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DEI Document - USD ($)	12 Months Ended
DEI Document - USD ($)	Dec. 31, 2018	Jan. 31, 2019	Jun. 30, 2018
Entity Information [Line Items]
Entity Registrant Name	ICU MEDICAL INC/DE
Entity Central Index Key	0000883984
Document Type	10-K
Document Period End Date	Dec. 31, 2018
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		20,498,949
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	FY
Entity Well-Known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Public Float			$ 5,575,024,829

Consolidated Balance Sheets - USD ($)	Dec. 31, 2018	Dec. 31, 2017
CURRENT ASSETS:
Cash and cash equivalents	$ 344,781,000	$ 290,072,000
Short-term investment securities	37,329,000	10,061,000
TOTAL CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENT SECURITIES	382,110,000	300,133,000
Accounts receivable, net of allowance for doubtful accounts of $5,768 at December 31, 2018 and $3,311 at December 31, 2017	176,298,000	112,696,000
Inventories	311,163,000	288,657,000
Prepaid income taxes	11,348,000	10,594,000
Prepaid expenses and other current assets	25,980,000	41,286,000
Related-party receivable	20,137,000	98,807,000
Assets Held-for-sale	0	12,489,000
Total current assets	927,036,000	864,662,000
PROPERTY AND EQUIPMENT, net	432,641,000	398,684,000
LONG-TERM INVESTMENT SECURITIES	2,025,000	14,579,000
GOODWILL	11,195,000	12,357,000
INTANGIBLE ASSETS, net	133,421,000	143,753,000
DEFERRED INCOME TAXES	38,654,000	24,775,000
Other Assets	40,419,000	38,141,000
TOTAL ASSETS	1,585,391,000	1,496,951,000
CURRENT LIABILITIES:
Accounts payable	120,469,000	78,228,000
Accrued liabilities	128,820,000	132,064,000
Total current liabilities	249,289,000	210,292,000
Contingent Earn-out Liability	47,400,000	27,000,000
OTHER LONG-TERM LIABILITIES	20,592,000	55,326,000
DEFERRED INCOME TAXES	721,000	1,487,000
INCOME TAX LIABILITY	3,734,000	4,592,000
COMMITMENTS AND CONTINGENCIES	0	0
STOCKHOLDERS' EQUITY:
Convertible preferred stock, $1.00 par value Authorized-500 shares; Issued and outstanding - none	0	0
Common stock, $0.10 par value - Authorized-80,000 shares; Issued 20,492 shares at December 31, 2018 and 20,210 at December 31, 2017 and outstanding 20,491 shares at December 31, 2018 and 20,210 shares at December 31, 2017	2,049,000	2,021,000
Additional paid-in capital	657,899,000	625,568,000
Treasury Stock, Value	(95,000)	0
Retained earnings	620,747,000	585,624,000
Accumulated other comprehensive loss	(16,945,000)	(14,959,000)
Total stockholders' equity	1,263,655,000	1,198,254,000
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY	1,585,391,000	1,496,951,000
Allowance for doubtful accounts	$ 5,768,045	$ 3,311,312
Convertible preferred stock, par value	$ 1	$ 1
Convertible preferred stock, authorized shares	500,000	500,000
Convertible preferred stock, issued shares	$ 0	$ 0
Convertible preferred stock, outstanding shares	0	0
Common stock, par value	$ 0.1	$ 0.1
Common stock, shares authorized	80,000,000	80,000,000
Common stock, shares issued	20,491,637	20,210,054
Common stock, shares outstanding	20,491,229	20,210,054
Treasury Stock, Common, Shares	408	0

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
REVENUES:
TOTAL REVENUE	$ 1,400,040	$ 1,292,613	$ 379,372
Cost of Goods Sold	830,012	866,518	177,974
Gross profit	570,028	426,095	201,398
OPERATING EXPENSES:
Selling, general and administrative	328,146	303,953	89,426
Research and development	52,867	51,253	12,955
Restructuring, strategic transaction and integration expenses	105,390	77,967	15,348
Change in fair value of contingent earn-out	20,400	8,000	0
Contractsettlements	41,613	0	0
Impairment of assets held for sale	0	0	728
Total operating expenses	548,416	441,173	118,457
Income (Loss) from operations	21,612	(15,078)	82,941
Bargain Purchase Gain	0	70,890	1,456
Interest Expense	(709)	(2,047)	(118)
OTHER INCOME (EXPENSE),NET	1,471	(2,482)	885
Income before income taxes	22,374	51,283	85,164
BENEFIT (PROVISION) FOR INCOME TAXES	6,419	17,361	(22,080)
Net Income	$ 28,793	$ 68,644	$ 63,084
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Basic	$ 1.41	$ 3.50	$ 3.90
Diluted	$ 1.33	$ 3.29	$ 3.66
WEIGHTED AVERAGE NUMBER OF SHARES
Basic (in shares)	20,394	19,614	16,168
Diluted (in shares)	21,601	20,858	17,254
Product [Member]
REVENUES:
Net sales	$ 1,400,040	$ 1,292,166	$ 379,339
Product and Service, Other [Member]
REVENUES:
Net sales	$ 0	$ 447	$ 33

Statement of Comprehensive Income - USD ($)	12 Months Ended
Statement of Comprehensive Income - USD ($)	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Net income	$ 28,793,000	$ 68,644,000	$ 63,084,000
Cash flow hedge adjustments, net of taxes of $317 and $224 for the years ended December 31, 2018 and 2017, respectively	1,003,000	(365,000)	0
Foreign currency translation adjustment, net of taxes of $0, $56 and $185 for the years ended December 31, 2018, 2017 and 2016, respectively	(3,104,000)	6,694,000	(514,000)
Other adjustments, net of taxes of $0 for the years ended December 31, 2018 and 2017	115,000	(16,000)	0
Other Comprehensive Income (Loss), Net of Tax	(1,986,000)	6,313,000	(514,000)
Comprehensive income	26,807,000	74,957,000	62,570,000
Other Comprehensive Income (Loss), Cash Flow Hedge Adjustments, Tax	317,000	(224,000)	0
Other Comprehensive Income (Loss), Foreign Currency Translation Adjustment, Tax	0	56,000	185,000
Other Comprehensive (Income) Loss, Other Adjustments, Tax	$ 0	$ 0	$ 0

- Definition

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

+ References + Details

Consolidated Statements of Stockholders Equity - USD ($) $ in Thousands	Total	Common Stock Shares [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Treasury Stock [Member]	Retained Earnings [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Balance, Shares at Dec. 31, 2015		16,086,000
Balance at Dec. 31, 2015	$ 579,871		$ 1,608	$ 145,125	$ 0	$ 453,896	$ (20,758)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of restricted stock and exercise of stock options, shares issued		416,000
Treasury Stock, Shares		(195,000)
Employee stock purchase plan, shares issued		31,000
Issuance of restricted stock and exercise of stock options, including excess income tax benefits	17,346		22	103	17,221
Purchase of treasury stock,treasury stock acquired in lieu of cash payment on stock option exercises and income tax withholding obligations	(17,235)			0	(17,235)
Issuance of common stock for acquisitions	0
Proceeds from employee stock purchase plan	2,361		3	2,358	0
Stock compensation	15,242			15,242
Foreign Currency Translation Adjustment	(514)						(514)
Net Income	63,084					63,084
Balance at Dec. 31, 2016	660,155		1,633	162,828	(14)	516,980	(21,272)
Balance, Shares at Dec. 31, 2016		16,338,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of restricted stock and exercise of stock options, shares issued		676,000
Treasury Stock, Shares		(27,000)
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares		3,200,000
Employee stock purchase plan, shares issued		23,000
Issuance of restricted stock and exercise of stock options, including excess income tax benefits	32,003		66	27,866	4,071
Purchase of treasury stock,treasury stock acquired in lieu of cash payment on stock option exercises and income tax withholding obligations	(4,057)			0	(4,057)
Issuance of common stock for acquisitions	413,139		320	412,819
Proceeds from employee stock purchase plan	2,705		2	2,703	0
Stock compensation	19,352			19,352
Foreign Currency Translation Adjustment	6,313						6,313
Net Income	68,644					68,644
Balance at Dec. 31, 2017	$ 1,198,254		2,021	625,568	0	585,624	(14,959)
Balance, Shares at Dec. 31, 2017	20,210,054	20,210,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of restricted stock and exercise of stock options, shares issued		307,000
Treasury Stock, Shares		(26,000)
Issuance of restricted stock and exercise of stock options, including excess income tax benefits	$ 14,275		28	8,090	6,157
Purchase of treasury stock,treasury stock acquired in lieu of cash payment on stock option exercises and income tax withholding obligations	(6,252)			0	(6,252)
Proceeds from employee stock purchase plan	0
Stock compensation	24,241			24,241
Foreign Currency Translation Adjustment	(1,986)						(1,986)
Net Income	28,793					28,793
Balance at Dec. 31, 2018	$ 1,263,655		$ 2,049	$ 657,899	$ (95)	620,747	$ (16,945)
Balance, Shares at Dec. 31, 2018	20,491,229	20,491,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Cumulative Effect of New Accounting Principle in Period of Adoption	$ 6,330					$ 6,330

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
CASH FLOWS FROM OPERATING ACTIVITIES:
Net Income	$ 28,793	$ 68,644	$ 63,084
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	74,735	66,569	19,050
Provision for doubtful accounts	781	2,308	0
Provision for warranty and returns	5,353	845	559
Stock compensation	24,241	19,352	15,242
Loss (gain) on disposal of property and equipment	8,867	3,778	59
Productrationalization	12,696	0	0
Impairment of Intangible Assets, Finite-lived	5,000	0	0
Bond premium amortization	342	103	1,355
Debt issuance cost amortization	288	48	0
Impairment of assets held for sale	269	0
Impairment of assets held for sale	0	0	728
Bargain Purchase Gain	0	(70,890)	(1,456)
Change in fair value of contingent earn-out	20,400	8,000	0
Other	3,856	(220)	75
Changes in operating assets and liabilities
Accounts receivable	(76,742)	(54,533)	744
Inventories	(21,770)	181,699	(5,501)
Prepaid expenses and other assets	1,943	(31,807)	(3,028)
Increase (Decrease) in Due from Related Parties, Current	97,443	(95,309)	0
Accounts payable	23,270	46,648	(463)
Accrued liabilities	(29,553)	33,813	(1,221)
Income taxes, including excess tax benefits and deferred income taxes	(19,997)	(24,625)	714
Net cash provided by operating activities	160,215	154,423	89,941
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property and equipment	(92,720)	(74,479)	(23,361)
Proceeds from sale of assets	765	2	0
Proceeds from the disposal of assets held for sale	13,000	0	3,268
Intangible asset additions	(8,059)	(5,203)	(1,192)
Business acquisitions, net of cash acquired	(1,300)	(162,448)	(2,584)
Purchases of investment securities	(30,496)	(24,743)	(118,384)
Proceeds from sale of investment securities	15,440	0	158,534
Net cash (used in) provided by investing activities	(103,370)	(266,871)	16,281
CASH FLOWS FROM FINANCING ACTIVITIES:
Repayments of Long-term obligations	0	(75,000)	0
Proceeds from exercise of stock options	14,275	32,003	17,346
Proceeds from employee stock purchase plan	0	2,705	2,361
Purchase of treasury stock	(6,252)	(4,057)	(17,235)
Net cash (used in) provided by financing activities	8,023	(44,349)	2,472
Effect of exchange rate changes on cash	(10,159)	1,787	224
NET (DECREASE) INCREASE IN CASH AND CASH EQUIVALENTS	54,709	(155,010)	108,918
CASH AND CASH EQUIVALENTS, beginning of period	290,072	445,082	336,164
CASH AND CASH EQUIVALENTS, end of period	344,781	290,072	445,082
SUPPLEMENTAL DISCLSOURE OF CASH FLOW INFORMATION
Cash paid during the year for income taxes	12,598	5,109	21,101
Cash paid during the year for interest	709	2,047	118
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Accounts payable for property and equipment	26,522	5,376	1,566
Fair value of assets acquired		886,569	3,306
Cash paid for acquisitions, net of cash acquired		(162,448)	(2,584)
Proceeds from Issuance of Debt		(75,000)	0
Estimated working capital adjustment		4,253	0
Contingent consideration		(19,000)	0
Issuance of common stock for acquisitions		(413,139)	0
Bargain Purchase Gain	0	(70,890)	(1,456)
Goodwill, Acquired During Period	$ 1,300	6,536	0
Liabilities Assumed/Adjustments to liabilities assumed			$ (734)
Adjustments to assumed liabilities		156,881
Hospira [Member]
Adjustments to reconcile net income to net cash provided by operating activities:
Bargain Purchase Gain		(70,890)
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Proceeds from Issuance of Debt		(75,000)
Contingent consideration		(19,000)
Issuance of common stock for acquisitions		(413,139)
Bargain Purchase Gain		$ (70,890)

General and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2018

Accounting Policies [Abstract]

Organization, Consolidation and Presentation of Financial Statements Disclosure and Significant Accounting Policies [Text Block]

BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Basis of Presentation and Preparation

ICU Medical, Inc. ("ICU"), a Delaware corporation, operates in one business segment engaged in the development, manufacturing and sale of innovative medical devices used in vascular therapy, and critical care applications. ICU's product portfolio includes intravenous smart pumps, sets, connectors, closed transfer devices for hazardous drugs, cardiac monitoring systems, along with pain management and safety software technology. We sell the majority of our products through our direct sales force and through independent distributors throughout the U. S. and internationally. Additionally, we sell our products on an original equipment manufacturer basis to other medical device manufacturers. The manufacturing for all product groups occurs in Salt Lake City, Utah, Austin, Texas, Mexico and Costa Rica.

All subsidiaries are wholly owned and are included in the consolidated financial statements. All intercompany accounts and transactions have been eliminated. Results of operations of companies purchased are included from the dates of acquisition.

The consolidated financial statements reflect all adjustments, which are normal and recurring in nature, necessary for fair financial statement presentation. These consolidated financial statements were prepared in accordance with accounting principles generally accepted in the United States of America ("GAAP"). Preparing financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amount 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.

Certain reclassifications have been made to prior year financial statements to conform to classifications used in the current year. These reclassifications had no impact on net income, stockholders' equity or cash flows as previously reported. These reclassifications were to the effective tax rate reconciliation table, the deferred income tax assets (liabilities) table in Note 12, Income Taxes and to the revenue by geography table in Note 4, Revenue.

Cash, Cash Equivalents

Cash equivalents are short-term, highly liquid investments that are readily convertible to known amounts of cash and have original maturities of three months or less from the date of purchase as cash equivalents.

Accounts Receivable

Accounts receivable are stated at net realizable value. An allowance is provided for estimated collection losses based on an assessment of various factors. We consider prior payment trends, the age of the accounts receivable balances, financial status and other factors to estimate the cash which ultimately will be received. Such amounts cannot be known with certainty at the financial statement date. We regularly review individual past due balances for collectability.

Inventories

Inventories are stated at the lower of cost or net realizable value with cost determined using the first-in, first-out method. Inventory costs include material, labor and overhead related to the manufacturing of medical devices.

Inventories consist of the following at December 31 (in thousands):



	2018		2017
Raw material	$	104,104	$	82,397
Work in process	52,909		42,304
Finished goods	154,150		163,956
Total	$	311,163	$	288,657

Property, Plant and Equipment

Property, plant and equipment consist of the following at December 31 (in thousands):



	2018			2017
Machinery and equipment	$	203,431		$	220,999
Land, building and building improvements	212,283			206,846
Molds	59,700			56,253
Computer equipment and software	80,420			44,408
Furniture and fixtures	7,409			7,361
Instruments placed with customers¹	60,757			15,812
Construction in progress	70,864			57,144
Total property, plant and equipment, cost	694,864			608,823
Accumulated depreciation	(262,223		)	(210,139		)
Net property, plant and equipment	$	432,641		$	398,684

______________________________

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

All property, plant and equipment are stated at cost. We use the straight-line method for depreciating property, plant and equipment over their estimated useful lives. Estimated useful lives are:



Buildings	15 - 30 years
Building improvements	15 - 30 years
Machinery, equipment and molds	2 - 15 years
Furniture, fixtures and office equipment	2 - 5 years
Computer equipment and software	3 - 5 years
Instruments placed with customers¹	3 - 7 years

We capitalize expenditures that materially increase the life of the related assets; maintenance and repairs are expensed as incurred. The costs and related accumulated depreciation applicable to property, plant and equipment sold or retired are removed from the accounts and any gain or loss is reflected in the statements of operations at the time of disposal. Depreciation expense was $58.1 million, $51.6 million and $16.3 million in the years ended December 31, 2018, 2017 and 2016, respectively.

Goodwill

We test goodwill for impairment on an annual basis in the month of November. If the carrying amount of goodwill exceeds the implied estimated fair value, an impairment charge to current operations is recorded to reduce the carrying value to the implied estimated fair value. There were no accumulated impairment losses as of December 31, 2018 and 2017.

The following table presents the changes in the carrying amount of our goodwill for 2018 and 2017 (in thousands):



	Total
Balance as of January 1, 2017	$	5,577
Goodwill acquired⁽¹⁾	6,536
Other⁽²⁾	244
Balance as of December 31, 2017	12,357
Goodwill acquired⁽³⁾	1,300
Other ⁽²⁾	(2,462		)
Balance as of December 31, 2018	$	11,195

______________________________

⁽¹⁾ In 2017, our Fannin (UK) Limited ("Fannin") acquisition resulted in $1.0 million of goodwill and our Medical Australia Limited ("MLA") acquisition resulted in $5.5 million of goodwill.

