended December 31,	Amounts due under operating leases
2022	$	12,405
2023		9,794
2024		8,847
2025		7,130
2026		6,378
Thereafter		43,306
Total lease payments		87,860
Less: Imputed interest		(15,666)
Total	$	72,194

Organization and Summary of Significant Accounting Policies - Organization (Details)	12 Months Ended
	Dec. 31, 2021 item segment
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Number of operating segments \| segment	2
Number of product categories \| item	5

Organization and Summary of Significant Accounting Policies - Cash and Cash Equivalents (Details) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020
Cash and Cash Equivalents
Restricted cash	$ 1.9	$ 0.0

Organization and Summary of Significant Accounting Policies - Reclassifications (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Fair value adjustments to contingent consideration	$ 3,161	$ (7,960)	$ (232)

Organization and Summary of Significant Accounting Policies - Property and Equipment (Details) $ in Millions	12 Months Ended
	Dec. 31, 2021 USD ($) segment	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Property, Plant and Equipment [Line Items]
Reporting units \| segment	4
Depreciation \| $	$ 34.5	$ 35.4	$ 31.4
Buildings
Property, Plant and Equipment [Line Items]
Useful life	40 years
Manufacturing equipment \| Minimum
Property, Plant and Equipment [Line Items]
Useful life	4 years
Manufacturing equipment \| Maximum
Property, Plant and Equipment [Line Items]
Useful life	20 years
Furniture and fixtures \| Minimum
Property, Plant and Equipment [Line Items]
Useful life	3 years
Furniture and fixtures \| Maximum
Property, Plant and Equipment [Line Items]
Useful life	20 years
Land improvements \| Minimum
Property, Plant and Equipment [Line Items]
Useful life	10 years
Land improvements \| Maximum
Property, Plant and Equipment [Line Items]
Useful life	20 years
Leasehold improvements \| Minimum
Property, Plant and Equipment [Line Items]
Useful life	4 years
Leasehold improvements \| Maximum
Property, Plant and Equipment [Line Items]
Useful life	25 years

Organization and Summary of Significant Accounting Policies - Deferred Compensation (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Cash surrender value of life insurance	$ 19,100	$ 17,100
Deferred compensation cost	$ 18,111	$ 16,808

Organization and Summary of Significant Accounting Policies - Other Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Other Assets
Deferred compensation plan assets	$ 19,126	$ 17,074
Investments in privately held companies	14,711	12,043
Long-term notes receivable	2,345	2,196
Other	5,239	6,363
Total Other Assets	$ 41,421	$ 37,676

Organization and Summary of Significant Accounting Policies - Other Long-term Obligations (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Contingent consideration liabilities	$ 13,500	$ 36,917
Other long-term obligations	10,084	15,831
Total	$ 23,584	$ 52,748

Organization and Summary of Significant Accounting Policies - Stock Based Compensation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Allocated share-based compensation	$ 16,090	$ 14,339	$ 9,382

Revenues - Disaggregation of Revenue (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($) item segment	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Disaggregation of Revenue [Line Items]
Number of operating segments \| segment	2
Number of product categories \| item	5
Net sales	$ 1,074,751	$ 963,875	$ 994,852
United States
Disaggregation of Revenue [Line Items]
Net sales	608,878	550,061	575,711
International
Disaggregation of Revenue [Line Items]
Net sales	$ 465,873	413,814	419,141
Cardiovascular
Disaggregation of Revenue [Line Items]
Number of product categories \| item	4
Net sales	$ 1,043,227	934,202	960,981
Cardiovascular \| Peripheral Intervention
Disaggregation of Revenue [Line Items]
Net sales	405,116	341,568	350,936
Cardiovascular \| Cardiac Intervention
Disaggregation of Revenue [Line Items]
Net sales	320,641	279,671	304,797
Cardiovascular \| Custom Procedural Solutions
Disaggregation of Revenue [Line Items]
Net sales	193,942	203,196	187,359
Cardiovascular \| OEM
Disaggregation of Revenue [Line Items]
Net sales	123,528	109,767	117,889
Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	579,415	522,203	543,116
Cardiovascular \| United States \| Peripheral Intervention
Disaggregation of Revenue [Line Items]
Net sales	244,459	211,999	226,788
Cardiovascular \| United States \| Cardiac Intervention
Disaggregation of Revenue [Line Items]
Net sales	122,452	108,109	115,604
Cardiovascular \| United States \| Custom Procedural Solutions
Disaggregation of Revenue [Line Items]
Net sales	108,068	110,269	99,659
Cardiovascular \| United States \| OEM
Disaggregation of Revenue [Line Items]
Net sales	104,436	91,826	101,065
Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	463,812	411,999	417,865
Cardiovascular \| International \| Peripheral Intervention
Disaggregation of Revenue [Line Items]
Net sales	160,657	129,569	124,148
Cardiovascular \| International \| Cardiac Intervention
Disaggregation of Revenue [Line Items]
Net sales	198,189	171,562	189,193
Cardiovascular \| International \| Custom Procedural Solutions
Disaggregation of Revenue [Line Items]
Net sales	85,874	92,927	87,700
Cardiovascular \| International \| OEM
Disaggregation of Revenue [Line Items]
Net sales	19,092	17,941	16,824
Endoscopy
Disaggregation of Revenue [Line Items]
Net sales	31,524	29,673	33,871
Endoscopy \| Endoscopy Devices
Disaggregation of Revenue [Line Items]
Net sales	31,524	29,673	33,871
Endoscopy \| United States \| Endoscopy Devices
Disaggregation of Revenue [Line Items]
Net sales	29,463	27,858	32,595
Endoscopy \| International \| Endoscopy Devices
Disaggregation of Revenue [Line Items]
Net sales	$ 2,061	$ 1,815	$ 1,276