⁽²⁾ In 2018, "Other" relates to a $1.9 million measurement period adjustment on our MLA acquisition and foreign currency translation. In 2017, "Other" relates to foreign currency translation.

⁽³⁾In 2018, we acquired the consulting arm of True Process Inc., which resulted in $1.3 million of goodwill.

Intangible Assets

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



	Weighted Average Amortization Life in Years	December 31, 2018
	Weighted Average Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	19,399	$	12,147	$	7,252
Customer contracts	9	5,319		5,272		47
Non-contractual customer relationships	9	57,916		13,363		44,553
Trademarks	4	425		425		—
Trade name	15	7,456		1,618		5,838
Developed technology	11	82,857		15,361		67,496
Total amortized intangible assets		$	173,372	$	48,186	$	125,186

IPR&D		$	8,235			$	8,235

Total intangible assets		$	181,607	$	48,186	$	133,421



	Weighted Average	December 31, 2017
	Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	17,064	$	10,970	$	6,094
Customer contracts	9	5,319		4,892		427
Non-contractual customer relationships	9	55,080		6,562		48,518
Trademarks	4	425		425		—
Trade name	15	7,310		1,096		6,214
Developed technology	11	81,846		7,571		74,275
Total		$	167,044	$	31,516	$	135,528

IPR&D		$	8,225			$	8,225

Total intangible assets		$	175,269	$	31,516	$	143,753

Amortization expense in 2018, 2017 and 2016 was $16.6 million, $15.0 million and $2.8 million, respectively.

As of December 31, 2018 estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):



2019	$	17,103
2020	16,126
2021	15,825
2022	15,681
2023	15,532
Thereafter	44,919
Total	$	125,186

Our intangible assets that are not subject to amortization are reviewed annually for impairment or more often if there are indications of possible impairment. We perform our annual intangible assets impairment test in November of each year.

Long-Lived Assets

We periodically evaluate the recoverability of long-lived assets whenever events and changes in circumstances indicate that the carrying amount of an asset may not be fully recoverable. When indicators of impairment are present, the carrying values of the assets are evaluated in relation to the operating performance and future undiscounted cash flows of the underlying business. The net book value of the underlying asset is adjusted to fair value if the sum of the expected discounted cash flows is less than book value. Fair values are based on estimates of market prices and assumptions concerning the amount and timing of estimated future cash flows and discount rates, reflecting varying degrees of perceived risk.

Investment Securities

Short-term investments, exclusive of cash equivalents, are marketable securities intended to be sold within one year and may include trading securities, available-for-sale securities, and held-to-maturity securities (if maturing within one year at the time of acquisition). Long-term investments are marketable securities intended to be sold after one year and may include trading securities, available-for-sale securities, and held-to-maturity securities.

Our investment securities are considered available-for-sale and are “investment grade” and carried at fair value. Our investments currently consist of corporate bonds. Available-for-sale securities are recorded at fair value, and unrealized holding gains and losses are recorded, net of tax, as a component of accumulated other comprehensive income (loss). Unrealized losses on available-for-sale securities are charged against net earnings when a decline in fair value is determined to be other than temporary. Our management reviews several factors to determine whether a loss is other than temporary, such as the length and extent of the fair value decline, the financial condition and near term prospects of the issuer, and for equity investments, our intent and ability to hold the security for a period of time sufficient to allow for any anticipated recovery in fair value. For debt securities, management also evaluates whether we have the intent to sell or will likely be required to sell before its anticipated recovery. Realized gains and losses are accounted for on the specific identification method. There have been no realized gains or losses on the disposal of investments. The scheduled maturities of the investment securities are between 2019 and 2020. All short-term investment securities are all callable within one year.

Our investment securities consist of the following (in thousands):



	December 31, 2018
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	37,329		$	—	$	37,329
Long-term corporate bonds	2,025		—		2,025
Total investment securities	$	39,354	$	—	$	39,354

	December 31, 2017
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	10,061	$	—	$	10,061
Long-term corporate bonds	14,579		—		14,579
Total investment securities	$	24,640	$	—	$	24,640

Income Taxes

Deferred taxes are determined based on the differences between the financial statements and the tax bases using rates as enacted in the laws. A valuation allowance is established if it is “more likely than not” that all or a portion of the deferred tax assets will not be realized.

We recognize interest and penalties related to unrecognized tax benefits in the tax provision. We recognize liabilities for uncertain tax positions when it is more likely than not that a tax position will not be sustained upon examination and settlement with various taxing authorities. Liabilities for uncertain tax positions are measured based upon the largest amount of benefit that is greater than 50% likely of being realized upon ultimate settlement. We have not recorded any material interest or penalties during any of the years presented.

Foreign Currency

Generally, the functional currency of our international subsidiaries is the local currency. Generally, we translate the financial statements of these subsidiaries to U.S. dollars at the exchange rate in effect at the balance sheet date and revenues and expenses are translated at the average monthly exchange rates during the year. Certain of our international subsidiaries consolidate first with another subsidiary that utilizes a functional currency other than U.S. dollars. In those cases, we follow a step by step translation process utilizing the same sequence as the consolidation process. Translation adjustments are recorded as a component of accumulated other comprehensive income (loss), a separate component of stockholders' equity on our consolidated balance sheets and the effect of exchange rate changes on cash and cash equivalents are reflected on our consolidated statements of cash flows. Gains and losses for transactions denominated in a currency other than the functional currency of the entity are included in our statements of operations in selling, general and administrative expense. Foreign currency transaction losses, net were $7.9 million in 2018, $1.8 million in 2017 and less than $0.3 million in 2016.

Revenue Recognition

We recognize revenues when we transfer control of promised goods to our customers in an amount that reflects the consideration to which we expect to be entitled to in exchange for those goods. We offer certain volume-based rebates to our distribution customers, which we consider variable consideration when calculating the transaction price. We also provide chargebacks to distributors that sell to end-customers at prices determined under a contract between us and the end-customer.

In estimating the most likely rebate and chargeback amounts for use in determining the transaction price, we use information available at the time and our historical experience. We also warrant products against defects and have a policy permitting the return of defective products, for which we accrue and expense at the time of sale using information available and our historical experience. Our revenues are recorded at the net sales price, which includes an estimate for variable consideration related to rebates, chargebacks and product returns.

The vast majority of our sales of Infusion Consumables, IV Solutions, Infusion Systems and Critical Care products are sold on a standalone basis and control of these products transfers to the customer upon shipment.

Our software license renewals are considered to be transferred to a customer at a point in time at the start of each renewal period, therefore revenue is recognized at that time.

Arrangements with Multiple Deliverables

In certain circumstances, we enter into arrangements in which we provide multiple deliverables to our customers. These bundled arrangements typically consist of the sale of infusion systems equipment, along with annual software licenses and related software implementation services, as well as infusion consumables, IV solutions and extended warranties.

Our most significant judgments related to these arrangements are (i) identifying the various performance obligations and (ii) estimating the relative standalone selling price of each performance obligation, typically using a directly observable method or calculated on a cost plus margin basis method. Revenue related to the bundled equipment, software and software implementation services are typically combined into a single performance obligation and recognized upon implementation. As annual software licenses are renewed, we recognize revenue for the license at a point in time, at the start of each annual renewal period. The transaction price allocated to the extended service-type warranty is recognized as revenue over the period the warranty service is provided. Consumables and solutions are separate performance obligations, recognized at a point in time.

Shipping Costs

Costs to ship finished goods to our customers are included in cost of goods sold on the consolidated statements of operations.

Advertising Expenses

Advertising expenses are expensed as incurred and reflected in selling, general and administrative expenses in our consolidated statements of operations and were $0.6 million in 2018, $0.2 million in 2017 and $0.1 million in 2016.

Post-retirement and Post-employment Benefits

We sponsor a Section 401(k) retirement plan ("plan") for employees. Our contributions to our 401(k) plan were approximately $11.4 million in 2018, $10.3 million in 2017 and $1.5 million in 2016. As a result of the Hospira Infusion Systems ("HIS") acquisition, we assumed certain post-retirement and post-employment obligations related to employees located in certain international countries. These obligations are immaterial to our financial statements taken as a whole.

Research and Development

The majority of our research and development costs are expensed as incurred. In certain circumstances when an asset will have an alternative future use we capitalize the costs related to those assets. Research and development costs include salaries and related benefits, consulting fees, production supplies, samples, travel costs, utilities and other miscellaneous administrative costs.

Net Income Per Share

Net income per share is computed by dividing net income by the weighted average number of common shares outstanding. Diluted net income per share is computed by dividing net income by the weighted average number of common shares outstanding plus dilutive securities. Dilutive securities include outstanding common stock options and unvested restricted stock units, less the number of shares that could have been purchased with the proceeds from the exercise of the options, using the treasury stock method. Options that are anti-dilutive, where their exercise price exceeds the average market price of the common stock are not included in the treasury stock method calculation. There were 5,300 and 337 anti-dilutive shares in 2018 and 2017, respectively. There were no anti-dilutive shares in 2016.

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



	Year ended December 31, (in thousands, except per share data)
	2018		2017		2016
Net income	$	28,793	$	68,644	$	63,084
Weighted average number of common shares outstanding (basic)	20,394		19,614		16,168
Dilutive securities	1,207		1,244		1,086
Weighted average common and common equivalent shares outstanding (diluted)	21,601		20,858		17,254
EPS - basic	$	1.41	$	3.50	$	3.90
EPS - diluted	$	1.33	$	3.29	$	3.66

On February 3, 2017, as part of the purchase price for the acquisition of Pfizer Inc.'s ("Pfizer") HIS business, we delivered to Pfizer 3.2 million newly issued common shares (see Note 2: Acquisitions, Strategic Transaction and Integration Expenses).

New Accounting Pronouncements

Recently Adopted Accounting Standards

In March 2018, the Financial Accounting Standards Board ("FASB") issued Accounting Standard Update ("ASU") No. 2018-05, Income Taxes (Topic 740): Amendments to SEC Paragraphs Pursuant to SEC Staff Accounting Bulletin No. 118. This update adds SEC paragraphs pursuant to the SEC Staff Accounting Bulletin No. 118, which expresses the view of the staff regarding application of Topic 740, Income Taxes, in the reporting period that includes December 22, 2017 - the date on which the Tax Cuts and Jobs Act (the "Tax Act") was signed into law. We applied the provisions of this ASU in the prior year and it did not have a material impact on our consolidated financial statements.

In August 2017, the FASB issued ASU No. 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. The amendments in this update change both the designation and measurement guidance for qualifying hedging relationships and the presentation of hedge results to facilitate financial reporting that more closely reflects an entity's risk management activities. The amendments in this update also make certain targeted improvements to simplify the application of hedge accounting guidance and ease the administrative burden of hedge documentation requirements and assessing hedge effectiveness. The amendments are effective for the fiscal years, and interim reporting periods within those years, beginning on or after December 15, 2018. For cash flow and net investment hedges existing at the date of adoption, an entity should apply a cumulative-effect adjustment related to eliminating the separate measurement of ineffectiveness to accumulated other comprehensive income with a corresponding adjustment to the opening balance of retained earnings as of the beginning of the fiscal year that an entity adopts the update. We early adopted this ASU on January 1, 2018 and this ASU did not have a material impact on our consolidated financial statements or related footnote disclosures.

In May 2017, the FASB issued ASU No. 2017-09, Compensation-Stock Compensation (Topic 718): Scope of Modification Accounting. The amendments in this update provide guidance about which changes to the terms or conditions of a share-based payment award require an entity to apply modification accounting. Under the ASU, an entity will account for the effects of a modification unless (i) the fair value of the modified award is the same as the fair value of the original award immediately before the original award is modified, (ii) the vesting conditions of the modified award are the same vesting conditions as the original award immediately before the original award is modified, and (iii) the classification of the modified award as an equity instrument or a liability instrument is the same as the classification of the original award immediately before the original award is modified. The amendments in this ASU are effective prospectively for annual periods, and interim periods within those annual periods, beginning after December 15, 2017. We adopted this ASU on January 1, 2018 and this ASU did not have a material impact on our consolidated financial statements or related footnote disclosures.

In January 2017, the FASB issued ASU No. 2017-01, Business Combinations (Topic 805): Clarifying the Definition of a Business. The amendments in this update clarify the definition of a business with the objective of adding guidance to assist entities with evaluating whether transactions should be accounted for as acquisitions (or disposals) of assets or businesses. The

amendments in this update provide a screen to determine when a set (integrated set of assets and activities) is not a business. If the screen is not met, it (1) requires that to be considered a business, a set must include, at a minimum, an input and a substantive process that together significantly contribute to the ability to create output and (2) removes the evaluation of whether a market participant could replace the missing elements. The amendments in ASU 2017-01 are effective for annual periods and interim periods within those annual periods beginning after December 15, 2017. The amendments in this ASU should be applied prospectively on or after the effective date. We adopted this ASU on January 1, 2018 and this ASU did not have a material impact on our consolidated financial statements or related footnote disclosures.

In October 2016, the FASB issued ASU No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory. Current generally accepted accounting principles prohibits the recognition of current and deferred income taxes for an intra-entity asset transfer until after the asset has been sold to an outside party. The amendments in ASU 2016-16 eliminates this prohibition. Accordingly an entity should recognize the income tax consequences of an intra-entity transfer of an asset other than inventory when the transfer occurs. Amendments in this update are effective for annual reporting periods beginning after December 15, 2017. We adopted this ASU on January 1, 2018 and this ASU did not have a material impact on our consolidated financial statements or related footnote disclosures.

In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments. ASU 2016-15 provides specific guidance on eight cash flow issues where current guidance is unclear or does not include any specifics on classification. The eight specific cash flow issues are: debt prepayment or debt extinguishment costs; settlement of zero-coupon debt instruments or other debt instruments with zero coupon interest rates that are insignificant in relation to the effective interest rate of the borrowing; contingent consideration payments made after a business combination; proceeds from the settlement of insurance claims; proceeds from the settlement of corporate-owned life insurance policies, including bank-owned policies; distributions received from equity method investees; beneficial interests in securitization transactions; and separately identifiable cash flows and application of the predominance principle. The amendments in ASU 2016-15 are effective for annual periods and interim periods within those annual periods beginning after December 15, 2017. Amendments should be applied using a retrospective transition method to each period presented. We adopted this ASU on January 1, 2018 and this ASU did not have a material impact on our consolidated financial statements or related footnote disclosures.

In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments – Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities, which amends certain aspects of recognition, measurement, presentation and disclosure of financial instruments. This amendment requires all equity investments to be measured at fair value with changes in the fair value recognized through net income (other than those accounted for under the equity method of accounting or those that result in the consolidation of the investee). The amendments in this update are effective for fiscal years beginning after December 15, 2017. We adopted this ASU on January 1, 2018 and this ASU did not have a material impact on our consolidated financial statements or related footnote disclosures.

In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606). ASU 2014-09 removes inconsistencies and weaknesses in revenue requirements, provides a more robust framework for addressing revenue issues, improves comparability of revenue recognition practices across entities, industries, jurisdictions and capital markets, provides more useful information to users of financial statements through improved disclosure requirements and simplifies the preparation of financial statements by reducing the number of requirements to which an entity must refer. This guidance requires that an entity depict the consideration by applying a five-step analysis in determining when and how revenue is recognized. The new model will require revenue recognition to depict the transfer of promised goods or services to customers in an amount that reflects the consideration a company expects to receive in exchange for those goods or services. On April 1, 2015, the FASB voted for a one-year deferral of the effective date of the new revenue recognition standard, ASU 2014-09. On July 15, 2015, the FASB affirmed these changes, which requires public entities to apply the amendments in ASU 2014-09 for annual reporting beginning after December 15, 2017. Subsequent to the issuance of this ASU, the FASB issued three amendments: ASU No. 2016-08, which clarifies principal versus agent considerations; ASU 2016-10, which clarifies guidance related to identifying performance obligations and licensing implementation; and ASU 2016-12, which provides narrow-scope improvements and practical expedients. All of the amendments have the same effective date mentioned above. We adopted the standard effective January 1, 2018. See Note 4, Revenue for a discussion of the impact and the required enhanced disclosures.

Recently Issued Accounting Standards

In August 2018, the FASB issued ASU No. 2018-15, Intangibles-Goodwill and Other-Internal-Use Software (Topic 350): Customer's Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract. The amendments in this update align the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software and hosting arrangements that include an internal use software license. Costs to develop or obtain internal-use software that cannot be capitalized under subtopic 350-40, such as training costs and certain data conversion costs, also cannot be capitalized for a hosting arrangement that is a service contract. Therefore, an entity in a hosting arrangement that is a service contract determines which project stage (that is, preliminary project stage, application development stage, or post-implementation stage) an implementation activity relates to. Costs for implementation activities in the application development stage are capitalized depending on the nature of the costs, while costs incurred during the preliminary project and post-implementation stages are expensed as the activities are performed. The amendments in this update require the entity to expense the capitalized implementation costs of a hosting arrangement that is a service contract over the term of the hosting arrangement. The amendments in this update are effective for fiscal years beginning after December 15, 2019, and interim periods within those fiscal years. The amendments in this update should be applied either retrospectively or prospectively to all implementation costs incurred after the date of adoption. We are currently evaluating the impact of this ASU on the consolidated financial statements and related disclosures.

In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework - Changes to the Disclosure Requirements for Fair Value Measurement. The amendments in this update modify the disclosure requirements in Topic 820. The amendments remove from disclosure: the amount of and reasons for transfers between Level 1 and Level 2 of the fair value hierarchy; the policy for timing of transfers between levels 3; and the valuation processes for Level 3 fair value measurements. The amendments also made the following disclosure modifications: for investments in certain entities that calculate net asset value, an entity is required to disclose the timing of liquidation of an investee’s assets and the date when restrictions from redemption might lapse only if the investee has communicated the timing to the entity or announced the timing publicly; and the amendments clarify that the measurement uncertainty disclosure is to communicate information about the uncertainty in measurement as of the reporting date. The amendments also added the following disclosure requirements: the changes in unrealized gains and losses for the period included in other comprehensive income for recurring Level 3 fair value measurements held at the end of the reporting period; and the range and weighted average of significant unobservable inputs used to develop Level 3 fair value measurements. For certain unobservable inputs, an entity may disclose other quantitative information (such as the median or arithmetic average) in lieu of the weighted average if the entity determines that other quantitative information would be a more reasonable and rational method to reflect the distribution of unobservable inputs used to develop Level 3 fair value measurements. The amendments in ASU 2018-02 are effective for fiscal years beginning after December 15, 2019. Early adoption is permitted. We are currently evaluating the impact of this ASU on the consolidated financial statements and related disclosures.

In February 2018, the FASB issued ASU No. 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income. The amendments in this update allow a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from the Tax Cuts and Jobs Act. The amendments in this update also require certain disclosures about stranded tax effects. The amendments in ASU 2018-02 are effective for fiscal years beginning after December 15, 2018. Early adoption is permitted. We are not electing to reclassify from accumulated OCI to retained earnings stranded tax effects resulting from the Tax Cuts and Jobs Act (the “Tax Act”).

In January 2017, the FASB issued ASU No. 2017-04, Intangibles-Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment. The amendments in this update remove the second step of the impairment test. An entity will apply a one-step quantitative test and record the amount of goodwill impairment as the excess of a reporting unit's carrying amount over its fair value, not to exceed the total amount of goodwill allocated to the reporting unit. The new guidance does not amend the optional qualitative assessment of goodwill impairment. The amendments in ASU 2017-04 are effective for the annual or interim impairment test in fiscal years beginning after December 15, 2019. Early adoption is permitted for interim or annual goodwill impairment tests performed on testing dates after January 1, 2017. This ASU is not expected to have a material impact on our consolidated financial statements or related footnote disclosures.

In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments-Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. This update amends the FASB's guidance on the impairment of financial instruments by requiring timelier recording of credit losses on loans and other financial instruments. The ASU adds an impairment model that is based on expected losses rather than incurred losses. The ASU also amends the accounting for credit losses on available-for-sale debt securities and purchased financial assets with credit deterioration. The amendments in this update will be effective for fiscal years beginning after December 15, 2019. Early adoption is permitted as of the fiscal years beginning after December 15, 2018. The updated guidance requires a modified retrospective adoption. In November 2018, the FASB issued ASU No. 2018-19, Codification Improvements to Topic 326, Financial Instruments-Credit Losses. This update clarifies that receivables arising from operating leases are not within the scope of this guidance, instead, impairment of receivables arising from operating leases should be accounted for in accordance with the lease guidance. This update has the same effective date as ASU No. 2016-13. We are currently evaluating the impact of this ASU on the consolidated financial statements and related disclosures.

In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842). The amendments in this update require an entity to recognize a Right Of Use asset and lease liability for all leases with terms of more than 12 months. Recognition, measurement and presentation of expenses will depend on classification as finance or operating lease. The amendments also require certain quantitative and qualitative disclosures about leasing arrangements. The updated guidance requires a modified retrospective adoption. In July 2018, the FASB issued ASU No. 2018-11, Targeted Improvements. The amendments in this update will provide entities with an additional (and optional) transition method to adopt the new lease requirements by allowing entities to initially apply the requirements by recognizing a cumulative-effect adjustment to the opening balance of retained earnings in the period of adoption. The amendments in this update also provide lessors with a practical expedient, by class of underlying asset, to not separate nonlease components from the associated lease contract. This expedient is limited to circumstances in which the nonlease components otherwise would be accounted for under the new revenue guidance and both (1) the timing and pattern of transfer are the same for the nonlease components and associated lease component and (2) the lease component, if accounted for separately, would be classified as an operating lease. If the lessor uses this practical expedient they would account for the lease contract in accordance with Topic 606 if the nonlease component is the predominant component otherwise, the lessor should account for the combined component as an operating lease in accordance with Topic 842. In July 2018, the FASB issued ASU No. 2018-10, Codification Improvements to Topic 842, Leases. This ASU clarifies certain language in ASU 2016-02 and corrects certain references and inconsistencies. In December 2018, the FASB issued ASU No. 2018-20-Leases-Narrow-Scope Improvements for Lessors. The amendments in this update permit lessors, as an accounting policy election, to not evaluate whether certain sales taxes and other similar taxes are lessor costs. If an entity takes this policy election sales taxes will be excluded from the consideration in the contract. The amendments in this update related to certain lessor costs permit lessors to exclude from variable payments, and therefore revenue, lessor costs paid by lessees directly to third parties from variable payments. The amendments also require lessors to account for costs excluded from the consideration of a contract that are paid by the lessor and reimbursed by the lessee as variable payments. A lessor will record those reimbursed costs as revenue. The amendments in this update related to recognizing variable payments for contracts with lease and nonlease components require lessors to allocate certain variable payments to the lease and nonlease components when the changes in facts and circumstances on which the variable payment is based occur. After the allocation, the amount of variable payments allocated to the lease components will be recognized as income in profit or loss in accordance with the lease guidance, while the amount of variable payments allocated to nonlease components will be recognized in accordance with other guidance. The amendments in these updates are effective for fiscal years beginning after December 15, 2018. We adopted ASU 2016-02, ASU 2018-11, ASU 2018-10 and ASU 2018-20 effective January 1, 2019. We elected the ‘package of practical expedients’, which permits us not to reassess under the new standard our prior conclusions about lease identification, lease classification and initial direct costs. We did not elect the use-of-hindsight or the practical expedient pertaining to land easements; the latter not being applicable to us. We elected the short-term lease recognition exemption for all leases that qualify. This means, for those leases that qualify, we did not recognize Right Of Use assets or lease liabilities, and this includes not recognizing Right Of Use assets or lease liabilities for existing short-term leases of those assets in transition. Furthermore, elected the practical expedient to not separate lease and non-lease components for all of our leases. We adopted ASU 2016-02 utilizing the modified retrospective transition method through a cumulative-effect adjustment at the beginning of the first quarter of 2019. We expect the adoption of ASU 2016-02 to result in the recognition of right-of-use assets and lease liabilities for operating leases of approximately $35.0 million to $50.0 million on our consolidated balance sheet, with no material impact to our consolidated statements of operations. We continue to evaluate the impact the adoption of this new guidance will have on our financial statements and related disclosures, in addition to the continued evaluation of business processes and internal controls related to lease accounting.

Acquisitions, Strategic Transaction and Integration Expenses (Notes)

12 Months Ended

Dec. 31, 2018

Acquisitions and Strategic Transaction Expenses [Abstract]

Acquisitions and Strategic Transaction Expenses [Text Block]

ACQUISITIONS, STRATEGIC TRANSACTION AND INTEGRATION EXPENSES

Significant 2017 Acquisitions

On February 3, 2017, we acquired 100% interest in Pfizer's HIS business for total cash consideration of approximately $260.0 million (net of estimated working capital adjustments paid at closing), which was financed with existing cash balances and a $75 million three-year interest-only seller note. We also issued 3.2 million shares of our common stock. The fair value of the common shares issued to Pfizer was determined based on the closing price of our common shares on the closing date, discounted to reflect a contractual lock-up period whereby Pfizer cannot transfer the shares, subject to certain exceptions, until the earlier of (i) the expiration of Pfizer’s services to us in the related transitional services agreement or (ii) eighteen months from the closing date. Additionally, Pfizer also may be entitled up to an additional $225 million in cash contingent consideration based on the achievement of performance targets for the combined company for the three years ending December 31, 2019 ("Earnout Period"). In the event that the sum of our Adjusted EBITDA as defined in the Amended and Restated Stock and Asset Purchase Agreement between us and Pfizer (the “HIS Purchase Agreement”) for the three years in the Earnout Period (the "Cumulative Adjusted EBITDA") is equal to or exceeds approximately $1 billion ("the "Earnout Target"), then Pfizer will be entitled to receive the full amount of the earnout. In the event that the Cumulative Adjusted EBITDA is equal to or greater than 85% of the Earnout Target (but less than the Earnout Target), Pfizer will be entitled to receive the corresponding percentage of the earnout. In the event that the Cumulative Adjusted EBITDA is less than 85% of the Earnout Target, then no earnout amount will be earned by Pfizer. The initial fair value of the earn-out was determined by employing a Monte Carlo simulation in a risk neutral framework. The underlying simulated variable was adjusted EBITDA. The adjusted EBITDA volatility estimate was based on a study of historical asset volatility for a set of comparable public companies. The model includes other assumptions including the market price of risk, which was calculated as the weighted average cost of capital ("WACC") less the long term risk free rate. We believe that the acquisition of the HIS business, which includes IV pumps, solutions and consumable devices complements our pre-existing business by creating a company that has a complete infusion therapy product portfolio. We believe that the acquisition significantly enhances our global footprint and platform for continued competitiveness and growth.

With the acquisition of HIS, pre-existing long-term supply and distribution contracts between ICU and HIS were effectively terminated.

Deferred Closings

In the HIS Purchase Agreement, we agreed with Pfizer to defer the local closing of the HIS business in certain foreign jurisdictions (the “Deferred Closing Businesses”) for periods ranging by jurisdiction from 3 to 12 months after the February 3, 2017 closing date (the "Deferred Closing Period"). The net assets in these jurisdictions represent an immaterial portion of the total HIS business net assets.

At the February 3, 2017 HIS business transaction closing, we entered into a Net Economic Benefit Agreement with Pfizer under which we agreed that (i) during the Deferred Closing Period, the economic benefits and burdens of the Deferred Closing Businesses are for our account, and we are to be treated as the beneficial owner of the Deferred Closing Businesses and (ii) Pfizer would continue to operate the Deferred Closing Businesses under our direction.

All of the deferred closing businesses were effectively closed in 2017.

Purchase Price

The following table summarizes the final purchase price and the final allocation of the purchase price related to the assets and liabilities purchased (in thousands, except per share data):



Cash consideration for acquired assets	$	180,785
Fair value of Seller Note	75,000
Fair value of contingent consideration payable to Pfizer (long-term)	19,000

Issuance of ICU Medical, Inc. common shares:
Number of shares issued to Pfizer	3,200
Price per share (ICU's trading closing share price on the Closing Date)	$	140.75
Market price of ICU shares issued to Pfizer	$	450,400
Less: Discount due to lack of marketability of 8.3%	(37,261		)
Equity portion of purchase price	413,139
Total Consideration	$	687,924

Purchase Price Allocation:
Cash and cash equivalents	$	31,082
Trade receivables	362
Inventories	417,622
Prepaid expenses and other assets	13,911
Property, plant and equipment	288,134
Intangible assets⁽¹⁾	131,000
Other assets	29,270
Accounts payable	(12,381		)
Accrued liabilities	(47,936		)
Long-term liabilities⁽²⁾	(67,170		)
Total identifiable net assets acquired	$	783,894
Deferred tax, net	(25,080		)
Estimated Gain on Bargain Purchase	(70,890		)
Estimated Purchase Consideration	$	687,924

______________________________

⁽¹⁾ Identifiable intangible assets includes $48 million of customer relationships, $44 million of developed technology - pumps and dedicated sets, $34 million of developed technology - consumables, and $5 million of in-process research and development ("IPR&D"). The weighted amortization period for the total identifiable assets is approximately nine years, for customer relationships the weighted amortization period is eight years, for the developed technology - pumps and dedicated sets the weighted amortization period is ten years and for the developed technology - consumables the weighted amortization period is twelve years. The IPR&D is non-amortizing until the associated research and development efforts are complete.

⁽²⁾Long-term liabilities primarily consisted of contract liabilities, product liabilities and long-term employee benefits.

The fair value of the assets acquired and liabilities assumed exceeded the fair value of the consideration to be paid resulting in a bargain purchase gain. Before recognizing a gain on a bargain purchase, we reassessed the methods used in the purchase accounting and verified that we had identified all of the assets acquired and all of the liabilities assumed, and that there were no additional assets or liabilities to be considered. We also reevaluated the fair value of the contingent consideration transferred to determine that it was appropriate. We determined that the bargain purchase gain was primarily attributable to expected restructuring costs as well as a reduction to the initially agreed upon transaction price caused primarily by revenue shortfalls across all market segments of the HIS business, negative manufacturing variance due to the drop in revenue and higher operating and required stand up costs, when compared to forecasts of the HIS business at the time that the purchase price was agreed upon. After the continuing review of the product demand and operations of the HIS Business, including the resulting expected restructuring activities, we forecasted our estimated Adjusted EBITDA from the HIS business in 2017 to be $35 million - $40 million, which was considerably lower than the forecast contemplated in initial negotiations with Pfizer, which resulted in an estimated fair value of $19 million related to the $225 million earn out. Restructuring costs, if incurred, will be expensed in future periods (see Note 3: Restructuring Charges). The bargain purchase gain is separately stated below income from operations in the accompanying consolidated statements of operations for the year ended December 31, 2017.

The identifiable intangible assets and other long-lived assets acquired have been valued as Level 3 assets at fair market value. The estimated fair value of identifiable intangible assets were developed using the income approach and are based on critical estimates, judgments and assumptions derived from: analysis of market conditions; discount rate; discounted cash flows; royalty rates; customer retention rates; and estimated useful lives. Fixed assets were valued with the consideration of remaining economic lives. The raw materials inventory was valued at historical cost and adjusted for any obsolescence, the work in process was valued at estimated sales proceeds less costs to complete and costs to sell, and finished goods inventory was valued at estimated sales proceeds less a nominal profit and costs to sell. The prepaid expenses and other current assets and assumed liabilities were recorded at their carrying values as of the date of the acquisition, as their carrying values approximated their fair values due to their short-term nature.

Unaudited Pro Forma Information

The pro forma financial information in the table below summarizes the combined results of operations for ICU and HIS as though the companies were combined as of the beginning of fiscal 2016. The pro forma financial information for all periods presented also includes the business combination accounting effects resulting from this acquisition including our amortization charges from acquired intangible assets, nonrecurring expense related to the fair value adjustment to acquisition-date inventory, acquisition and integration-related costs, interest expense on the Pfizer seller note and the related tax effects as though the aforementioned companies were combined as of the beginning of fiscal 2016. The pro forma financial information as presented below is for informational purposes only and is not indicative of the results of operations that would have been achieved if the acquisitions had taken place at the beginning of fiscal 2016.



(In millions)	Revenue		Earnings
Actual from 2/3/2017 - 12/31/2017⁽³⁾	$	1,062	*
2017 supplemental pro forma from 1/1/2017 - 12/31/2017⁽¹⁾⁽²⁾	$	1,373	$	91
2016 supplemental pro forma from 1/1/2016 - 12/31/2016⁽¹⁾⁽²⁾	$	1,418	$	99

______________________________

* Impracticable to calculate.

⁽¹⁾2017 supplemental pro forma earnings were adjusted to exclude $66.3 million of nonrecurring expense related to the fair value adjustment to acquisition-date inventory, $59.2 million of acquisition and integration-related costs and $70.9 million in bargain purchase gain. 2016 supplemental pro forma earnings were adjusted to include these charges. These amounts were updated in 2018 from the 2017 disclosed amounts to incorporate information not previously available.

⁽²⁾Unaudited.

⁽³⁾ Amount represents activity of HIS from the date of the acquisition.

Strategic Transaction and Integration Expenses

In 2018, we incurred $100.9 million in transaction and integration costs primarily related to our acquisition of HIS. In 2017, we incurred $59.2 million in transaction and integration costs primarily related to our acquisition of HIS. In 2016, we incurred $14.3 million in transaction costs primarily related to our 2017 acquisition of HIS.

Restructuring Charges (Notes)

12 Months Ended

Dec. 31, 2018

Restructuring and Related Activities [Abstract]

Restructuring and Related Activities Disclosure [Text Block]

RESTRUCTURING CHARGES

In 2018 and 2017, we incurred restructuring charges related to the acquisition of the HIS business (see Note 2: Acquisitions, Strategic Transaction and Integration Expenses). The restructuring charges were incurred as a result of integrating the acquired operations into our business and include severance costs related to involuntary employee terminations and facility exit costs related to the closure of the Dominican Republic manufacturing facilities acquired from Pfizer. All material charges in regard to these restructuring activities have been paid as of December 31, 2018. The cumulative amount incurred to date in connection with the HIS acquisition is $23.1 million.

In 2016, we incurred an additional 0.8 million related to the closure of our Slovakian manufacturing facility. Additionally, we incurred $0.2 million related to a one-time charge unrelated to the events disclosed in the table below.

In 2015, we incurred restructuring charges related to an agreement with Dr. Lopez, a member of our Board of Directors and a former employee in our research and development department, pursuant to which we bought out Dr. Lopez's right to employment under his then-existing employment agreement, the buy-out, including payroll taxes, will be paid in equal monthly installments until December 2020 and payments that will exceed one year have been accrued under long-term liabilities in our consolidated balance sheet.