Acquisitions and Other Strategic Transactions - Narrative (Details) € in Millions					1 Months Ended	12 Months Ended
	Nov. 06, 2020 USD ($)	Oct. 11, 2019 USD ($) shares	Aug. 01, 2019 USD ($)	Jun. 14, 2019 USD ($)	Sep. 30, 2021 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Dec. 31, 2021 EUR (€)
Business Acquisition [Line Items]
Contingent liability						$ 13,500,000	$ 36,917,000
Payments to acquire intangible assets						2,834,000	3,288,000	$ 3,324,000
Impairment charges						4,283,000	$ 36,504,000	23,750,000
NinePoint Medical, Inc.
Business Acquisition [Line Items]
Write off of accrued interest								(1,600,000)
KA Medical
Business Acquisition [Line Items]
Purchase consideration, upfront payment	$ 14,600,000
Purchase consideration, note payable	$ 4,000,000
KA Medical \| Developed technology
Business Acquisition [Line Items]
Weighted average useful life	17 years
Selio
Business Acquisition [Line Items]
Ownership percentage		19.50%
Equity method investment		$ 2,600,000
Loan from acquisition						$ 2,500,000
Interest rate on loan						5.00%			5.00%
Selio \| Maximum
Business Acquisition [Line Items]
Loan commitment from acquisition \| €									€ 2
Selio \| Ordinary shares
Business Acquisition [Line Items]
Shares acquired (in shares) \| shares		3,900
Term of option to purchase equity		45 days
Selio \| C Ordinary shares
Business Acquisition [Line Items]
Shares acquired (in shares) \| shares		1,365
Fibrovein Holdings Limited
Business Acquisition [Line Items]
Purchase consideration, upfront payment			$ 13,700,000
Weighted average useful life			12 years
Contingent liability			$ 934,000
Fibrovein Holdings Limited \| Developed technology
Business Acquisition [Line Items]
Weighted average useful life			12 years
Fibrovein Holdings Limited \| STD Pharmaceutical Products Limited
Business Acquisition [Line Items]
Ownership percentage			100.00%
Brightwater
Business Acquisition [Line Items]
Purchase consideration, upfront payment				$ 35,000,000
Weighted average useful life				12 years 10 months 24 days
Brightwater \| Developed technology
Business Acquisition [Line Items]
Weighted average useful life				13 years
Brightwater \| Trademarks
Business Acquisition [Line Items]
Weighted average useful life				5 years
Brightwater \| Customer Lists
Business Acquisition [Line Items]
Weighted average useful life				1 year
Brightwater \| Maximum \| Achievement of CE Certification
Business Acquisition [Line Items]
Earn-out payments				$ 5,000,000
Brightwater \| Maximum \| Achievement of Sales Milestones
Business Acquisition [Line Items]
Earn-out payments				$ 10,000,000
Fluidx
Business Acquisition [Line Items]
Payments to acquire shares					$ 2,700,000			$ 2,000,000
Ownership percentage						15.00%			15.00%
Fusion Medical, Inc.
Business Acquisition [Line Items]
Ownership percentage						19.50%			19.50%

Acquisitions and Other Strategic Transactions - Purchase Price Allocation (Details) - USD ($) $ in Thousands	Nov. 06, 2020	Aug. 01, 2019	Jun. 14, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Assets Acquired
Goodwill				$ 361,741	$ 363,533	$ 353,193
KA Medical
Assets Acquired
Trade receivables	$ 24
Other receivables	13
Inventories	211
Property and equipment	298
Other long-term assets	10
Goodwill	8,570
Total assets acquired	15,126
Liabilities Assumed
Trade payables	(31)
Accrued expenses	(507)
Total liabilities assumed	(538)
Total net assets acquired	14,588
KA Medical \| Developed technology
Assets Acquired
Intangible assets	$ 6,000
Liabilities Assumed
Weighted average useful life	17 years
Fibrovein Holdings Limited
Assets Acquired
Trade receivables		$ 277
Inventories		843
Prepaid expenses and other assets		49
Goodwill		4,975
Total assets acquired		16,572
Liabilities Assumed
Trade payables		(53)
Accrued expenses		(29)
Deferred income tax liabilities		(1,890)
Total liabilities assumed		(1,972)
Total net assets acquired		$ 14,600
Weighted average useful life		12 years
Fibrovein Holdings Limited \| Developed technology
Assets Acquired
Intangible assets		$ 10,428
Liabilities Assumed
Weighted average useful life		12 years
Brightwater
Assets Acquired
Trade receivables			$ 55
Inventories			349
Property and equipment			409
Other long-term assets			30
Goodwill			17,607
Total assets acquired			50,743
Liabilities Assumed
Trade payables			(58)
Accrued expenses			(261)
Other long-term liabilities			(1,522)
Deferred income tax liabilities			(4,263)
Total liabilities assumed			(6,104)
Total net assets acquired			$ 44,639
Weighted average useful life			12 years 10 months 24 days
Brightwater \| Developed technology
Assets Acquired
Intangible assets			$ 31,960
Liabilities Assumed
Weighted average useful life			13 years
Brightwater \| Customer Lists
Assets Acquired
Intangible assets			$ 83
Liabilities Assumed
Weighted average useful life			1 year
Brightwater \| Trademarks
Assets Acquired
Intangible assets			$ 250
Liabilities Assumed
Weighted average useful life			5 years

Inventories (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Finished goods	$ 132,403	$ 110,933
Work-in-process	22,160	19,308
Raw materials	67,359	67,778
Total Inventories	$ 221,922	$ 198,019

Goodwill and Intangible Assets - Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Goodwill [Roll Forward]
Goodwill balance at beginning of period	$ 363,533	$ 353,193
Effect of foreign exchange	(2,078)	1,941
Additions and adjustments as the result of acquisitions	286	8,399
Goodwill balance at end of period	$ 361,741	$ 363,533

Goodwill and Intangible Assets - Other Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Other
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 107,489	$ 106,799
Accumulated Amortization	(65,053)	(56,943)
Net Carrying Amount	42,436	49,856
Patents
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	26,349	23,669
Accumulated Amortization	(8,315)	(6,460)
Net Carrying Amount	18,034	17,209
Distribution agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	3,250	3,250
Accumulated Amortization	(2,519)	(2,319)
Net Carrying Amount	731	931
License agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	12,663	14,453
Accumulated Amortization	(7,768)	(6,647)
Net Carrying Amount	4,895	7,806
Trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	30,242	30,273
Accumulated Amortization	(15,256)	(12,414)
Net Carrying Amount	14,986	17,859
Customer Lists
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	34,985	35,154
Accumulated Amortization	(31,195)	(29,103)
Net Carrying Amount	$ 3,790	$ 6,051

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Accumulated goodwill impairment losses	$ 8.3	$ 8.3
Goodwill impairment loss	0.0	0.0	$ 0.0
Aggregate amortization expense	49.6	58.6	60.7
Impairment of intangible assets	1.6	28.7	$ 3.3
ArraVasc Limited
Finite-Lived Intangible Assets [Line Items]
Impairment of intangible assets	$ 1.6	4.8
STD Pharmaceutical Products Limited
Finite-Lived Intangible Assets [Line Items]
Impairment of intangible assets		8.2
Laurane Medical S.A.S.
Finite-Lived Intangible Assets [Line Items]
Impairment of intangible assets		8.0
Other Acquisitions
Finite-Lived Intangible Assets [Line Items]
Impairment of intangible assets		$ 7.7

Goodwill and Intangible Assets - Future Amortization Expense (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2022	$ 48,195
2023	47,101
2024	44,165
2025	42,396
2025	$ 31,843

Income Taxes - Domestic and Foreign (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Domestic	$ 21,328	$ (32,216)	$ (37,277)
Foreign	32,589	18,985	39,470
Income (loss) before income taxes	$ 53,917	$ (13,231)	$ 2,193

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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-Section 50
-Paragraph 32
-Subparagraph (f)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
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-Section 25
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-URI http://asc.fasb.org/extlink&oid=123384075&loc=d3e41242-110953

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
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-Subparagraph (SX 210.5-03(10))
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Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
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-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(8))
-URI http://asc.fasb.org/extlink&oid=120400993&loc=SL114874131-224263

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
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-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-URI http://asc.fasb.org/extlink&oid=120399901&loc=d3e537907-122884

Reference 9: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8924-108599

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
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-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(15))
-URI http://asc.fasb.org/extlink&oid=120399700&loc=SL114874048-224260

+ Details

Income Taxes - Components of Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Current expense (benefit):
Federal	$ 808	$ (937)	$ 479
State	806	437	662
Foreign	8,480	8,407	8,037
Total current expense	10,094	7,907	9,178
Deferred expense (benefit):
Federal	(468)	(2,688)	(8,111)
State	(1,845)	(4,524)	(3,523)
Foreign	(2,318)	(4,083)	(802)
Total deferred expense (benefit)	(4,631)	(11,295)	(12,436)
Total income tax expense (benefit)	$ 5,463	$ (3,388)	$ (3,258)

Income Taxes - Effective Income Tax Rate Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Statutory federal rate	21.00%	21.00%	21.00%
Computed federal income tax expense (benefit) at applicable statutory rate of 21%	$ 11,323	$ (2,778)	$ 461
State income tax benefit	(283)	(1,448)	(2,241)
Tax credits	(2,507)	(2,391)	(1,064)
Tax effect of international items	(281)	4,705	1,325
Uncertain tax positions	401	(455)	(574)
Deferred compensation insurance assets	(413)	(290)	(493)
Stock-based compensation	(5,571)	(1,822)	(1,659)
Valuation allowance		1,257
DOJ Settlement		1,890
Remeasurement of state deferred taxes	(526)	(1,765)
Non-deductible expenses	2,455	1,077	1,320
Remeasurement of contingent consideration liabilities	733	(1,185)	(87)
Other - including the effect of graduated rates	132	(183)	(246)
Total income tax expense (benefit)	$ 5,463	$ (3,388)	$ (3,258)

Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred income tax assets:
Allowance for credit losses on trade receivables	$ 1,494	$ 1,198
Accrued compensation expense	11,063	9,694
Inventory differences	4,887	3,161
Net operating loss carryforwards	14,833	18,622
Stock-based compensation expense	6,388	7,360
Operating lease assets	13,431	15,182
Federal R&D tax credit	5,003	3,607
UT R&D Credit	4,126	3,484
Other	9,939	11,126
Total deferred income tax assets	71,164	73,434
Deferred income tax liabilities:
Prepaid expenses	(1,047)	(1,078)
Property and equipment	(20,797)	(20,671)
Intangible assets	(42,888)	(47,178)
Foreign withholding tax	(5,575)	(5,358)
Operating lease liabilities	(11,938)	(13,855)
Other	(3,556)	(3,796)
Total deferred income tax liabilities	(85,801)	(91,936)
Valuation allowance	(10,786)	(10,213)
Net deferred income tax liabilities	(25,423)	(28,715)
Reported as:
Deferred income tax assets	6,080	4,597
Deferred income tax liabilities	(31,503)	(33,312)
Net deferred income tax liabilities	$ (25,423)	$ (28,715)

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
Income Taxes - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Significant Change in Unrecognized Tax Benefits is Reasonably Possible [Line Items]
Increase (Decrease) in valuation allowance	$ 573	$ 5,600	$ (345)
U.S. federal net operating loss carryforwards	45,600
Foreign operating loss carryforwards	22,800
Foreign withholding tax	288	228	638
Unrecognized tax benefits including interest and penalties	2,000	2,000
Unrecognized tax benefits that would impact effective rate	2,000	1,600
Unrecognized tax benefits reduction to non-current deferred income tax assets	1,000	627
Accrued interest and penalties	322	276
Increase (decrease) of uncertain tax benefits related to certain liabilities for unrecognized tax benefits	46	$ (90)	$ (7)
Estimated decrease in unrecognized tax benefit in next twelve months	86
Domestic
Significant Change in Unrecognized Tax Benefits is Reasonably Possible [Line Items]
Operating loss carryforward, expiring	34,500
Operating loss carryforward, no expiration	$ 11,100
Period to utilize the net operating loss carryforwards	14 years
NOL carryforward used in period	$ 21,300
Foreign
Significant Change in Unrecognized Tax Benefits is Reasonably Possible [Line Items]
Operating loss carryforward, expiring	879
Operating loss carryforward, no expiration	$ 21,900