The following table summarizes the activity for the restructuring-related charges discussed above and related accrual (in thousands):



	Accrued Balance January 1, 2017		Charges incurred		Payments			Other Adjustments			Accrued Balance December 31, 2017		Charges incurred		Payments			Other Adjustments			Accrued Balance December 31, 2018
Severance pay and benefits	$	53	$	15,983	$	(15,104	)	$	(17	)	$	915	$	4,311	$	(4,549	)	$	—		$	677
Employment agreement buyout	1,477		—		(363		)	—			1,114		—		(368		)	(7		)	739
Retention and facility closure expenses	—		2,789		(2,789		)	—			—		160		(160		)	—			—
	$	1,530	$	18,772	$	(18,256	)	$	(17	)	$	2,029	$	4,471	$	(5,077	)	$	(7	)	$	1,416

Revenue (Notes)

12 Months Ended

Dec. 31, 2018

Revenue Recognition and Deferred Revenue [Abstract]

Revenue from Contract with Customer [Text Block]

Revenue

Adoption of ASC Topic 606, “Revenue from Contracts with Customers”

We adopted ASU No. 2014-09, Revenue from Contracts with Customers (ASC Topic 606), effective January 1, 2018 using the modified retrospective method applied to those contracts which were not completed as of January 1, 2018. Results for reporting beginning after January 1, 2018 are presented under ASC Topic 606, while prior period amounts are not adjusted and will continue to be reported in accordance with our historic accounting under ASC Topic 605, Revenue Recognition.

Due to the cumulative impact, net of tax, of adopting ASC Topic 606, we recorded a net increase of $6.3 million to opening retained earnings as of January 1, 2018. The impact is primarily related to our bundled arrangements where we sell software licenses and implementation services, in addition to equipment, consumables and solutions. Under ASC Topic 605, revenue for the equipment was recognized upon delivery and software licenses and implementation services were typically recognized over the contract term. Under ASC Topic 606, revenue for the bundled equipment, software and software implementation services are recognized upon implementation. This results in an acceleration of software related revenue, offset by a delay in the recognition of related revenue of the equipment. Under ASC Topic 605, consumables and solutions revenues were typically recognized upon delivery. Under ASC 606, consumables and solutions revenues are recognized as the customer obtains control of the asset, which is at shipping point. This results in an acceleration in the recognition of consumables and solutions revenue.

Additionally, the timing of revenue recognition for software license renewals changed under ASC Topic 606. Under ASC Topic 605, revenue related to software renewals was recognized on a ratable basis over the license period. Under ASC Topic 606, the license, which is considered functional IP, is considered to be transferred to the customer at a point in time, specifically, at the start of each annual renewal period. As a result, under ASC Topic 606, revenue related to our annual software license renewals is accelerated when compared to ASC Topic 605.

Revenues are recognized when control of the promised goods or services is transferred to the customer, in an amount that reflects the consideration we expect to be entitled to in exchange for those goods or services.

The following tables represent the amounts by which each financial statement line item is affected in the current year as a result of applying ASC Topic 606 (in thousands):



	For the year ended December 31, 2018
	As Reported		Without Adoption of ASC 606		Effect of Adoption
Revenue	$	1,400,040	$	1,388,923	$	11,117
Cost of goods sold	$	830,012	$	826,607	$	3,405
Gross Profit	$	570,028	$	562,316	$	7,712



	As of December 31, 2018
	As Reported		Without Adoption of ASC Topic 606		Effect of Adoption
Prepaid expenses and other current assets	$	25,980	$	32,487	$	(6,507	)
Accrued liabilities	$	128,820	$	151,408	$	(22,588	)
Deferred income taxes	$	38,654	$	40,653	$	(1,999	)

Revenue Recognition

We report revenue on a "where sold" basis, which reflects the revenue within the country or region in which the ultimate sale is made to our external customer.

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



	For the year ended December 31,
Geography	2018		2017 ⁽¹⁾		2016⁽¹⁾
Europe, the Middle East and Africa	$	134,363	$	119,934	$	50,105
Other Foreign	210,996		192,640		67,573
Total Foreign	345,359		312,574		117,678
United States	1,054,681		980,039		261,694
Total Revenues	$	1,400,040	$	1,292,613	$	379,372

_______________________________

⁽¹⁾As noted above, prior period amounts have not been adjusted under the modified retrospective method.

Domestic sales accounted for 75%, 76% and 69% of total revenue in 2018, 2017 and 2016, respectively. International sales accounted for 25%, 24% and 31% of total revenue in 2018, 2017 and 2016, respectively.

The following table represents our revenues disaggregated by product line (in thousands) and our disaggregated product line revenue as a percentage of total revenue:



	For the year ended December 31,
	2018				2017 ⁽¹⁾				2016⁽¹⁾
Product line	Revenue		% of Revenue		Revenue		% of Revenue		Revenue		% of Revenue
Infusion Consumables	$	483,039	35	%	$	365,665	28	%	$	324,868	86	%
IV Solutions	507,985		36	%	521,963		40	%	—		—	%
Infusion Systems	355,484		25	%	290,207		23	%	—		—	%
Critical Care	53,532		4	%	49,961		4	%	53,601		14	%
Other	—		—	%	64,817		5	%	903		—	%
Total Revenues	$	1,400,040	100	%	$	1,292,613	100	%	$	379,372	100	%

_______________________________

⁽¹⁾As noted above, prior period amounts have not been adjusted under the modified retrospective method.

Our primary product lines are Infusion Consumables, IV Solutions, Infusion Systems and Critical Care. The vast majority of our sales of these products are made on a stand-alone basis to hospitals, group purchasing organization member hospitals, distributors and to other non-acute facilities. Our product sales are typically free on board shipping point and ownership of the product transfers to the customer upon shipment. As a result, revenue is typically recognized upon transfer of control of the products, which we deem to be at point of shipment.

Payment is typically due in full within 30 days of invoicing. Revenue is recorded in an amount that reflects the consideration we expect to be entitled to in exchange for those goods or services. We offer certain volume-based rebates to our distribution customers, which we record as variable consideration when calculating the transaction price. We also provide chargebacks to distributors that sell to end-customers at prices determined under a contract between us and the end-customer.

We use information available at the time and our historical experience to estimate and record provisions for rebates and chargebacks.

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

Arrangements with Multiple Performance Obligations

We also enter into arrangements which include multiple performance obligations, see Note 1, Basis of Presentation and Summary of Significant Accounting Policies.

The most significant judgments related to these arrangements include:


•	Identifying the various performance obligations of these arrangements.


•	Estimating the relative standalone selling price of each performance obligation, typically using directly observable method or calculated on a cost plus margin basis method.

Contract balances

Our contract balances (deferred revenue) are recorded in accrued liabilities and other long-term liabilities in our consolidated balance sheet (see Note 10, Accrued Liabilities). The following table presents our changes in the contract balances for the year ended December 31, 2018, (in thousands):



	Contract Liabilities
Beginning balance, January 1, 2018	$	(7,066	)
Equipment revenue recognized	6,696
Equipment revenue deferred due to implementation	(4,196		)
Software revenue recognized	6,553
Software revenue deferred due to implementation	(6,269		)
Ending balance, December 31, 2018	$	(4,282	)

As of December 31, 2018, revenue from remaining performance obligations related to implementation of software and equipment is $2.9 million. We expect to recognize substantially all of this revenue within the next three months. Revenue from remaining performance obligations related to annual software licenses is $1.6 million. We expect to recognize substantially all of this revenue over the next twelve months.

Costs to Obtain a Contract with a Customer

As part of the cost to obtain a contract, we may pay incremental commissions to sales employees upon entering into a sales contract. Under ASC Topic 606, we have elected to expense these costs as incurred as the period of benefit is less than one year.

Practical expedients and exemptions

In addition to the practical expedient applied to sales commissions, under ASC Topic 606, we elected to apply the practical expedient for shipping and handling costs incurred after the customer has obtained control of a good. We will continue to treat these costs as a fulfillment cost rather than as an additional promised service.

Impairment on assets held for sale (Notes)	12 Months Ended
Impairment on assets held for sale (Notes)	Dec. 31, 2018
Impairment of assets held for sale [Abstract]
Asset Impairment Charges [Text Block]	IMPAIRMENT OF ASSETS HELD FOR SALE During 2016, we completed the closure of our Slovakia manufacturing facility and sold the land and building held-for- sale for $3.3 million, net of costs to sell, resulting in an additional $0.7 million impairment charge on those assets. The impairment charges are separately stated in our consolidated statements of operations above income from operations.

Share Based Award Share awards (Notes)

12 Months Ended

Dec. 31, 2018

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

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

SHARE BASED AWARDS

We have a stock incentive plan for employees and directors and an employee stock purchase plan. Shares to be issued under these plans will be issued either from authorized but unissued shares or from treasury shares.

We incur stock compensation expense for stock options, restricted stock units ("RSU"), performance restricted stock units ("PRSU") and in years prior to 2018 stock purchased under our employee stock purchase plan ("ESPP"). We receive a tax benefit on stock compensation expense and direct tax benefits from the exercise of stock options. We also have indirect tax benefits upon exercise of stock options related to research and development tax credits which are recorded as a reduction of income tax expense. The table below summarizes compensation costs and related tax benefits (in thousands):



	Year ended December 31,
(In thousands)	2018		2017		2016
Stock compensation expense	$	24,241	$	19,352	$	15,242
Tax benefit from stock-based compensation cost	$	5,706	$	7,247	$	5,682
Indirect tax benefit	$	2,199	$	1,374	$	—

As of December 31, 2018, we had $28.0 million of unamortized stock compensation cost which we will recognize as an expense over approximately 0.9 years.

Stock Incentive and Stock Option Plans

Our 2011 Stock Incentive Plan ("2011 Plan") replaced our 2003 Stock Option Plan (“2003 Plan”). Our 2011 Plan initially had 650,000 shares available for issuance, plus the remaining available shares for grant from the 2003 Plan. In 2012, 2014 and 2017, our stockholders approved amendments to the 2011 plan that increased the shares available for issuance by 3,275,000, bringing the initial shares available for issuance to 3,925,000, plus the remaining 248,700 shares that remained available for grant from the 2003 Plan. In addition, any forfeited, terminated or expired shares that would otherwise return to the 2003 Plan are available under the 2011 Plan. As of December 31, 2018, the 2011 Plan has 4,188,300 shares of common stock reserved for issuance to employees, which includes 263,300 shares that transferred from the 2003 Plan. Shares issued as options or stock appreciation rights ("SARs") are charged against the 2011 Plan's share reserve as one share for one share issued. Shares subject to awards other than options and SARs are charged against the 2011 Plan's share reserve as 2.09 shares for 1 share issued. Options may be granted with exercise prices at no less than fair market value at date of grant. Options granted under the 2011 Plan may be “non-statutory stock options” which expire no more than ten years from date of grant or “incentive stock options” as defined in Section 422 of the Internal Revenue Code of 1986, as amended. Upon exercise of non-statutory stock options, we are generally entitled to a tax deduction on the exercise of the option for an amount equal to the excess over the exercise price of the fair market value of the shares at the date of exercise; we are generally not entitled to any tax deduction on the exercise of an incentive stock option. The 2011 Plan includes conditions whereby unvested options are cancelled if employment is terminated.

In 2014, our Compensation Committee of the Board of Directors awarded our then new Chief Executive Officer an employment inducement option to purchase 182,366 shares of our common stock and an employment inducement grant of restricted stock units with respect to 68,039 shares of our common stock. The inducement grants were made out of our 2014 Inducement Incentive Plan ("2014 Plan").

Our 2001 Directors’ Stock Option Plan (the “Directors’ Plan”), initially had 750,000 shares reserved for issuance to members of our Board of Directors, expired in November 2011. Although no new grants may be made under the Director's Plan, grants made under the Director's Plan prior to its expiration continue to remain outstanding. Options not vested terminate if the directorship is terminated.

Time-based Stock Options

To date, all options granted under the 2014 Plan, 2011 Plan, 2003 Plan and Directors' Plan have been non-statutory stock options. The majority of the time-based outstanding employee option grants vest 25% after one year from the grant date and the balance vests ratably on a monthly basis over 36 months. The majority of the outstanding options granted to non-employee directors vest one year from the grant date. The options generally expire 10 years from the grant date.

The fair value of time-based option grants is calculated using the Black-Scholes option valuation model. The expected term for the option grants was based on historical experience and expected future employee behavior. We estimate the volatility of our common stock at the date of grant based on the historical volatility of our common stock, based on the average expected exercise term. The table below summarizes the total time-based stock options granted, total valuation and the weighted average assumptions (dollars in thousands, except per option amounts):



	Year ended December 31,
	2018			2017			2016
Number of time-based options granted	5,815			8,825			13,405
Grant date fair value of options granted (in thousands)	$	425		$	375		$	413
Weighted average assumptions for stock option valuation:
Expected term (years)	5.5			5.5			5.5
Expected stock price volatility	24.0		%	27.0		%	31.8		%
Risk-free interest rate	2.3		%	1.1		%	0.7		%
Expected dividend yield	—		%	—		%	—		%
Weighted average grant price per option	$	269.80		$	158.20		$	101.32
Weighted average grant date fair value per option	$	73.14		$	42.51		$	30.78

Performance Stock Options

In 2015, we granted performance stock option grants which are exercisable if the common stock price condition and the time-based vesting have been met. The 2015 performance based stock option grants vest ratably at 33% per year over three years. For the 2015 grants, the vested performance stock options became exercisable when the closing price of our common stock was equal to or more than 130% of the exercise price for 30 consecutive trading days during the term of the grant. All of the 2015 performance stock option grant's common stock price conditions have been met.

The fair value of performance option grants is calculated using the Monte Carlo Simulation. The expected term of the performance option grants is based on the expected number of years to achieve the exercisable goal trigger and assumes that the vested option will be immediately exercised or cancelled, if underwater. We estimate the volatility of our common stock at the date of grant based on the historical volatility of our common stock over a 10-year period.

The table below indicates the number of shares of 2015 performance stock options that were earned in 2016. There were no performance option grants to employees in 2018, 2017 or 2016.



	Year ended December 31,
	2018	2017	2016
Number of performance options earned			244,825

A summary of our stock option activity as of and for the year ended December 31, 2018 is as follows:



	Shares		Weighted Average Exercise Price Per Share		Weighted Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding at December 31, 2017	1,416,727		$	62.30
Granted	5,815		$	269.80
Exercised	(235,614	)	$	60.60
Forfeited or expired	—		$	—
Outstanding at December 31, 2018	1,186,928		$	63.66	4.9	$	197,232
Exercisable at December 31, 2018	1,181,113		$	62.64	4.8	$	197,232
Vested and expected to vest, December 31, 2018	1,186,928		$	63.66	4.9	$	197,232

The intrinsic values for options exercisable, outstanding and vested or expected to vest at December 31, 2018 is based on our closing stock price of $229.63 at December 31, 2018 and are before applicable taxes.

The following table presents information regarding Stock Option activity:



	Year ended December 31,
(In thousands)	2018		2017		2016
Intrinsic value of options exercised	$	51,105	$	71,283	$	25,065
Cash received from exercise of stock options	$	14,275	$	32,003	$	17,346
Tax benefit from stock option exercises	$	12,617	$	20,004	$	7,556

Stock Awards

In 2018, we granted performance restricted stock units ("PRSU") to our executive officers. For the executive officers other than the Chief Executive Officer ("CEO") and the Chief Operations Officer ("COO"), the PRSUs will vest subject to a three-year time vesting and further subject to a determination by the Compensation Committee that the officers have met their individual performance goals for the applicable year. For the CEO and the COO, the performance shares will cliff-vest ending on February 15, 2021 and further subject to the achievement of a minimum Cumulative Adjusted EBITDA. If for the three year period ending on December 31, 2020 the Cumulative Adjusted EBITDA has a growth of at least 6% to 8%, 50% of the awarded units will vest. If on the vest date the Cumulative Adjusted EBITDA has a growth of between 8% to 10%, 100% of the awarded units will vest. If on the vest date the Cumulative Adjusted EBITDA has a growth of over 10%, 200% of the awarded units will vest.

In 2017, we granted PRSUs to our executive officers. The PRSUs will vest, if at all, upon the achievement of a minimum Cumulative Adjusted EBITDA, subject to a three-year cliff vesting ending on December 31, 2019. If at that date, our Cumulative Adjusted EBITDA is at least $600 million but less than $650 million, 100% of the awarded units will vest. If our Cumulative Adjusted EBITDA is at least $650 million but less than $700 million, 200% of the awarded units will vest. If our Cumulative Adjusted EBITDA is at least $700 million, 300% of the awarded units will vest.

In 2016, we granted PRSUs to our executive officers, which will vest, if at all, upon the achievement of a minimum specified compound annual growth rate ("CAGR") in adjusted EBITDA per share, subject to a three-year cliff vesting ending on December 31, 2018. If at that date, our adjusted EBITDA per share CAGR is at least 8% but less than 10%, 100% of the awarded units will vest. If our adjusted EBITDA per share CAGR is at least 10% but less than 12%, 200% of the awarded units will vest. If our adjusted EBITDA per share CAGR is greater than 12%, 300% of the awarded units will vest. The Compensation Committee has up until March 15, 2019 to make a determination on the level of achievement of minimum Cumulative Adjusted EBITDA reached, the awards will vest upon the conclusion of that determination.

Restricted stock units ("RSU") are granted annually to our Board of Directors and vest on the first anniversary of the grant date.