Income Taxes - Summary of Income Tax Contingencies (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Unrecognized tax benefits, opening balance	$ 1,674	$ 2,161	$ 2,947
Gross increases in tax positions taken in a prior year	82	115
Gross decreases in tax positions taken in a prior year			(244)
Gross increases in tax positions taken in the current year	316	283	229
Lapse of applicable statute of limitations	(437)	(885)	(771)
Unrecognized tax benefits, ending balance	$ 1,635	$ 1,674	$ 2,161

Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Payroll and related liabilities	$ 59,435	$ 41,023
Current portion of contingent liabilities	34,735	18,833
Advances from employees	201	259
Accrued rebates payable	11,271	9,532
Accrued legal settlement	18,250
Other accrued expenses	35,122	42,297
Accrued Liabilities, Current, Total	$ 159,014	$ 111,944

Revolving Credit Facility and Long-Term Debt - Principal Balances under Long-term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Long-term debt	$ 243,125
Less unamortized debt issuance costs	(290)	$ (403)
Total long-term debt	242,835	351,222
Less current portion	8,438	7,500
Long-term portion	234,397	343,722
Term Loan
Debt Instrument [Line Items]
Long-term debt	133,125	140,625
Revolving Credit Facility
Debt Instrument [Line Items]
Long-term debt	$ 110,000	$ 211,000

- Definition

Amount, after unamortized (discount) premium and debt issuance costs, of long-term debt. Includes, but not limited to, notes payable, bonds payable, debentures, mortgage loans and commercial paper. Excludes capital lease obligations.

+ References + Details

Revolving Credit Facility and Long-Term Debt - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Outstanding borrowings	$ 243,125
Credit Agreement
Debt Instrument [Line Items]
Outstanding borrowings	243,100
Letter of credit guarantees	3,500
Available borrowing capacity	$ 490,000
Fixed interest rate percent	2.71%	2.37%
Debt subject to fixed interest rate	$ 75,000	$ 175,000
Variable interest rate percent	1.10%	1.40%
Debt subject to variable interest rate	$ 168,100	$ 176,600
Term Loan
Debt Instrument [Line Items]
Outstanding borrowings	133,125	140,625
Term Loan \| Credit Agreement
Debt Instrument [Line Items]
Debt instrument, face amount	150,000
Revolving Credit Facility
Debt Instrument [Line Items]
Outstanding borrowings	110,000	$ 211,000
Revolving Credit Facility \| Credit Agreement
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 600,000

Revolving Credit Facility and Long-Term Debt - Financial Covenants (Details) - Credit Agreement $ in Millions	12 Months Ended
	Dec. 31, 2021 USD ($)
Debt Instrument [Line Items]
Consolidated Total Leverage Ratio	4.0
Consolidated Interest Coverage Ratio	3.0
Facility Capital Expenditures	$ 50

Revolving Credit Facility and Long-Term Debt - Future Minimum Payments on Long-term Debt (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Debt Disclosure [Abstract]
2022	$ 8,438
2023	11,250
2024	223,437
Total future minimum principal payments	$ 243,125

Derivatives - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
Derivatives - Narrative (Details) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020	Dec. 23, 2019	Aug. 05, 2016
Revenue and cost of sales
Derivative [Line Items]
Amount expected to be reclassified from accumulated other comprehensive income (loss) to earnings in next twelve months, gross	$ (1.4)
Amount expected to be reclassified from accumulated other comprehensive income to earnings (loss) in next twelve months, net of tax	(1.0)
Interest expense
Derivative [Line Items]
Amount expected to be reclassified from accumulated other comprehensive income (loss) to earnings in next twelve months, gross	(1.0)
Amount expected to be reclassified from accumulated other comprehensive income to earnings (loss) in next twelve months, net of tax	(0.7)
Interest rate swap
Derivative [Line Items]
Notional amount of derivative			$ 75.0	$ 175.0
Interest rate swap \| Designated as hedging instrument
Derivative [Line Items]
Fair value of derivative liability	1.4	$ 4.4
Deferred tax asset used to offset fair value of interest rate swap	$ 0.4	$ 1.1
Interest rate swap \| LIBOR Swap Rate
Derivative [Line Items]
Fixed rate			1.71%	1.12%
Foreign currency forward contracts
Derivative [Line Items]
Maturity of derivative contract (up to)	2 years

Derivatives - Forward Notional Contracts (Details) - Foreign currency forward contracts $ in Millions	Dec. 31, 2021 USD ($) DerivativeInstrument	Dec. 31, 2020 USD ($)
Designated as hedging instrument \| Derivatives designated as cash flow hedges
Derivative [Line Items]
Average number of contracts entered into per month \| DerivativeInstrument	100
Aggregate notional amount of derivative \| $	$ 123.0	$ 168.2
Not designated as hedging instrument
Derivative [Line Items]
Average number of contracts entered into per month \| DerivativeInstrument	50
Aggregate notional amount of derivative \| $	$ 86.0	$ 74.8

Derivatives - Fair Value of Derivative Instruments (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Designated as hedging instrument \| Interest rate swap \| Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives		$ (896)
Designated as hedging instrument \| Interest rate swap \| Other long-term obligations
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	$ (1,447)	(3,462)
Designated as hedging instrument \| Foreign currency forward contracts \| Other assets (long-term)
Derivatives, Fair Value [Line Items]
Fair value of derivative asset	179	424
Designated as hedging instrument \| Foreign currency forward contracts \| Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Fair value of derivative asset	1,326	1,777
Designated as hedging instrument \| Foreign currency forward contracts \| Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(2,288)	(5,281)
Designated as hedging instrument \| Foreign currency forward contracts \| Other long-term obligations
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(502)	(866)
Not designated as hedging instrument \| Foreign currency forward contracts \| Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Fair value of derivative asset	736	877
Not designated as hedging instrument \| Foreign currency forward contracts \| Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	$ (856)	$ (2,120)