In 2018, 2017 and 2016, we granted RSUs to certain employees that vest ratably on the anniversary of the grant over three years. We recognize forfeitures as they occur.

The table below summarizes our restricted stock award activity (dollars in thousands):



	Year ended December 31,
(In thousands except shares and per share amounts)	2018		2017		2016
PRSU
Shares granted	30,348		20,686		36,370
Shares earned	—		—		—
Grant date fair value per share	$	248.65	$	154.75	$	86.47
Grant date fair value	$	7,546	$	3,201	$	3,145
Intrinsic value vested	$	—	$	—	$	—

RSU
Shares granted	63,094		107,678		60,377
Grant date fair value per share	$	252.42	$	156.49	$	87.47
Grant date fair value	$	15,926	$	16,851	$	5,281
Intrinsic value vested	$	17,086	$	9,813	$	4,680

The table below provides a summary of our PRSU and RSU activity as of and for the year ended December 31, 2018.



	Number of Units		Grant Date Fair Value Per Share		Weighted Average Contractual Life (Years)	Aggregate Intrinsic Value
Non-vested at December 31, 2017	285,503		$	116.28
Change in units due to performance expectations^(a)	41,372		$	154.75
Granted	93,442		$	251.19
Vested	(71,868	)	$	122.00
Forfeited	(7,745	)	$	181.07
Non-vested and expected to vest at December 31, 2018	340,704		$	155.27	1.0	$	78,236

(a) Relates to the 2017 PRSUs, assumes attainment of maximum payout rate as set forth in performance criteria.

ESPP

We have an ESPP under which U.S. employees may purchase up to $25,000 annually of common stock at 85% of its fair market value at the beginning or the end of a six-month offering period, whichever is lower. There are 750,000 shares of common stock reserved for issuance under the ESPP, which is subject to an annual increase of the least of 300,000 shares, two percent of the shares outstanding or such a number as determined by the Board. To date, there have been no increases. As of December 31, 2018, there were 133,487 shares available for future issuance. The ESPP is intended to constitute an “employee stock purchase plan” within the meaning of Section 423 of the Internal Revenue Code. During 2017, we suspended our ESPP.

The fair value of rights to purchase shares under the ESPP is calculated using the Black-Scholes option valuation model. The table below summarizes the number and intrinsic value of ESPP share purchases and the weighted average valuation assumptions for the 2017 and 2016 purchase periods.




	2017			2016
ESPP shares purchased by employees	23,426			31,227
Intrinsic value of ESPP purchases (in thousands)	$	986		$	955
Weighted average assumptions for ESPP valuation:
Expected term (in years)	0.5			0.5
Expected stock price volatility	28.1		%	32.5		%
Risk-free interest rate	0.6		%	0.3		%
Expected dividend yield	—		%	—		%

Derivatives and Hedging Activities (Notes)

12 Months Ended

Dec. 31, 2018

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Derivative Instruments and Hedging Activities Disclosure [Text Block]

DERIVATIVES AND HEDGING ACTIVITIES

Hedge Accounting and Hedging Program

During the second quarter of 2017, we implemented a cash flow hedging program. The purpose of our hedging program is to manage the foreign currency exchange rate risk on forecasted expenses denominated in currencies other than the functional currency of the operating unit. We do not issue derivatives for trading or speculative purposes.

In May 2017, we entered into a two-year cross-currency par forward contract to hedge a portion of our Mexico forecasted expenses denominated in Pesos ("MXN"). To receive hedge accounting treatment, all hedging relationships are formally documented at the inception of the hedge, and the hedges must be highly effective in offsetting changes to future cash flows on hedged transactions. The par forward contract is designated and qualifies as a cash flow hedge. Our derivative instrument is recorded at fair value on the Consolidated Balance Sheets and is classified based on the instrument's maturity date. We record changes in the fair value of the effective portion of the derivative instrument as a component of Other Comprehensive (Loss) Income and we reclassify that gain or loss into earnings in the same line item associated with the forecasted transaction and in the same period during which the hedged transaction affects earnings. The total notional amount of our outstanding derivative as of December 31, 2018 was approximately 150.1 million MXN. The term of our currency forward contract is May 1, 2017 to May 1, 2019. The derivative instrument matures in equal monthly amounts at a fixed forward rate of 20.01MXN/USD over the term of the two-year contract.

In January 2018, we entered into an additional six-month cross-currency par forward contract that extends our current hedge of a portion of our Mexico forecasted expenses denominated in MXN. The total notional amount of this outstanding derivative as of December 31, 2018 was approximately 183.9 million MXN. The term of the six-month contract is May 1, 2019 to November 1, 2019. The derivative instrument matures in equal monthly amounts at a fixed forward rate of 20.43 MXN/USD over the term of the six-month contract.

In November 2018, we entered into a one-year cross-currency par forward contract again extending the hedge of a portion of our Mexico forecasted expenses denominated in MXN. The total notional amount of this outstanding derivative as of December 31, 2018 was approximately 398.0 million MXN. The term of the one-year hedge is November 1, 2019 to November 3, 2020. The derivative instrument matures in equal monthly amounts at a fixed forward rate of 22.109 MXN/USD.

The following table presents the fair values of our derivative instruments included within the Consolidated Balance Sheets (in thousands):



	Derivatives
	Consolidated Balance Sheet Location	December 31, 2018		December 31, 2017
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contract:	Prepaid expenses and other current assets	$	187	$	—
	Other assets	545		—
	Accrued liabilities	—		187
	Other long-term liabilities	—		402
Total derivatives designated as cash flow hedging instruments		$	732	$	589

The following table presents the amounts affecting the Consolidated Statements of Operations (in thousands):



	Line Item in the Consolidated Statements of Operations	Year Ended December 31, 2018		Year Ended December 31, 2017
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contracts	Cost of goods sold	$	743	$	885

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



	Amount of Gain Recognized in Other Comprehensive Income on Derivatives		Amount of Gain Recognized in Other Comprehensive Income on Derivatives		Amount of Gain Reclassified From Accumulated Other Comprehensive Income into Income
	Year Ended December 31, 2018		Year Ended December 31, 2017		Location of Gain Reclassified From Accumulated Other Comprehensive Income into Income	Year Ended December 31, 2018		Year Ended December 31, 2017
Derivatives designated as cash flow hedges:
Foreign exchange forward contract	$	2,063	$	296	Cost of goods sold	$	743	$	885
Total derivatives designated as cash flow hedging instruments	$	2,063	$	296		$	743	$	885

As of December 31, 2018, we expect approximately $0.2 million of the deferred gain on the outstanding derivatives in accumulated other comprehensive income to be reclassified to net income during the next 12 months concurrent with the underlying hedged transactions also being reported in net income.

Fair Value Measurements (Notes)

12 Months Ended

Dec. 31, 2018

Fair Value Disclosures [Abstract]

Fair Value Disclosures [Text Block]

FAIR VALUE MEASUREMENTS

Fair value is the price that would be received from selling an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Fair value is estimated by applying the following hierarchy, which prioritizes the inputs used to measure fair value into three levels and bases the categorization within the hierarchy upon the lowest level of input that is available and significant to the fair value measurement:


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

•

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


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

During the first quarter of 2017, we recognized an earn-out liability upon the acquisition of HIS from Pfizer. Pfizer may be entitled up to $225 million in cash if certain performance targets for the combined company for the three years ending December 31, 2019 are achieved. The initial fair value of the earn-out was determined by employing a Monte Carlo simulation in a risk neutral framework. The underlying simulated variable was adjusted EBITDA. The adjusted EBITDA volatility estimate was based on a study of historical asset volatility for a set of comparable public companies. The model includes other assumptions including the market price of risk, which was calculated as the weighted average cost of capital ("WACC") less the long term risk free rate. The initial value assigned to the contingent consideration was a result of forecasted product demand of our HIS business, as discussed further in Note 2: Acquisition, Strategic Transaction and Integration Expenses. At each reporting date subsequent to the acquisition we remeasure the earn-out using the same methodology above and recognize any changes in value. If the probability of achieving the performance target significantly changes from what we initially anticipated, the change could have a significant impact on our financial statements in the period recognized. Our contingent earn-out liability is separately stated in our consolidated balance sheets.

The following table provides a reconciliation of the Level 3 earn-out liability measured at estimated fair value based on an initial valuation and updated quarterly for the years ended December 31, 2018 and 2017 (in thousands):



	Earn-out Liability
Contingent earn-out liability, January 1, 2017	$	—
Acquisition date fair value estimate of earn-out	19,000
Change in fair value of contingent earn-out (included in income from operations as a separate line item)	8,000
Contingent earn-out liability, December 31, 2017	27,000
Change in fair value of contingent earn-out (included in income from operations as a separate line item)	20,400
Contingent earn-out liability, December 31, 2018	$	47,400

Changes in the fair value of the earn-out subsequent to the fair value calculated at acquisition are due to a change in the forecast of the underlying target, adjusted EBITDA, and due to changes in other assumptions used in the Monte Carlo simulation, as detailed in the below table.

The following table provides quantitative information about Level 3 inputs for fair value measurement of our earn-out liability as of the acquisition date to December 31, 2018. Significant increases or decreases in these inputs in isolation could result in a significant impact on our fair value measurement:



Simulation Input	As of December 31, 2018		As of December 31, 2017		At Acquisition February 3, 2017
Adjusted EBITDA Volatility	30.00	%	26.00	%	29.00	%
WACC	8.25	%	8.75	%	10.00	%
20-year risk free rate	2.87	%	2.58	%	2.82	%
Market price of risk	5.24	%	5.99	%	6.93	%
Cost of debt	5.25	%	4.08	%	4.16	%

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

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

The assets related to our Dominican Republic manufacturing facilities were classified as assets held-for-sale as of December 31, 2017. These assets are separately stated in our 2017 consolidated balance sheet. The fair value of these Level 3 assets was determined as part of the HIS business valuation and was based on a market approach using comparable building and land sales data and the analysis of market conditions. We sold these assets during 2018.

There were no transfers between levels in 2018 or 2017.

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



	Fair value measurements at December 31, 2018
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	37,329	$	—	$	37,329	$	—
Long-term	2,025		—		2,025		—
Foreign exchange forwards:
Prepaid expenses and other current assets	187		—		187		—
Other assets	545		—		545		—
Total Assets	$	40,086	$	—	$	40,086	$	—

Liabilities:

Earn-out liability	$	47,400	$	—	$	—	$	47,400
Total Liabilities	$	47,400	$	—	$	—	$	47,400



	Fair value measurements at December 31, 2017
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	10,061	$	—	$	10,061	$	—
Long-term	14,579		—		14,579		—
Total Assets	$	24,640	$	—	$	24,640	$	—

Liabilities:

Earn-out liability	$	27,000	$	—	$	—	$	27,000
Foreign exchange forwards:
Accrued liabilities	187		—		187		—
Other long-term liabilities	402		—		402		—
Total Liabilities	$	27,589	$	—	$	589	$	27,000

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



	Fair value measurements at December 31, 2017
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Assets held-for-sale	$	12,489	$	—	$	—	$	12,489
Total Assets	$	12,489	$	—	$	—	$	12,489

- 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

Prepaids and Other Current Assets (Notes)

12 Months Ended

Dec. 31, 2018

Prepaid Expense and Other Assets, Current [Abstract]

Other Current Assets [Text Block]

PREPAID EXPENSES, OTHER CURRENT ASSETS AND RELATED-PARTY RECEIVABLE

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



	2018		2017
Deposits	$	1,087	$	21,940
Other prepaid expenses and receivables	12,476		4,208
Deferred costs	1,951		1,301
Prepaid insurance and property taxes	2,666		2,580
VAT/GST receivable	5,072		8,097
Deferred tax charge	1,180		1,326
Other	1,548		1,834
	$	25,980	$	41,286

Related-party receivables consist of the following (in thousands):



	2018		2017
Third-party receivables due from Pfizer	$	4,904	$	36,425
HIS business acquisition related	15,233		62,382
	$	20,137	$	98,807

Third-party receivables due from Pfizer relates to trade accounts receivable that have already been collected from customers by Pfizer on our behalf. HIS business acquisition related receivables include amounts due from Pfizer related to the manufacturing and supply agreements and deferred close entities and amounts we prepaid to Pfizer for operational expenses under the transition services agreement.

Pfizer became a related party to us when we issued 3.2 million shares of our common stock as partial consideration for the acquisition of HIS. As of December 31, 2018, Pfizer has sold all of its shares of our common stock. In connection with the sale of 2.5 million of the shares Pfizer held, we incurred a one-time fee payable to Pfizer in the amount of $8.0 million included in restructuring, strategic transaction and integration expense in our consolidated statement of operations.

On February 3, 2017, we entered into a transitional services agreement and two Manufacturing and Supply Agreements ("MSA's") with Pfizer, (see Note 16, Collaborative and Other Arrangements). During 2018, the revenue for goods manufactured for Pfizer was $78.2 million and the cost of product manufactured by Pfizer for us was $81.0 million. During 2017, the revenue for goods manufactured for Pfizer was $72.4 million and the cost of product manufactured by Pfizer for us was $70.2 million.

Accrued Liabilities an Other Long-term Liabilities

12 Months Ended

Dec. 31, 2018

Accrued Liabilities [Abstract]

Accounts Payable and Accrued Liabilities Disclosure [Text Block]

ACCRUED LIABILITIES AND OTHER LONG-TERM LIABILITIES

Accrued liabilities consist of the following (in thousands):



	December 31,
	2018		2017
Salaries and benefits	$	20,538	$	20,745
Incentive compensation	42,913		40,682
Accrued professional fees	15,996		13,319
Accrued product field action	5,316		11,810
Consigned inventory	1,118		5,210
Third-party inventory	1,089		4,284
Legal accrual	1,400		3,538
Accrued sales taxes	2,941		6,291
Warranties and Returns	1,124		3,360
Deferred revenue	3,814		3,326
Accrued other taxes	3,213		2,771
Distribution fees	3,977		725
Accrued freight	10,953		5,696
Restructuring accrual	1,046		1,290
Contract settlement	2,083		—
Accrued research and development	1,451		—
Other	9,848		9,017
	$	128,820	$	132,064

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



	December 31,
	2018		2017
Contract liabilities⁽¹⁾	$	14,020	$	40,148
Deferred revenue	468		7,099
Benefits	962		2,104
Accrued rent	1,779		—
Contract settlement	1,667		—
Other	1,696		5,975
	$	20,592	$	55,326

__________________________________________

⁽¹⁾ Consists of multiple contracts with customers and suppliers that were valued at below market at the time of the HIS acquisition. During 2018, the decrease to contract liabilities was primarily due to the resolution and settlement of a dispute with a product partner.

Long-Term Obligations (Notes)

12 Months Ended

Dec. 31, 2018

LOng-Term Obligations Disclosure [Abstract]

Debt Disclosure [Text Block]

LONG-TERM OBLIGATIONS

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

On November 8, 2017, we entered into a five-year Revolving Credit Facility ("Credit Facility") with various lenders for $150 million, with Wells Fargo Bank, N.A. as the administrative agent, swingline lender and issuing lender. As of December 31, 2018, we had no borrowings and $150 million of availability under the Credit Facility. The Credit Facility matures on November 8, 2022.

The Credit Facility has an accordion feature that would enable us to increase the borrowing capacity of the Credit Facility by the greater of (i) $100 million and (ii) 2.00x Total Leverage.

In connection with the Credit Facility, for the year ended December 31, 2017, we incurred $1.4 million in financing costs, which were capitalized and are included in prepaid expenses and other current assets and other assets in our consolidated balance sheets, in accordance with the appropriate short-term or long-term classification. These fees are being amortized to interest expense over the remaining term of the Credit Facility.

Principal payments

Principal payments, when drawn on the Credit Facility, are made at our discretion with the entire unpaid amount due at maturity.

Interest rate

In general, borrowing under the Credit Facility (other than Swingline loans) bears interest, at our option, based on the Base Rate plus applicable margin or the London Interbank Offered Rate ("LIBOR") rate plus applicable margin, as defined below:

(A) Base Rate is defined as the highest of: (a) the Prime Rate; (b) the Federal Funds Rate plus 0.50%; and (c) the daily LIBOR (as defined below) for a one month Interest Period plus 1%.

(B) LIBOR Rate, as determined by the Administrative Agent, is defined as the rate per annum obtained by dividing (1) LIBOR by (2) 1.00 - Eurodollar Reserve Percentage.

Swingline loans will bear interest at the Base Rate plus the applicable Interest Margin. The Credit Facility has a per annum commitment fee (see table below) that will accrue on the unused amounts of the commitments under the Credit Facility.

The applicable interest margins and the commitment fee with respect to the Credit Facility shall be based on the Total Leverage Ratio pursuant to the following pricing grid:



Level	Consolidated Total Leverage Ratio	Commitment Fee	LIBOR +	Base Rate +
I	Less than 1.00 to 1.00	0.15%	1.25%	0.25%
II	Greater than or equal to 1.00 to 1.00 but less than 2.00 to 1.00	0.20%	1.50%	0.50%
III	Greater than or equal to 2.00 to 1.00 but less than 2.50 to 1.00	0.25%	1.75%	0.75%
IV	Greater than or equal to 2.50 to 1.00	0.30%	2.00%	1.00%

Guarantors and Collateral

Our obligations under the Credit Facility are unconditionally guaranteed, on a joint and several basis, by ICU Medical, Inc. and certain of our existing subsidiaries. Our obligations are secured by: (i) 100% of the equity interests of our guarantor subsidiaries; and (ii) all of the tangible and intangible personal property and assets related to us and our guarantor subsidiaries (including, without limitation, all accounts, equipment, inventory and other goods, all instruments, intellectual property and other general intangibles, deposit accounts, securities accounts and other investment property and cash), and (iii) all products, profits and proceeds of the foregoing. Notwithstanding the foregoing, the collateral shall not include certain excluded property.

Debt Covenants

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

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

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

We were in compliance with all financial covenants as of December 31, 2018.

Three-Year Interest-Only Senior Note

On February 3, 2017, we partially funded the acquisition of the HIS business from Pfizer with a $75 million Seller Note issued by Pfizer contemporaneous with the acquisition. We had fully repaid the seller note as of December 31, 2017.

Income Taxes:

12 Months Ended

Dec. 31, 2018

Income Tax Disclosure [Abstract]

Income Tax Disclosure [Text Block]

INCOME TAXES

Income from continuing operations before taxes consisted of the following (in thousands):



	Year Ended December 31,
	2018			2017			2016
United States	$	(8,600	)	$	59,872		$	80,714
Foreign	30,974			(8,589		)	4,450
	$	22,374		$	51,283		$	85,164

The (benefit) provision for income taxes consisted of the following (in thousands):



	Year Ended December 31,
	2018			2017			2016
Current:
Federal	$	492		$	2,774		$	21,123
State	1,865			2,263			2,347
Foreign	9,136			3,170			1,118
	11,493			8,207			24,588
Deferred:
Federal	$	(9,118	)	$	(20,878	)	$	(2,045	)
State	(3,072		)	(4,619		)	(767		)
Foreign	(5,722		)	(71		)	304
	(17,912		)	(25,568		)	(2,508		)
	$	(6,419	)	$	(17,361	)	$	22,080

We have accrued for tax contingencies for potential tax assessments, and in 2018 we recognized a $4.3 million net increase, most of which related to various federal and state tax reserves.

On December 22, 2017, the Tax Act was enacted into legislation, which includes a broad range of provisions affecting businesses. The Tax Act significantly revises how companies compute their U.S. corporate tax liability by, among other provisions, reducing the corporate tax rate from 35% to 21% for tax years beginning after December 31, 2017, implementing a territorial tax system, and requiring a mandatory one-time tax on U.S. owned undistributed foreign earnings and profits known as the toll charge or transition tax.

Pursuant to the SEC Staff Accounting Bulletin ("SAB") No. 118, "Income Tax Accounting Implications of the Tax Cuts and Jobs Act" ("SAB 118"), a company selects between one of three scenarios to reflect the impact of the Tax Act in its financial statements within a measurement period. Those scenarios are (i) a final estimate which effectively closes the measurement period; (ii) a reasonable estimate leaving the measurement period open for future revisions; and (iii) no estimate as the law is still being analyzed in which case a company continues to apply its accounting on the basis of the provisions of the tax laws that were in effect immediately before the enactment of the Tax Act. SAB 118 allows for the reporting provisional amounts for certain income tax effects in scenario (ii) and (iii). The measurement period begins in the reporting period that includes the Act’s enactment date and ends when an entity has obtained, prepared, and analyzed the information that was needed in order to complete the accounting requirements under ASC Topic 740. As of December 31, 2018, our accounting for the Tax Act is complete.

The toll charge on undistributed foreign earnings and profits (the “Transition Tax”) is a tax on certain untaxed accumulated and current earnings and profits ("E&P") of our foreign subsidiaries. We were able to reasonably estimate the Transition Tax and recorded a provisional Transition Tax expense of $2.0 million for the year ended December 31, 2017. On the basis of revised E&P computations that were completed during the reporting period, we recognized an additional measurement-period adjustment of $0.6 million to the Transition Tax obligation, with a corresponding adjustment of $0.6 million to income tax expense.

The revaluation of deferred taxes is an adjustment to future tax obligations as a result of the reduction of the corporate tax rate from 35% to 21%. We were able to reasonably estimate the effect of the revaluation of deferred taxes and recorded a provisional tax expense of $1.1 million for the year ended December 31, 2017. The computation of timing differences was completed during the reporting period. We recognized an additional measurement-period adjustment of $0.2 million, with a corresponding adjustment of $0.2 million to income tax expense.

We continue to evaluate various international provisions included in the Tax Act due to the lack of final Treasury Regulations and ongoing guidance. These provisions include, but are not limited to, the anti-base-erosion and anti-abuse tax regime (BEAT), the global intangible low-taxed income (GILTI) provisions, the foreign derived intangible income (FDII) provisions, and the changes to the deductibility of interest. These provisions were effective for us beginning on January 1, 2018, and may materially impact our effective tax rate in future years. We elected to treat the GILTI as period costs when incurred, and for the year ended December 31, 2018, we recorded an income tax expense of $2.4 million for GILTI.

A reconciliation of the provision for income taxes at the statutory rate to our effective tax rate is as follows (dollars in thousands):



	Year Ended December 31,
	2018					2017					2016
	Amount			Percent		Amount			Percent		Amount			Percent
Federal tax at the expected statutory rate	$	4,699		21.0	%	$	17,950		35.0	%	$	29,807		35.0	%
State income tax, net of federal effect	927			4.1	%	(403		)	(0.8	)%	1,795			2.1	%
Tax credits	(4,961		)	(22.2	)%	(2,783		)	(5.4	)%	(1,014		)	(1.2	)%
Global intangible low-taxed income	2,363			10.6	%	—			—	%	—			—	%
Foreign income tax differential	(2,944		)	(13.2	)%	3,481			6.8	%	(135		)	(0.1	)%
Stock based compensation	(11,040		)	(49.3	)%	(18,958		)	(37.0	)%	(7,720		)	(9.1	)%
Impact of the Tax Act	826			3.7	%	3,076			6.0	%	—			—	%
IP installment sale	3,252			14.5	%	3,367			6.6	%	—			—	%
Bargain purchase gain	—			—	%	(24,811		)	(48.4	)%	—			—	%
Section 162(m)	456			2.0	%	595			1.2	%	1,133			1.3	%
Other	3			0.1	%	1,125			2.2	%	(1,786		)	(2.1	)%
	$	(6,419	)	(28.7	)%	$	(17,361	)	(33.8	)%	$	22,080		25.9	%

Tax credits in 2018, 2017 and 2016 consist principally of research and developmental tax credits.

The tax effect of the gain on bargain purchase is treated as a discrete item part of purchase accounting and is not a component of the income tax provision.

The components of our deferred income tax assets (liabilities) are as follows (in thousands):



	December 31,
	2018			2017
Deferred tax asset:
Accruals/other	11,291			956
Contingent consideration	12,451			7,412
Net operating loss carryforwards	12,686			—
Acquired future tax deductions	10,722			10,580
Stock-based compensation	10,775			8,633
Foreign currency translation adjustments	3,108			3,425
Tax credits	14,470			11,220
Inventory reserves	5,674			10,658
Allowance for doubtful accounts	830			636
Valuation allowance	(5,436		)	(7,385		)
	$	76,571		$	46,135
Deferred tax liability:
State income taxes	$	2,639		$	1,640
Foreign	612			202
Depreciation and amortization	35,387			21,005
	$	38,638		$	22,847

Deferred tax asset, net	$	37,933		$	23,288

Tax Holidays and Carryforwards

Net operating loss ("NOL") carryforwards consist of: (a) federal NOL carryforwards of $68.9 million which will expire at various dates from 2020 to indefinite carryforward periods, (b) state NOL carryforwards of $20.2 million which will expire at various dates from 2028 to indifinite carryforward periods, and (c) foreign NOL carryforwards of $21.4 million which will expire at various dates from 2019 to indefinite carryforward periods. Under Section 382 of the Internal Revenue Code, certain ownership changes limit the utilization of the NOL carryforwards, and the amount of federal NOL carryforwards recorded is the net federal benefit available.

Other carryforwards include research and development (“R&D”), federal and state tax credit carryforwards of $7.4 million and $13.6 million, respectively.

A substantial portion of our manufacturing operations in Costa Rica operate under various tax holidays and tax incentive programs which will expire in whole or in part in 2027. Certain of the holidays may be extended if specific conditions are met. The net impact of these tax holidays and tax incentives was an increase to our net earnings by $8.8 million or $0.41 per diluted share in 2018.

Foreign currency translation adjustments, and related tax effects, are an element of “other comprehensive income” and are not included in net income other than the revaluation of the associated deferred tax asset due to the Tax Act.

As of December 31, 2018, we have estimated $20.8 million of undistributed foreign earnings and profits. We have not provided deferred tax liabilities for foreign withholding taxes and certain state income taxes on the undistributed earnings and profits from certain non-U.S. subsidiaries that will be permanently reinvested outside the United States.

Upon the distribution of foreign earnings and profits, certain foreign countries impose withholding taxes. If the foreign earnings and profits were distributed, we would need to accrue an additional income tax liability. However, we may also be allowed a credit against our U.S. tax liability for substantially all the taxes paid in foreign jurisdictions.

We are subject to taxation in the United States and various states and foreign jurisdictions. Our United States federal income tax returns for tax years 2015 and forward are subject to examination by the Internal Revenue Service. Our principal state income tax returns for tax years 2013 and forward are subject to examination by the state tax authorities. The total gross amount of unrecognized tax benefits as of December 31, 2018 was $10.8 million which, if recognized, would impact the effective tax rate. We believe that adequate provision has been made for any adjustments that may result from tax examinations. However, the outcome of tax examinations cannot be predicted with certainty. As of December 31, 2018, it is not possible to estimate the amount of change, if any, in the unrecognized tax benefits that is reasonably possible within the next twelve months. We recognize accrued interest and penalties related to unrecognized tax benefits as a component of income tax expense. We have not accrued any penalties or interest as of December 31, 2018 or December 31, 2017.

The following table summarizes our cumulative gross unrecognized tax benefits (in thousands):



	Year Ended December 31,
	2018			2017			2016
Beginning balance	$	6,527		$	2,000		$	1,772
Increases to prior year tax positions	—			77			77
Increases due to acquisitions	—			640			—
Increases to current year tax positions	4,536			3,992			345
Decreases to prior year tax positions	(146		)	(12		)	(46		)
Decrease related to lapse of statute of limitations	(93		)	(170		)	(148		)
Ending balance	$	10,824		$	6,527		$	2,000

Geographic Information and Significant Customers Geographic Information and Significant Customers (Notes)

12 Months Ended

Dec. 31, 2018

Geographic Areas, Long-Lived Assets [Abstract]

Information by Geographic Area and Customer Concentration [Text Block]

GEOGRAPHIC INFORMATION AND SIGNIFICANT CUSTOMERS

Significant Customers

We sell products worldwide, on credit terms on an unsecured basis, as an OEM supplier, to independent medical supply distributors and directly to the end customer. The manufacturers and distributors, in turn, sell our products to healthcare providers. For the year ended December 31, 2016, we had worldwide sales to one manufacturer, Pfizer, of 30% of consolidated revenue and as of December 31, 2016, accounts receivable from Pfizer was 23% of consolidated accounts receivable. In February 2017, we completed the acquisition of Pfizer's HIS business, which eliminated the significant earnings exposure indicated above (see Note 2: Acquisitions and Strategic Transaction Expenses).

Geographic Information

The table below presents our gross long-lived assets, consisting of property, plant and equipment, by country or region (in thousands):



	As of December 31,
	2018		2017
Costa Rica	$	81,920	$	80,956
Mexico	64,242		61,008
Other LATAM	22,828		19,432
Canada	4,545		4,362
Italy	7,819		6,860
Spain	6,516		5,601
Other Europe	2,427		2,625
APAC	15,152		5,169
Total Foreign	$	205,449	$	186,013
United States	489,415		422,810
Worldwide Total	$	694,864	$	608,823

Stockholders' Equity

12 Months Ended

Dec. 31, 2018

Stockholders' Equity Attributable to Parent [Abstract]

Treasury Stock [Text Block]

Stockholders' Equity

Treasury Stock

In July 2010, our Board of Directors approved a common stock purchase plan to purchase up to $40.0 million of our common stock. This plan has no expiration date and we have $7.2 million remaining on this purchase plan. During 2016, we purchased $15.4 million of our common stock. We did not purchase any of our common stock under our purchase plan in 2018 or 2017. We used the treasury stock to issue shares for stock option exercises, restricted stock grants and employee stock purchase plan stock purchases. We are currently limited on share purchases in accordance with the terms and conditions of our Credit Facility, (see Note 11: Long-Term Obligations).

In 2018, we withheld 26,307 shares of our common stock from employee vested restricted stock units in consideration for $6.3 million in payments for the employee's share award income tax withholding obligations. We have 408 shares remaining in treasury at December 31, 2018.

In 2017, we withheld 27,636 shares of our common stock from employee vested restricted stock units in consideration for $4.1 million in payments for the employee's share award income tax withholding obligations. We had no shares remaining in treasury at December 31, 2017.

Accumulated Other Comprehensive Income (Loss)

The components of AOCI, net of tax, were as follows (in thousands):



	Foreign Currency Translation Adjustments			Unrealized Gains on Cash Flow Hedges			Other Adjustments			Total
Balance as of January 1, 2017	$	(21,272	)	$	—		$	—		$	(21,272	)
Other comprehensive income (loss) before reclassifications	6,694			184			(16		)	6,862
Amounts reclassified from AOCI	—			(549		)	—			(549		)
Other comprehensive income (loss)	6,694			(365		)	(16		)	6,313
Balance as of December 31, 2017	$	(14,578	)	$	(365	)	$	(16	)	$	(14,959	)
Other comprehensive (loss) income before reclassifications	(3,104		)	1,568			115			(1,421		)
Amounts reclassified from AOCI	—			(565		)	—			(565		)
Other comprehensive (loss) income	(3,104		)	1,003			115			(1,986		)
Balance as of December 31, 2018	$	(17,682	)	$	638		$	99		$	(16,945	)

Commitments and Contingencies

12 Months Ended

Dec. 31, 2018

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies Disclosure [Text Block]

COMMITMENTS AND CONTINGENCIES

Lease Commitments

We have entered into various non-cancellable operating lease agreements for offices and facilities, passenger vehicles, and IT services throughout the world with original lease periods expiring primarily between 2019 and 2030 and remaining lease terms of 1 to 11 years. Some of these agreements have escalating rent payment provisions, as well as options to extend the lease for up to 5 years.

We recognize rent expense under such agreements on a straight-line basis. Our rent expense under operating leases was $11.0 million in 2018, $7.9 million in 2017 and $0.6 million in 2016.

As of December 31, 2018, undiscounted future minimum lease payments under our non-cancelable operating leases are as follows over each of the next five years and thereafter (in millions):



2019	$	8.3
2020	8.6
2021	6.5
2022	5.9
2023	5.6
Thereafter	13.2
Total	$	48.1

The weighted-average lease term for the operating lease liabilities is approximately 6.3 years.

Legal Proceedings

Beginning in November 2016, purported class actions were filed in the U.S. District Court for the Northern District of Illinois against Pfizer, Inc. subsidiaries, Hospira, Inc., Hospira Worldwide, Inc. and certain other defendants relating to the intravenous saline solutions part of the HIS business. Plaintiffs seek to represent classes consisting of all persons and entities in the U.S. who directly purchased intravenous saline solution sold by any of the defendants from January 1, 2013 until the time the defendants’ allegedly unlawful conduct ceases. Plaintiffs allege that U.S. manufacturer defendants conspired together to restrict output and artificially fix, raise, maintain and/or stabilize the prices of intravenous saline solution sold throughout the U.S. in violation of federal antitrust laws. Plaintiffs seek treble damages (for themselves and on behalf of the putative classes) and an injunction against defendants for alleged price overcharges for intravenous saline solution in the U.S. since January 1, 2013. On July 5, 2018, the District Court granted defendants’ motion to dismiss the operative complaint for failing to state a valid antitrust claim, but allowed the plaintiffs to file a second amended complaint. On September 6, 2018, plaintiffs filed a second amended complaint adding new allegations in support of their conspiracy claims and adding ICU as a defendant. All defendants have filed a motion to dismiss this second amended complaint. On February 3, 2017, we completed the acquisition of the HIS business from Pfizer. This litigation is the subject of a claim for indemnification against us by Pfizer and a cross-claim for indemnification against Pfizer by us under the HIS stock and asset purchase agreement (“SAPA”).

In addition, in August 2015, the New York Attorney General issued a subpoena to Hospira, Inc. requesting that the company provide information regarding certain business practices in the intravenous solutions part of the HIS business. Separately, in April 2017, we received a grand jury subpoena issued by the United States District Court for the Eastern District of Pennsylvania, in connection with an investigation by the U.S. Department of Justice, Antitrust Division. The subpoena calls for production of documents related to the manufacturing, selling, pricing and shortages of intravenous solutions, including saline, as well as communications among market participants regarding these issues. On December 10, 2018, we were informed by the U.S. Department of Justice, Antitrust Division, that their investigation has been closed.

In April 2018, the U.S. Department of Justice issued a HIPAA subpoena to Hospira, Inc., requesting production of documents and records regarding the manufacturing, production, testing, quality and validation of the Sapphire™ infusion pumps, sets and related accessories distributed by the Company. We are coordinating with Pfizer to produce the requested records to the Department of Justice.

In March 2018, a dispute with a product partner resulted in a redefinition of our contractual arrangement and in the rights and remedies determined under such arrangement. The resolution of the dispute resulted in a $28.9 million net charge to the consolidated statement of operations. During the fourth quarter of 2018, we incurred $12.7 million in additional contract settlement charges related to this arrangement as a result of the write-off of assets and additional expenses associated with the restructuring of products.