Derivatives - Amount of Gain (Loss) Recognized in OCI and Income Statement (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	$ 5,965	$ (9,523)	$ (5,456)
Interest expense	(5,261)	(9,994)	(12,413)
Net sales	1,074,751	963,875	994,852
Cost of sales	(589,418)	(562,698)	(562,486)
Derivatives designated as cash flow hedges \| Interest expense
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) reclassified from AOCI	(1,509)	(872)	2,040
Derivatives designated as cash flow hedges \| Revenue
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) reclassified from AOCI	(5,592)	36	577
Derivatives designated as cash flow hedges \| Cost of sales
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) reclassified from AOCI	1,017	(1,288)	(578)
Derivatives designated as cash flow hedges \| Interest rate swap
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	1,402	(6,131)	(2,830)
Derivatives designated as cash flow hedges \| Foreign currency forward contracts
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	$ (1,521)	$ (5,516)	$ (587)

Derivatives - Gain (Loss) in the Consolidated Statements of Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Not designated as hedging instrument \| Foreign currency forward contracts \| Other income (expense)
Derivative [Line Items]
Gain (loss) on derivative	$ (1,598)	$ (2,190)	$ (307)

Commitments and Contingencies - Narrative (Details) - USD ($) $ in Thousands		1 Months Ended	12 Months Ended
	Oct. 13, 2020	Nov. 30, 2021	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Other Commitments [Line Items]
Royalty expense			$ 7,600	$ 7,100	$ 6,700
Legal settlement			$ 10,036	18,684
Securities Litigation
Other Commitments [Line Items]
Aggregate settlement amount		$ 18,250
Proceeds from available insurance		$ 8,200
DOJ
Other Commitments [Line Items]
Aggregate settlement amount	$ 18,000
Legal settlement				$ 18,700

Earnings Per Common Share (EPS) - Basic EPS (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Earnings Per Share, Basic and Diluted [Abstract]
Net income (loss)	$ 48,454	$ (9,843)	$ 5,451
Average common shares outstanding (in shares)	56,145	55,434	55,075
Basic EPS (in dollars per share)	$ 0.86	$ (0.18)	$ 0.10

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 40
-Section 65
-Paragraph 1
-Subparagraph (e)(4)
-URI http://asc.fasb.org/extlink&oid=123482062&loc=SL123482106-238011

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=124431687&loc=d3e22583-107794

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 11
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=124431687&loc=d3e22694-107794

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=125511455&loc=d3e1448-109256

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 4
-URI http://asc.fasb.org/extlink&oid=124431687&loc=d3e22595-107794

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 11
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=124431687&loc=d3e22694-107794

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
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+ Details

- Definition

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

+ References

+ Details

Earnings Per Common Share (EPS) - Diluted EPS (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Earnings Per Share, Basic and Diluted [Abstract]
Average common shares outstanding (in shares)	56,145	55,434	55,075
Effect of dilutive stock awards (in shares)	1,214		1,160
Total potential shares outstanding (in shares)	57,359	55,434	56,235
Diluted EPS (in dollars per share)	$ 0.84	$ (0.18)	$ 0.10
Equity awards excluded as the impact was anti-dilutive (in shares)	799	4,216	1,750

- 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

Employee Stock Purchase Plan, Stock Options and Warrants - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands		3 Months Ended	12 Months Ended
	Jun. 17, 2021	Jun. 30, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Allocated share-based compensation			$ 16,090	$ 14,339	$ 9,382
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted in period (in shares)			716,000	329,000	1,200,000
Compensation cost not yet recognized			$ 26,500
Compensation cost not yet recognized, period of recognition			2 years 6 months
Fair value of options, net of forfeitures			$ 17,500	$ 4,500	$ 20,900
Options granted in period, weighted average grant date fair value (in dollars per share)			$ 24.38	$ 13.70	$ 16.78
Stock-Settled Performance-Based Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			1 year
Compensation cost not yet recognized			$ 4,400
Compensation cost not yet recognized, period of recognition			1 year 6 months
Vested (in shares)			26,000	0	0
Forfeited (in shares)			21,000
Weighted average grant-date fair value (in dollars per share)			$ 61.39	$ 43.63
Restricted stock units granted (in shares)			103,000
Restricted stock units vested (in shares)			26,000	0	0
Number of shares of common stock for each unit			1
Stock-Settled Performance-Based Restricted Stock Units \| FCF \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Multiplying factor			100.00%	100.00%	200.00%
Stock-Settled Performance-Based Restricted Stock Units \| rTSR
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Multiplying factor			125.00%
Stock-Settled Performance-Based Restricted Stock Units \| rTSR \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Multiplying factor			75.00%
Stock-Settled Performance-Based Restricted Stock Units \| rTSR \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Multiplying factor			125.00%
Stock-Settled Performance-Based Restricted Stock Units \| Performance period 1
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			1 year
Decrease in the potential shares of common stock to be granted		25,415
Stock-Settled Performance-Based Restricted Stock Units \| Performance period 1 \| FCF \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Multiplying factor				0.00%
Stock-Settled Performance-Based Restricted Stock Units \| Performance period 1 \| FCF \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Multiplying factor			100.00%	100.00%
Stock-Settled Performance-Based Restricted Stock Units \| Performance period 2
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			2 years
Stock-Settled Performance-Based Restricted Stock Units \| Performance period 2 \| FCF \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Multiplying factor			0.00%	0.00%
Stock-Settled Performance-Based Restricted Stock Units \| Performance period 2 \| FCF \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Multiplying factor			200.00%	200.00%
Stock-Settled Performance-Based Restricted Stock Units \| Performance period 3
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
Cash-Settled Performance-Based Share-Based Awards (Liability Awards)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Target cash incentive			$ 1,000	$ 1,000
Liabilities associated with awards			2,000
Compensation cost not yet recognized			$ 1,700
Compensation cost not yet recognized, period of recognition			1 year 7 months 6 days
Amount paid in connection with liability awards			$ 417
Vested (in shares)				0	0
Forfeited (in shares)			0	0	0
Restricted stock units vested (in shares)				0	0
Cash-Settled Performance-Based Share-Based Awards (Liability Awards) \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Target cash incentive			$ 2,500	$ 2,100
Multiplying factor			250.00%	250.00%
Cash-Settled Performance-Based Share-Based Awards (Liability Awards) \| Performance period 1
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			1 year
Cash-Settled Performance-Based Share-Based Awards (Liability Awards) \| Performance period 1 \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Multiplying factor				125.00%
Cash-Settled Performance-Based Share-Based Awards (Liability Awards) \| Performance period 2
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			2 years
Cash-Settled Performance-Based Share-Based Awards (Liability Awards) \| Performance period 3
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			1 year
Compensation cost not yet recognized			$ 700
Compensation cost not yet recognized, period of recognition			6 months
Vested (in shares)			34,000	0	0
Weighted average grant-date fair value (in dollars per share)			$ 61.77	$ 42.98
Restricted stock units granted (in shares)			26,000	34,000
Restricted stock units vested (in shares)			34,000	0	0
2018 Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Additional shares available for grant (in shares)	3,000,000
Shares available for grant (in shares)			3,205,529
2018 Incentive Plan \| Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period			7 years
2018 Incentive Plan \| Stock Options \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
2018 Incentive Plan \| Stock Options \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			5 years
ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Additional shares available for grant (in shares)	100,000
Shares available for grant (in shares)			121,959
Purchase price for ESPP, percent of market price			95.00%