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

Off Balance Sheet Arrangements

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

Contingencies

We have a contractual earn-out arrangement in connection with our acquisition of the HIS business, whereby Pfizer may be entitled up to an additional $225 million in cash upon achievement of performance targets for the company for the three years ending December 31, 2019, see (Note 2: Acquisitions and Strategic Transaction Expenses). The amount to be paid cannot be determined until the earn-out period has expired.

Commitments and Contingencies Leases (Notes)

12 Months Ended

Dec. 31, 2018

Commitments and Contingencies Disclosure [Abstract]

Leases of Lessee Disclosure [Text Block]

Lease Commitments

We recognize rent expense under such agreements on a straight-line basis. Our rent expense under operating leases was $11.0 million in 2018, $7.9 million in 2017 and $0.6 million in 2016.

As of December 31, 2018, undiscounted future minimum lease payments under our non-cancelable operating leases are as follows over each of the next five years and thereafter (in millions):



2019	$	8.3
2020	8.6
2021	6.5
2022	5.9
2023	5.6
Thereafter	13.2
Total	$	48.1

Collaborative and Other Arrangements (Notes)	12 Months Ended
Collaborative and Other Arrangements (Notes)	Dec. 31, 2018
Collaborative and Other Arrangements [Abstract]
Collaborative Arrangement Disclosure [Text Block]	COLLABORATIVE AND OTHER ARRANGEMENTS On February 3, 2017, we entered into two MSA's, (i) whereby Pfizer will manufacture and supply us with certain agreed upon products for an initial five-year term with a one-time two-year option to extend and (ii) whereby we will manufacture and supply Pfizer certain agreed upon products for a term of five or ten years depending on the product, also with a one-time two-year option to extend. The MSA's provide each party with mutually beneficial interests and both of the MSA's are to be jointly managed by both Pfizer and ICU. The initial supply price, which will be annually updated, is in full consideration for all costs associated with the manufacture, documentation, packaging and certification of the products. On February 3, 2017, as part of the HIS business acquisition, we entered into an agreement with Pfizer, whereby Pfizer will provide certain transitional services to us for finance, business technology, regulatory, human resources, global operations, procurement, quality and global commercial operation services ("Enabling Function Services"). We pay a monthly service fee for each service provided, and share equally with Pfizer in certain set-up costs and, as applicable, service exit costs. Our share of the set-up costs and service exit costs, in the aggregate, are not to exceed $22.0 million. The service fees are subject to a fee cap of (i) $62.5 million during the initial twelve month period and (ii) $31.3 million during the subsequent six month period. Only the Enabling Function Services are subject to the fee cap, any services provided after expiration of the agreement or services that are not Enabling Function Services may result in service fees outside the fee cap. The service fees are intended to reasonably approximate Pfizer’s cost of providing the Enabling Function Services. We may terminate, in whole only, any particular service and the fee cap would be reduced proportionate to the services terminated. Partial reduction in the provision of any specific service may be made but only with the prior written consent of Pfizer. On February 3, 2017, as part of the HIS business acquisition, we also entered into a reverse transitional services agreement, where we will provide to Pfizer certain transitional services ranging in term from three to eighteen months. Services include support for real estate, research and development, infrastructure, logistics, quality, site operations, safety, commercial and finance, and regulatory support services.

Selected Quarterly Financial Data - Unaudited

12 Months Ended

Dec. 31, 2018

Quarterly Financial Data - Unaudited [Abstract]

Quarterly Financial Information [Text Block]

SELECTED QUARTERLY FINANCIAL DATA - UNAUDITED



	Quarter Ended
	Mar. 31		Jun. 30			Sept. 30		Dec. 31
	(in thousands except per share data)
2018
Total revenue	$	372,033	$	360,460		$	327,169	$	340,378
Gross profit	$	149,001	$	151,800		$	134,587	$	134,640
Net income (loss)	$	4,875	$	31,054		$	219	$	(7,355	)
Net income (loss) per share:
Basic	$	0.24	$	1.53		$	0.01	$	(0.36	)
Diluted	$	0.23	$	1.44		$	0.01	$	(0.36	)
2017
Total revenue	$	247,739	$	331,514		$	343,236	$	370,124
Gross profit	$	88,945	$	88,062		$	111,598	$	137,490
Net income (loss)	$	55,863	$	(37,060	)	$	136	$	49,705
Net income (loss) per share:
Basic	$	3.03	$	(1.87	)	$	0.01	$	2.47
Diluted	$	2.86	$	(1.87	)	$	0.01	$	2.33

______________________________________

On February 3, 2017, we acquired HIS, see Note 2, Acquisitions, Strategic Transaction and Integration Costs.

Net loss for the quarter ended December 31, 2018 included the impact of $41.1 million in restructuring, strategic transaction and integration expenses. We also incurred an $8.6 million non-cash charge in the quarter ended December 31, 2018 associated with a contract settlement that took place in the quarter ended March 31, 2018, which is included in contract settlement. Management of the Company concluded the contract settlement charge is not material to the three months ended December 31, 2018, or to any previously issued interim financial statements.

General and Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2018

Accounting Policies [Abstract]

Business Description and Basis of Presentation [Text Block]

Basis of Presentation and Preparation

Use of Estimates, Policy [Policy Text Block]

Preparing financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amount 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.

Cash and Cash Equivalents, Policy [Policy Text Block]

Receivables, Trade and Other Accounts Receivable, Allowance for Doubtful Accounts, Policy [Policy Text Block]

Inventory, Policy [Policy Text Block]

Inventories are stated at the lower of cost or net realizable value with cost determined using the first-in, first-out method.

Property, Plant and Equipment, Policy [Policy Text Block]

All property, plant and equipment are stated at cost. We use the straight-line method for depreciating property, plant and equipment over their estimated useful lives. Estimated useful lives are:



Buildings	15 - 30 years
Building improvements	15 - 30 years
Machinery, equipment and molds	2 - 15 years
Furniture, fixtures and office equipment	2 - 5 years
Computer equipment and software	3 - 5 years
Instruments placed with customers¹	3 - 7 years

Goodwill and Intangible Assets, Goodwill, Policy [Policy Text Block]

Goodwill

Goodwill and Intangible Assets, Intangible Assets, Policy [Policy Text Block]

Intangible assets, carried at cost less accumulated amortization and amortized on a straight-lined basis

Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]

Long-Lived Assets

Investment, Policy [Policy Text Block]

Investment Securities

Income Tax, Policy [Policy Text Block]

Income Taxes

Foreign Currency Transactions and Translations Policy [Policy Text Block]

Foreign Currency

Revenue Recognition, Policy [Policy Text Block]

Revenue Recognition

Our software license renewals are considered to be transferred to a customer at a point in time at the start of each renewal period, therefore revenue is recognized at that time.

Arrangements with Multiple Deliverables

Shipping and Handling Cost, Policy [Policy Text Block]

Shipping Costs

Costs to ship finished goods to our customers are included in cost of goods sold on the consolidated statements of operations.

Advertising Costs, Policy [Policy Text Block]

Advertising Expenses

Pension and Other Postretirement Plans, Policy [Policy Text Block]

Post-retirement and Post-employment Benefits

Research and Development Expense, Policy [Policy Text Block]

Research and Development

Earnings Per Share, Policy [Policy Text Block]

Net Income Per Share

General and Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2018

Accounting Policies [Abstract]

Schedule of Inventory, Current [Table Text Block]

Inventories consist of the following at December 31 (in thousands):



	2018		2017
Raw material	$	104,104	$	82,397
Work in process	52,909		42,304
Finished goods	154,150		163,956
Total	$	311,163	$	288,657

Property, Plant and Equipment [Table Text Block]

Property, plant and equipment consist of the following at December 31 (in thousands):



	2018			2017
Machinery and equipment	$	203,431		$	220,999
Land, building and building improvements	212,283			206,846
Molds	59,700			56,253
Computer equipment and software	80,420			44,408
Furniture and fixtures	7,409			7,361
Instruments placed with customers¹	60,757			15,812
Construction in progress	70,864			57,144
Total property, plant and equipment, cost	694,864			608,823
Accumulated depreciation	(262,223		)	(210,139		)
Net property, plant and equipment	$	432,641		$	398,684

______________________________

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

All property, plant and equipment are stated at cost. We use the straight-line method for depreciating property, plant and equipment over their estimated useful lives. Estimated useful lives are:



Buildings	15 - 30 years
Building improvements	15 - 30 years
Machinery, equipment and molds	2 - 15 years
Furniture, fixtures and office equipment	2 - 5 years
Computer equipment and software	3 - 5 years
Instruments placed with customers¹	3 - 7 years

Schedule of Intangible Assets and Goodwill [Table Text Block]

The following table presents the changes in the carrying amount of our goodwill for 2018 and 2017 (in thousands):



	Total
Balance as of January 1, 2017	$	5,577
Goodwill acquired⁽¹⁾	6,536
Other⁽²⁾	244
Balance as of December 31, 2017	12,357
Goodwill acquired⁽³⁾	1,300
Other ⁽²⁾	(2,462		)
Balance as of December 31, 2018	$	11,195

______________________________

⁽¹⁾ In 2017, our Fannin (UK) Limited ("Fannin") acquisition resulted in $1.0 million of goodwill and our Medical Australia Limited ("MLA") acquisition resulted in $5.5 million of goodwill.

⁽²⁾ In 2018, "Other" relates to a $1.9 million measurement period adjustment on our MLA acquisition and foreign currency translation. In 2017, "Other" relates to foreign currency translation.

⁽³⁾In 2018, we acquired the consulting arm of True Process Inc., which resulted in $1.3 million of goodwill.

Intangible Assets

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



	Weighted Average Amortization Life in Years	December 31, 2018
	Weighted Average Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	19,399	$	12,147	$	7,252
Customer contracts	9	5,319		5,272		47
Non-contractual customer relationships	9	57,916		13,363		44,553
Trademarks	4	425		425		—
Trade name	15	7,456		1,618		5,838
Developed technology	11	82,857		15,361		67,496
Total amortized intangible assets		$	173,372	$	48,186	$	125,186

IPR&D		$	8,235			$	8,235

Total intangible assets		$	181,607	$	48,186	$	133,421



	Weighted Average	December 31, 2017
	Amortization Life in Years	Cost		Accumulated Amortization		Net
Patents	10	$	17,064	$	10,970	$	6,094
Customer contracts	9	5,319		4,892		427
Non-contractual customer relationships	9	55,080		6,562		48,518
Trademarks	4	425		425		—
Trade name	15	7,310		1,096		6,214
Developed technology	11	81,846		7,571		74,275
Total		$	167,044	$	31,516	$	135,528

IPR&D		$	8,225			$	8,225

Total intangible assets		$	175,269	$	31,516	$	143,753

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

As of December 31, 2018 estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):



2019	$	17,103
2020	16,126
2021	15,825
2022	15,681
2023	15,532
Thereafter	44,919
Total	$	125,186

Available-for-sale Securities [Table Text Block]

Our investment securities consist of the following (in thousands):



	December 31, 2018
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	37,329		$	—	$	37,329
Long-term corporate bonds	2,025		—		2,025
Total investment securities	$	39,354	$	—	$	39,354

	December 31, 2017
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	10,061	$	—	$	10,061
Long-term corporate bonds	14,579		—		14,579
Total investment securities	$	24,640	$	—	$	24,640

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

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



	Year ended December 31, (in thousands, except per share data)
	2018		2017		2016
Net income	$	28,793	$	68,644	$	63,084
Weighted average number of common shares outstanding (basic)	20,394		19,614		16,168
Dilutive securities	1,207		1,244		1,086
Weighted average common and common equivalent shares outstanding (diluted)	21,601		20,858		17,254
EPS - basic	$	1.41	$	3.50	$	3.90
EPS - diluted	$	1.33	$	3.29	$	3.66

Acquisitions, Strategic Transaction and Integration Expenses Business Combination (Tables)

12 Months Ended

Dec. 31, 2018

Business Acquisition [Line Items]

Business Acquisition, Pro Forma Information [Table Text Block]



(In millions)	Revenue		Earnings
Actual from 2/3/2017 - 12/31/2017⁽³⁾	$	1,062	*
2017 supplemental pro forma from 1/1/2017 - 12/31/2017⁽¹⁾⁽²⁾	$	1,373	$	91
2016 supplemental pro forma from 1/1/2016 - 12/31/2016⁽¹⁾⁽²⁾	$	1,418	$	99

______________________________

* Impracticable to calculate.

⁽²⁾Unaudited.

⁽³⁾ Amount represents activity of HIS from the date of the acquisition.

Hospira [Member]

Business Acquisition [Line Items]

Schedule of Business Acquisitions, by Acquisition [Table Text Block]

The following table summarizes the final purchase price and the final allocation of the purchase price related to the assets and liabilities purchased (in thousands, except per share data):



Cash consideration for acquired assets	$	180,785
Fair value of Seller Note	75,000
Fair value of contingent consideration payable to Pfizer (long-term)	19,000

Issuance of ICU Medical, Inc. common shares:
Number of shares issued to Pfizer	3,200
Price per share (ICU's trading closing share price on the Closing Date)	$	140.75
Market price of ICU shares issued to Pfizer	$	450,400
Less: Discount due to lack of marketability of 8.3%	(37,261		)
Equity portion of purchase price	413,139
Total Consideration	$	687,924

Purchase Price Allocation:
Cash and cash equivalents	$	31,082
Trade receivables	362
Inventories	417,622
Prepaid expenses and other assets	13,911
Property, plant and equipment	288,134
Intangible assets⁽¹⁾	131,000
Other assets	29,270
Accounts payable	(12,381		)
Accrued liabilities	(47,936		)
Long-term liabilities⁽²⁾	(67,170		)
Total identifiable net assets acquired	$	783,894
Deferred tax, net	(25,080		)
Estimated Gain on Bargain Purchase	(70,890		)
Estimated Purchase Consideration	$	687,924

______________________________

⁽²⁾Long-term liabilities primarily consisted of contract liabilities, product liabilities and long-term employee benefits.

Restructuring Charges Schedule of Restructuring and Related Costs (Tables)

12 Months Ended

Dec. 31, 2018

Restructuring and Related Activities [Abstract]

Restructuring and Related Costs [Table Text Block]

The following table summarizes the activity for the restructuring-related charges discussed above and related accrual (in thousands):



	Accrued Balance January 1, 2017		Charges incurred		Payments			Other Adjustments			Accrued Balance December 31, 2017		Charges incurred		Payments			Other Adjustments			Accrued Balance December 31, 2018
Severance pay and benefits	$	53	$	15,983	$	(15,104	)	$	(17	)	$	915	$	4,311	$	(4,549	)	$	—		$	677
Employment agreement buyout	1,477		—		(363		)	—			1,114		—		(368		)	(7		)	739
Retention and facility closure expenses	—		2,789		(2,789		)	—			—		160		(160		)	—			—
	$	1,530	$	18,772	$	(18,256	)	$	(17	)	$	2,029	$	4,471	$	(5,077	)	$	(7	)	$	1,416

Revenue (Tables)

12 Months Ended

Dec. 31, 2018

Revenue Recognition and Deferred Revenue [Abstract]

Impact of ASC 606 in Current Period [Table Text Block]

The following tables represent the amounts by which each financial statement line item is affected in the current year as a result of applying ASC Topic 606 (in thousands):



	For the year ended December 31, 2018
	As Reported		Without Adoption of ASC 606		Effect of Adoption
Revenue	$	1,400,040	$	1,388,923	$	11,117
Cost of goods sold	$	830,012	$	826,607	$	3,405
Gross Profit	$	570,028	$	562,316	$	7,712



	As of December 31, 2018
	As Reported		Without Adoption of ASC Topic 606		Effect of Adoption
Prepaid expenses and other current assets	$	25,980	$	32,487	$	(6,507	)
Accrued liabilities	$	128,820	$	151,408	$	(22,588	)
Deferred income taxes	$	38,654	$	40,653	$	(1,999	)

Disaggregation of Revenue [Table Text Block]

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



	For the year ended December 31,
Geography	2018		2017 ⁽¹⁾		2016⁽¹⁾
Europe, the Middle East and Africa	$	134,363	$	119,934	$	50,105
Other Foreign	210,996		192,640		67,573
Total Foreign	345,359		312,574		117,678
United States	1,054,681		980,039		261,694
Total Revenues	$	1,400,040	$	1,292,613	$	379,372

_______________________________

⁽¹⁾As noted above, prior period amounts have not been adjusted under the modified retrospective method.

The following table represents our revenues disaggregated by product line (in thousands) and our disaggregated product line revenue as a percentage of total revenue:



	For the year ended December 31,
	2018				2017 ⁽¹⁾				2016⁽¹⁾
Product line	Revenue		% of Revenue		Revenue		% of Revenue		Revenue		% of Revenue
Infusion Consumables	$	483,039	35	%	$	365,665	28	%	$	324,868	86	%
IV Solutions	507,985		36	%	521,963		40	%	—		—	%
Infusion Systems	355,484		25	%	290,207		23	%	—		—	%
Critical Care	53,532		4	%	49,961		4	%	53,601		14	%
Other	—		—	%	64,817		5	%	903		—	%
Total Revenues	$	1,400,040	100	%	$	1,292,613	100	%	$	379,372	100	%

_______________________________

⁽¹⁾As noted above, prior period amounts have not been adjusted under the modified retrospective method.