Employee Stock Purchase Plan, Stock Options and Warrants - Allocation of Recognized Period Costs (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	$ 16,090	$ 14,339	$ 9,382
Cost of sales \| Stock Options
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	1,476	1,357	1,289
Research and development \| Stock Options
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	1,343	1,157	961
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	13,271	11,825	7,132
Selling, general and administrative \| Stock Options
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	6,678	7,332	$ 7,132
Selling, general and administrative \| Stock-Settled Performance-Based Restricted Stock Units
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	3,525	2,829
Selling, general and administrative \| Restricted Stock Units
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	1,557	758
Selling, general and administrative \| Cash-Settled Performance-Based Share-Based Awards (Liability Awards)
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	$ 1,511	$ 906

Employee Stock Purchase Plan, Stock Options and Warrants - Option Granted Fair Value Calculation Assumptions (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected dividend yield	0.00%	0.00%
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate, minimum	0.50%	0.30%	1.40%
Risk-free interest rate, maximum	1.10%	1.70%	2.60%
Expected option term / Performance Period	4 years
Expected price volatility, minimum	46.10%	38.70%	28.70%
Expected price volatility, maximum	46.70%	45.10%	39.40%
Stock Options \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected option term / Performance Period		4 years	3 years
Stock Options \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected option term / Performance Period		5 years	5 years

Employee Stock Purchase Plan, Stock Options and Warrants - Stock Option Activity (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Total intrinsic value of stock options exercised	$ 36,086	$ 11,733	$ 9,910
Cash received from stock option exercises	20,194	5,481	4,837
Excess tax benefit from the exercise of stock options	$ 5,571	$ 1,815	$ 1,654
Number of Shares
Beginning balance (in shares)	3,942
Granted (in shares)	716
Exercised (in shares)	(883)
Forfeited/expired (in shares)	(135)
Outstanding at December 31 (in shares)	3,640	3,942
Exercisable (in shares)	1,762
Ending vested and expected to vest (in shares)	3,537
Weighted Average Exercise Price
Beginning balance (in dollars per share)	$ 35.98
Granted (in dollars per share)	66.60
Exercised (in dollars per share)	23.08
Forfeited/expired (in dollars per share)	47.60
Outstanding at December 31 (in dollars per share)	44.70	$ 35.98
Exercisable (in dollars per share)	35.86
Ending vested and expected to vest (in dollars per share)	$ 44.32
Outstanding, remaining contractual term	3 years 10 months 24 days
Exercisable, remaining contractual term	2 years 9 months 18 days
Ending vested and expected to vest, remaining contractual term	3 years 10 months 6 days
Outstanding, intrinsic value	$ 67,868
Exercisable, intrinsic value	46,601
Ending vested and expected to vest, intrinsic value	$ 67,063

Employee Stock Purchase Plan, Stock Options and Warrants - Changes in PSUs and RSUs (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Stock-Settled Performance-Based Restricted Stock Units
Stock Units
Beginning balance (in shares)	102
Granted (in shares)	103
rTSR adjustment (in shares)	5
Vested (in shares)	(26)	0	0
Forfeited (in shares)	(21)
Balance at December 31 (in shares)	163	102
Weighted Average Grant Date Fair Value
Beginning balance (in dollars per share)	$ 43.63
Granted (in dollars per share)	61.39	$ 43.63
rTSR adjustment (in dollars per share)	43.43
Vested (in dollars per share)	43.43
Forfeited (in dollars per share)	52.56
Balance at December 31 (in dollars per share)	$ 53.71	$ 43.63
Stock-Settled Performance-Based Restricted Stock Units \| rTSR
Stock Units
Multiplying factor	125.00%
Stock-Settled Performance-Based Restricted Stock Units \| rTSR \| Minimum
Stock Units
Multiplying factor	75.00%
Stock-Settled Performance-Based Restricted Stock Units \| rTSR \| Maximum
Stock Units
Multiplying factor	125.00%
Restricted Stock Units
Stock Units
Beginning balance (in shares)	34
Granted (in shares)	26	34
Vested (in shares)	(34)	0	0
Balance at December 31 (in shares)	26	34
Weighted Average Grant Date Fair Value
Beginning balance (in dollars per share)	$ 42.98
Granted (in dollars per share)	61.77	$ 42.98
Vested (in dollars per share)	42.98
Balance at December 31 (in dollars per share)	$ 61.77	$ 42.98

Employee Stock Purchase Plan, Stock Options and Warrants - PSUs and RSUs Granted (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Stock-Settled Performance-Based Restricted Stock Units
PSUs and RSUs Granted
Granted (in shares)	103
Weighted average grant-date fair value (in dollars per share)	$ 61.39	$ 43.63
Vested (in shares)	26	0	0
Stock-Settled Performance-Based Restricted Stock Units \| Target units granted
PSUs and RSUs Granted
Granted (in shares)	52	61
Stock-Settled Performance-Based Restricted Stock Units \| Maximum units granted
PSUs and RSUs Granted
Granted (in shares)	103	102
Stock-Settled Performance-Based Restricted Stock Units \| Maximum potential shares
PSUs and RSUs Granted
Granted (in shares)	129	127
Stock-Settled Performance-Based Restricted Stock Units \| rTSR
PSUs and RSUs Granted
Multiplying factor	125.00%
Stock-Settled Performance-Based Restricted Stock Units \| rTSR \| Maximum
PSUs and RSUs Granted
Multiplying factor	125.00%
Stock-Settled Performance-Based Restricted Stock Units \| FCF \| Maximum
PSUs and RSUs Granted
Multiplying factor	100.00%	100.00%	200.00%
Restricted Stock Units
PSUs and RSUs Granted
Granted (in shares)	26	34
Weighted average grant-date fair value (in dollars per share)	$ 61.77	$ 42.98
Vested (in shares)	34	0	0

Stock-Based Compensation Expense - PSUs Fair Value Calculation Assumptions (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected dividend yield	0.00%	0.00%
Stock-Settled Performance-Based Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate, minimum	0.10%	1.10%
Risk-free interest rate, maximum	0.30%	1.30%
Expected price volatility, minimum	43.70%	40.20%
Expected price volatility, maximum	49.30%	56.10%
Stock-Settled Performance-Based Restricted Stock Units \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected option term / Performance Period	1 year 9 months 18 days	9 months 18 days
Stock-Settled Performance-Based Restricted Stock Units \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected option term / Performance Period	2 years 9 months 18 days	2 years 9 months 18 days

Segment Reporting and Foreign Operations - Narrative (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($) segment	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Segment Reporting Information [Line Items]
Number of operating segments \| segment	2
Net sales	$ 1,074,751	$ 963,875	$ 994,852
International
Segment Reporting Information [Line Items]
Net sales	$ 465,873	$ 413,814	$ 419,141
International \| Sales Revenue \| Geographic Concentration
Segment Reporting Information [Line Items]
Concentration for geographic sales	43.00%	43.00%	42.00%
CHINA
Segment Reporting Information [Line Items]
Net sales	$ 138,200	$ 113,200	$ 113,300

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
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-Paragraph 32
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 606
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-Paragraph 4
-Subparagraph (a)
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 1
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-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Segment Reporting and Foreign Operations - Long-lived Assets by Geographic Area (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-lived assets	$ 371,658	$ 382,728	$ 378,785
United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-lived assets	275,311	277,643	273,816
Ireland
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-lived assets	39,863	42,951	44,912
Other foreign countries
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-lived assets	$ 56,484	$ 62,134	$ 60,057

Segment Reporting and Foreign Operations - Operating Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Segment Reporting Information [Line Items]
Net sales	$ 1,074,751	$ 963,875	$ 994,852
Operating income (loss)	60,916	(1,562)	15,434
Total other income (expense) - net	(6,999)	(11,669)	(13,241)
Income tax (benefit) expense	5,463	(3,388)	(3,258)
Net income (loss)	48,454	(9,843)	5,451
Cardiovascular
Segment Reporting Information [Line Items]
Net sales	1,043,227	934,202	960,981
Operating income (loss)	53,415	(7,042)	25,780
Endoscopy
Segment Reporting Information [Line Items]
Net sales	31,524	29,673	33,871
Operating income (loss)	$ 7,501	$ 5,480	$ (10,346)

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

- Definition

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

Segment Reporting and Foreign Operations - Assets, Depreciation, Amortization and Capital Expenditures (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	$ 1,648,294	$ 1,664,396	$ 1,757,321
Depreciation and amortization	84,066	94,070	92,100
Capital expenditures	27,939	45,988	78,173
Cardiovascular
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	1,635,676	1,654,866	1,745,057
Depreciation and amortization	83,000	93,160	91,151
Capital expenditures	27,557	45,803	77,631
Endoscopy
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	12,618	9,530	12,264
Depreciation and amortization	1,066	910	949
Capital expenditures	$ 382	$ 185	$ 542

- Definition

Sum of the carrying amounts as of the balance sheet date of all assets that are recognized. Assets are probable future economic benefits obtained or controlled by an entity as a result of past transactions or events.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
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-Paragraph 1
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Reference 2: http://www.xbrl.org/2003/role/exampleRef
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-Name Accounting Standards Codification
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Topic 944
-SubTopic 210
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-03(a)(12))
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
-Topic 852
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-URI http://asc.fasb.org/extlink&oid=124433192&loc=SL2890621-112765

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
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-Paragraph 1A
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 1A
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 1
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 14: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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Reference 22: http://www.xbrl.org/2003/role/disclosureRef
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Reference 23: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 30
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

+ Details

Employee Benefit Plans (Details) - USD ($) $ in Millions	12 Months Ended
Employee Benefit Plans (Details) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Defined Contribution Plan [Abstract]
Total expense for contributions made	$ 6.5	$ 3.9	$ 6.6

Fair Value Measurements - Financial Assets and (Liabilities) Carried at Fair Value (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liabilities	$ (13,500)	$ (36,917)
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contract liabilities, current and long-term	(1,447)	(4,358)
Foreign currency contract assets, current and long-term	2,241	3,078
Foreign currency contract liabilities, current and long-term	(3,646)	(8,267)
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liabilities	(48,234)	(55,750)
Estimate of Fair Value, Fair Value Disclosure \| Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contract liabilities, current and long-term	(1,447)	(4,358)
Foreign currency contract assets, current and long-term	2,241	3,078
Foreign currency contract liabilities, current and long-term	(3,646)	(8,267)
Contingent consideration liabilities	$ (48,234)	$ (55,750)

Fair Value Measurements - Liability Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Fair Value, Recurring Basis, Unobservable Input Reconciliation, Liability, Gain (Loss), Statement of Income [Extensible List]	Business Combination, Contingent Consideration Arrangements, Contingent Consideration Benefit	Business Combination, Contingent Consideration Arrangements, Contingent Consideration Benefit
Contingent Consideration
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 55,750	$ 76,709
Contingent consideration expense	3,161	(7,960)
Contingent payments made	(10,665)	(13,100)
Effect of foreign exchange	(12)	101
Ending balance	$ 48,234	$ 55,750

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Oct. 11, 2019
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment of intangible assets	$ 1,600	$ 28,700	$ 3,300
Impairment loss on operating lease asset	1,400	1,500
Investments in privately held companies	14,711	12,043
Long-term notes receivable	2,345	2,196
Allowance for expected credit losses	199	730
Interest income	769	604	(291)
NinePoint Medical, Inc.
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment of equity method investment			20,500
Impairment of property and equipment		359
Write off of accrued interest			$ (1,600)
Interest income	400	300
Bluegrass Vascular Technologies, Inc
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment of equity method investment		3,500
Payment received on entire principal balance and all accrued interest	$ 2,800
Fusion Medical, Inc.
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment of equity method investment		2,500
Ownership percentage	19.50%
Selio
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Ownership percentage				19.50%
Equity method investment				$ 2,600
ArraVasc Limited
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment of intangible assets	$ 1,600	4,800
Impairment of property and equipment	1,300
Director \| Cianna Medical
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent payments related to acquisition	800	1,000
Other long-term obligations
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liability, noncurrent	13,500	36,900
Accrued expenses
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liability, current	$ 34,700	$ 18,800

Fair Value Measurements - Fair Value Inputs, Liabilities, Quantitative Information (Details) $ in Thousands	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration liabilities	$ 13,500	$ 36,917
Revenue-based royalty \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration liabilities	2,870	4,545
Revenue milestones \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration liabilities	41,671	46,305
Regulatory approval \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration liabilities	$ 3,693	$ 4,900
Discount rate \| Revenue-based royalty \| Minimum \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable inputs, contingent liability	0.13	0.12
Discount rate \| Revenue-based royalty \| Maximum \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable inputs, contingent liability	0.16	0.15
Discount rate \| Revenue-based royalty \| Weighted Average \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable inputs, contingent liability	0.147	0.135
Discount rate \| Revenue milestones \| Minimum \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable inputs, contingent liability	0.075	0.075
Discount rate \| Revenue milestones \| Maximum \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable inputs, contingent liability	0.125	0.12
Discount rate \| Revenue milestones \| Weighted Average \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable inputs, contingent liability	0.082	0.090
Discount rate \| Regulatory approval \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable inputs, contingent liability	0.026	0.01
Probability of milestone payment \| Regulatory approval \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable inputs, contingent liability	0.80	1

Fair Value Measurements - Allowance for Credit Losses (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Allowance for Loan and Lease Losses [Roll Forward]
Beginning balance	$ 730
Cumulative effect adjustment upon adoption of ASU 2016-13, Credit Losses		$ 575
Provision for credit loss - expense (benefit)	(531)	155
Ending balance	$ 199	$ 730

Accumulated Other Comprehensive Income (Loss) - Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Cash Flow Hedges
Balance at beginning of the year	$ (6,940)	$ 218	$ 3,522
OCI (loss)	(119)	(11,647)	(3,417)
Income taxes	(1,489)	2,365	1,404
Net OCI (loss)	4,476	(7,158)	(4,052)
Reclassification of stranded tax effects			748
Balance at end of the year	(2,464)	(6,940)	218
Foreign Currency Translation
Balance at beginning of the year	1,488	(5,512)	(5,555)
OCI (loss)	(7,704)	7,786	(18)
Income taxes	689	(786)	61
Net OCI (loss)	(7,015)	7,000	43
Balance at end of the year	(5,527)	1,488	(5,512)
Total
Balance at beginning of the year	(5,452)	(5,294)	(2,033)
OCI (loss)	(7,823)	(3,861)	(3,435)
Income taxes	(800)	1,579	1,465
Net OCI (loss)	(2,539)	(158)	(4,009)
Reclassification of stranded tax effects			748
Balance at end of the year	(7,991)	(5,452)	(5,294)
Revenue
Cash Flow Hedges
Reclassifications to	5,592	(36)	(577)
Total
Reclassifications to	5,592	(36)	(577)
Cost of sales
Cash Flow Hedges
Reclassifications to	(1,017)	1,288	578
Total
Reclassifications to	(1,017)	1,288	578
Interest expense
Cash Flow Hedges
Reclassifications to	1,509	872	(2,040)
Total
Reclassifications to	$ 1,509	$ 872	$ (2,040)

Leases - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
Leases - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2018	Dec. 31, 2015
Lessee, Lease, Description [Line Items]
Renewal term (up to)	15 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	28 years

Leases - Schedule of Consolidated Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
ROU operating lease assets	$ 65,913	$ 78,240
Short-term operating lease liabilities	10,668	12,903
Long-term operating lease liabilities	61,526	70,941
Total operating lease liabilities	$ 72,194	$ 83,844

Leases - Components of Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating lease cost	$ 16,013	$ 16,735	$ 16,828
Sublease (income)	(75)	(15)	(361)
Net lease cost	$ 15,938	$ 16,720	$ 16,467

Leases - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 14,970	$ 15,059	$ 14,646
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 1,524	$ 10,938	$ 10,637

Leases - Supplemental Disclosure (Details)	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Weighted average remaining lease term	11 years 4 months 24 days	11 years 6 months	12 years 3 months 18 days
Weighted average discount rate	3.40%	3.30%	3.20%

Leases - Maturities of Operating Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
2022	$ 12,405
2023	9,794
2024	8,847
2025	7,130
2026	6,378
Thereafter	43,306
Total minimum lease payments	87,860
Less: Imputed interest	(15,666)
Total	$ 72,194	$ 83,844

Schedule II - Valuation and qualifying accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Allowance for Doubtful Accounts
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Year	$ (5,313)	$ (3,108)	$ (2,355)
Additions Charged to Costs and Expenses	(2,678)	(3,115)	(1,163)
Deduction	1,224	910	410
Balance at End of Year	(6,767)	(5,313)	(3,108)
Tax Valuation Allowance
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Year	(10,213)	(4,644)	(4,989)
Additions Charged to Costs and Expenses	(573)	(5,569)
Deduction			345
Balance at End of Year	$ (10,786)	$ (10,213)	$ (4,644)