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



	Contract Liabilities
Beginning balance, January 1, 2018	$	(7,066	)
Equipment revenue recognized	6,696
Equipment revenue deferred due to implementation	(4,196		)
Software revenue recognized	6,553
Software revenue deferred due to implementation	(6,269		)
Ending balance, December 31, 2018	$	(4,282	)

Share Based Award (Tables)

12 Months Ended

Dec. 31, 2018

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

Schedule of stock compensation and related tax benefits [Table Text Block]

The table below summarizes compensation costs and related tax benefits (in thousands):



	Year ended December 31,
(In thousands)	2018		2017		2016
Stock compensation expense	$	24,241	$	19,352	$	15,242
Tax benefit from stock-based compensation cost	$	5,706	$	7,247	$	5,682
Indirect tax benefit	$	2,199	$	1,374	$	—

Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]

The table below summarizes the total time-based stock options granted, total valuation and the weighted average assumptions (dollars in thousands, except per option amounts):



	Year ended December 31,
	2018			2017			2016
Number of time-based options granted	5,815			8,825			13,405
Grant date fair value of options granted (in thousands)	$	425		$	375		$	413
Weighted average assumptions for stock option valuation:
Expected term (years)	5.5			5.5			5.5
Expected stock price volatility	24.0		%	27.0		%	31.8		%
Risk-free interest rate	2.3		%	1.1		%	0.7		%
Expected dividend yield	—		%	—		%	—		%
Weighted average grant price per option	$	269.80		$	158.20		$	101.32
Weighted average grant date fair value per option	$	73.14		$	42.51		$	30.78

Schedule of Share-based compensation, performance stock option activity [Table Text Block]

The table below indicates the number of shares of 2015 performance stock options that were earned in 2016. There were no performance option grants to employees in 2018, 2017 or 2016.



	Year ended December 31,
	2018	2017	2016
Number of performance options earned			244,825

Share-based Compensation, Stock Options, Activity [Table Text Block]

A summary of our stock option activity as of and for the year ended December 31, 2018 is as follows:



	Shares		Weighted Average Exercise Price Per Share		Weighted Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding at December 31, 2017	1,416,727		$	62.30
Granted	5,815		$	269.80
Exercised	(235,614	)	$	60.60
Forfeited or expired	—		$	—
Outstanding at December 31, 2018	1,186,928		$	63.66	4.9	$	197,232
Exercisable at December 31, 2018	1,181,113		$	62.64	4.8	$	197,232
Vested and expected to vest, December 31, 2018	1,186,928		$	63.66	4.9	$	197,232

Exercised Options Data [Table Text Block]

The following table presents information regarding Stock Option activity:



	Year ended December 31,
(In thousands)	2018		2017		2016
Intrinsic value of options exercised	$	51,105	$	71,283	$	25,065
Cash received from exercise of stock options	$	14,275	$	32,003	$	17,346
Tax benefit from stock option exercises	$	12,617	$	20,004	$	7,556

Schedule of Share-based Compensation, Restricted Stock Units Award Activity [Table Text Block]

The table below summarizes our restricted stock award activity (dollars in thousands):



	Year ended December 31,
(In thousands except shares and per share amounts)	2018		2017		2016
PRSU
Shares granted	30,348		20,686		36,370
Shares earned	—		—		—
Grant date fair value per share	$	248.65	$	154.75	$	86.47
Grant date fair value	$	7,546	$	3,201	$	3,145
Intrinsic value vested	$	—	$	—	$	—

RSU
Shares granted	63,094		107,678		60,377
Grant date fair value per share	$	252.42	$	156.49	$	87.47
Grant date fair value	$	15,926	$	16,851	$	5,281
Intrinsic value vested	$	17,086	$	9,813	$	4,680

Nonvested Restricted Stock Shares Activity [Table Text Block]

The table below provides a summary of our PRSU and RSU activity as of and for the year ended December 31, 2018.



	Number of Units		Grant Date Fair Value Per Share		Weighted Average Contractual Life (Years)	Aggregate Intrinsic Value
Non-vested at December 31, 2017	285,503		$	116.28
Change in units due to performance expectations^(a)	41,372		$	154.75
Granted	93,442		$	251.19
Vested	(71,868	)	$	122.00
Forfeited	(7,745	)	$	181.07
Non-vested and expected to vest at December 31, 2018	340,704		$	155.27	1.0	$	78,236

Schedule of employee stock purchase plan (ESPP) [Table Text Block]

The table below summarizes the number and intrinsic value of ESPP share purchases and the weighted average valuation assumptions for the 2017 and 2016 purchase periods.




	2017			2016
ESPP shares purchased by employees	23,426			31,227
Intrinsic value of ESPP purchases (in thousands)	$	986		$	955
Weighted average assumptions for ESPP valuation:
Expected term (in years)	0.5			0.5
Expected stock price volatility	28.1		%	32.5		%
Risk-free interest rate	0.6		%	0.3		%
Expected dividend yield	—		%	—		%

Derivatives and Hedging Activities (Tables)

12 Months Ended

Dec. 31, 2018

Derivative Instruments and Hedging Activities Disclosure [Abstract]

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

The following table presents the fair values of our derivative instruments included within the Consolidated Balance Sheets (in thousands):



	Derivatives
	Consolidated Balance Sheet Location	December 31, 2018		December 31, 2017
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contract:	Prepaid expenses and other current assets	$	187	$	—
	Other assets	545		—
	Accrued liabilities	—		187
	Other long-term liabilities	—		402
Total derivatives designated as cash flow hedging instruments		$	732	$	589

The following table presents the amounts affecting the Consolidated Statements of Operations (in thousands):



	Line Item in the Consolidated Statements of Operations	Year Ended December 31, 2018		Year Ended December 31, 2017
Derivatives designated as cash flow hedging instruments
Foreign exchange forward contracts	Cost of goods sold	$	743	$	885

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

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



	Amount of Gain Recognized in Other Comprehensive Income on Derivatives		Amount of Gain Recognized in Other Comprehensive Income on Derivatives		Amount of Gain Reclassified From Accumulated Other Comprehensive Income into Income
	Year Ended December 31, 2018		Year Ended December 31, 2017		Location of Gain Reclassified From Accumulated Other Comprehensive Income into Income	Year Ended December 31, 2018		Year Ended December 31, 2017
Derivatives designated as cash flow hedges:
Foreign exchange forward contract	$	2,063	$	296	Cost of goods sold	$	743	$	885
Total derivatives designated as cash flow hedging instruments	$	2,063	$	296		$	743	$	885

Fair Value Measurements (Tables)

12 Months Ended

Dec. 31, 2018

Fair Value Disclosures [Abstract]

Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Table Text Block]



	Earn-out Liability
Contingent earn-out liability, January 1, 2017	$	—
Acquisition date fair value estimate of earn-out	19,000
Change in fair value of contingent earn-out (included in income from operations as a separate line item)	8,000
Contingent earn-out liability, December 31, 2017	27,000
Change in fair value of contingent earn-out (included in income from operations as a separate line item)	20,400
Contingent earn-out liability, December 31, 2018	$	47,400

Fair Value Measurement Inputs and Valuation Techniques [Table Text Block]



Simulation Input	As of December 31, 2018		As of December 31, 2017		At Acquisition February 3, 2017
Adjusted EBITDA Volatility	30.00	%	26.00	%	29.00	%
WACC	8.25	%	8.75	%	10.00	%
20-year risk free rate	2.87	%	2.58	%	2.82	%
Market price of risk	5.24	%	5.99	%	6.93	%
Cost of debt	5.25	%	4.08	%	4.16	%

Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block]

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



	Fair value measurements at December 31, 2018
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	37,329	$	—	$	37,329	$	—
Long-term	2,025		—		2,025		—
Foreign exchange forwards:
Prepaid expenses and other current assets	187		—		187		—
Other assets	545		—		545		—
Total Assets	$	40,086	$	—	$	40,086	$	—

Liabilities:

Earn-out liability	$	47,400	$	—	$	—	$	47,400
Total Liabilities	$	47,400	$	—	$	—	$	47,400



	Fair value measurements at December 31, 2017
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available for sale securities:
Short-term	$	10,061	$	—	$	10,061	$	—
Long-term	14,579		—		14,579		—
Total Assets	$	24,640	$	—	$	24,640	$	—

Liabilities:

Earn-out liability	$	27,000	$	—	$	—	$	27,000
Foreign exchange forwards:
Accrued liabilities	187		—		187		—
Other long-term liabilities	402		—		402		—
Total Liabilities	$	27,589	$	—	$	589	$	27,000

Fair Value Measurements, Nonrecurring [Table Text Block]

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



	Fair value measurements at December 31, 2017
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Assets held-for-sale	$	12,489	$	—	$	—	$	12,489
Total Assets	$	12,489	$	—	$	—	$	12,489

Prepaids and Other Current Assets (Tables)

12 Months Ended

Dec. 31, 2018

Prepaid Expense and Other Assets, Current [Abstract]

Prepaid Expenses and Other Current Assets [Table Text Block]

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



	2018		2017
Deposits	$	1,087	$	21,940
Other prepaid expenses and receivables	12,476		4,208
Deferred costs	1,951		1,301
Prepaid insurance and property taxes	2,666		2,580
VAT/GST receivable	5,072		8,097
Deferred tax charge	1,180		1,326
Other	1,548		1,834
	$	25,980	$	41,286

Related-party receivables consist of the following (in thousands):



	2018		2017
Third-party receivables due from Pfizer	$	4,904	$	36,425
HIS business acquisition related	15,233		62,382
	$	20,137	$	98,807

Accrued Liabilities an Other Long-term Liabilities (Tables)

12 Months Ended

Dec. 31, 2018

Accrued Liabilities [Abstract]

Schedule of Accrued Liabilities [Table Text Block]

Accrued liabilities consist of the following (in thousands):



	December 31,
	2018		2017
Salaries and benefits	$	20,538	$	20,745
Incentive compensation	42,913		40,682
Accrued professional fees	15,996		13,319
Accrued product field action	5,316		11,810
Consigned inventory	1,118		5,210
Third-party inventory	1,089		4,284
Legal accrual	1,400		3,538
Accrued sales taxes	2,941		6,291
Warranties and Returns	1,124		3,360
Deferred revenue	3,814		3,326
Accrued other taxes	3,213		2,771
Distribution fees	3,977		725
Accrued freight	10,953		5,696
Restructuring accrual	1,046		1,290
Contract settlement	2,083		—
Accrued research and development	1,451		—
Other	9,848		9,017
	$	128,820	$	132,064

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



	December 31,
	2018		2017
Contract liabilities⁽¹⁾	$	14,020	$	40,148
Deferred revenue	468		7,099
Benefits	962		2,104
Accrued rent	1,779		—
Contract settlement	1,667		—
Other	1,696		5,975
	$	20,592	$	55,326

__________________________________________

Long-Term Obligations (Tables)

12 Months Ended

Dec. 31, 2018

LOng-Term Obligations Disclosure [Abstract]

Interest Margin and Commitment Fee [Table Text Block]

The applicable interest margins and the commitment fee with respect to the Credit Facility shall be based on the Total Leverage Ratio pursuant to the following pricing grid:



Level	Consolidated Total Leverage Ratio	Commitment Fee	LIBOR +	Base Rate +
I	Less than 1.00 to 1.00	0.15%	1.25%	0.25%
II	Greater than or equal to 1.00 to 1.00 but less than 2.00 to 1.00	0.20%	1.50%	0.50%
III	Greater than or equal to 2.00 to 1.00 but less than 2.50 to 1.00	0.25%	1.75%	0.75%
IV	Greater than or equal to 2.50 to 1.00	0.30%	2.00%	1.00%

Income Taxes Income tax disclosure (Tables)

12 Months Ended

Dec. 31, 2018

Income Tax Disclosure [Abstract]

Schedule of Income before Income Tax, Domestic and Foreign [Table Text Block]

Income from continuing operations before taxes consisted of the following (in thousands):



	Year Ended December 31,
	2018			2017			2016
United States	$	(8,600	)	$	59,872		$	80,714
Foreign	30,974			(8,589		)	4,450
	$	22,374		$	51,283		$	85,164

Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]

The (benefit) provision for income taxes consisted of the following (in thousands):



	Year Ended December 31,
	2018			2017			2016
Current:
Federal	$	492		$	2,774		$	21,123
State	1,865			2,263			2,347
Foreign	9,136			3,170			1,118
	11,493			8,207			24,588
Deferred:
Federal	$	(9,118	)	$	(20,878	)	$	(2,045	)
State	(3,072		)	(4,619		)	(767		)
Foreign	(5,722		)	(71		)	304
	(17,912		)	(25,568		)	(2,508		)
	$	(6,419	)	$	(17,361	)	$	22,080

Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]

A reconciliation of the provision for income taxes at the statutory rate to our effective tax rate is as follows (dollars in thousands):



	Year Ended December 31,
	2018					2017					2016
	Amount			Percent		Amount			Percent		Amount			Percent
Federal tax at the expected statutory rate	$	4,699		21.0	%	$	17,950		35.0	%	$	29,807		35.0	%
State income tax, net of federal effect	927			4.1	%	(403		)	(0.8	)%	1,795			2.1	%
Tax credits	(4,961		)	(22.2	)%	(2,783		)	(5.4	)%	(1,014		)	(1.2	)%
Global intangible low-taxed income	2,363			10.6	%	—			—	%	—			—	%
Foreign income tax differential	(2,944		)	(13.2	)%	3,481			6.8	%	(135		)	(0.1	)%
Stock based compensation	(11,040		)	(49.3	)%	(18,958		)	(37.0	)%	(7,720		)	(9.1	)%
Impact of the Tax Act	826			3.7	%	3,076			6.0	%	—			—	%
IP installment sale	3,252			14.5	%	3,367			6.6	%	—			—	%
Bargain purchase gain	—			—	%	(24,811		)	(48.4	)%	—			—	%
Section 162(m)	456			2.0	%	595			1.2	%	1,133			1.3	%
Other	3			0.1	%	1,125			2.2	%	(1,786		)	(2.1	)%
	$	(6,419	)	(28.7	)%	$	(17,361	)	(33.8	)%	$	22,080		25.9	%

Schedule of Deferred Tax Assets and Liabilities [Table Text Block]

The components of our deferred income tax assets (liabilities) are as follows (in thousands):



	December 31,
	2018			2017
Deferred tax asset:
Accruals/other	11,291			956
Contingent consideration	12,451			7,412
Net operating loss carryforwards	12,686			—
Acquired future tax deductions	10,722			10,580
Stock-based compensation	10,775			8,633
Foreign currency translation adjustments	3,108			3,425
Tax credits	14,470			11,220
Inventory reserves	5,674			10,658
Allowance for doubtful accounts	830			636
Valuation allowance	(5,436		)	(7,385		)
	$	76,571		$	46,135
Deferred tax liability:
State income taxes	$	2,639		$	1,640
Foreign	612			202
Depreciation and amortization	35,387			21,005
	$	38,638		$	22,847

Deferred tax asset, net	$	37,933		$	23,288

Summary of Positions for which Significant Change in Unrecognized Tax Benefits is Reasonably Possible [Table Text Block]

The following table summarizes our cumulative gross unrecognized tax benefits (in thousands):



	Year Ended December 31,
	2018			2017			2016
Beginning balance	$	6,527		$	2,000		$	1,772
Increases to prior year tax positions	—			77			77
Increases due to acquisitions	—			640			—
Increases to current year tax positions	4,536			3,992			345
Decreases to prior year tax positions	(146		)	(12		)	(46		)
Decrease related to lapse of statute of limitations	(93		)	(170		)	(148		)
Ending balance	$	10,824		$	6,527		$	2,000

Geographic Information and Significant Customers Geographic Information (Tables)

12 Months Ended

Dec. 31, 2018

Geographic Areas, Long-Lived Assets [Abstract]

Long-lived Assets by Geographic Areas [Table Text Block]

The table below presents our gross long-lived assets, consisting of property, plant and equipment, by country or region (in thousands):



	As of December 31,
	2018		2017
Costa Rica	$	81,920	$	80,956
Mexico	64,242		61,008
Other LATAM	22,828		19,432
Canada	4,545		4,362
Italy	7,819		6,860
Spain	6,516		5,601
Other Europe	2,427		2,625
APAC	15,152		5,169
Total Foreign	$	205,449	$	186,013
United States	489,415		422,810
Worldwide Total	$	694,864	$	608,823

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2018

Stockholders' Equity Attributable to Parent [Abstract]

Schedule of Accumulated Other Comprehensive Income (Loss) [Table Text Block]

The components of AOCI, net of tax, were as follows (in thousands):



	Foreign Currency Translation Adjustments			Unrealized Gains on Cash Flow Hedges			Other Adjustments			Total
Balance as of January 1, 2017	$	(21,272	)	$	—		$	—		$	(21,272	)
Other comprehensive income (loss) before reclassifications	6,694			184			(16		)	6,862
Amounts reclassified from AOCI	—			(549		)	—			(549		)
Other comprehensive income (loss)	6,694			(365		)	(16		)	6,313
Balance as of December 31, 2017	$	(14,578	)	$	(365	)	$	(16	)	$	(14,959	)
Other comprehensive (loss) income before reclassifications	(3,104		)	1,568			115			(1,421		)
Amounts reclassified from AOCI	—			(565		)	—			(565		)
Other comprehensive (loss) income	(3,104		)	1,003			115			(1,986		)
Balance as of December 31, 2018	$	(17,682	)	$	638		$	99		$	(16,945	)

Commitments and Contingencies Leases (Tables)

12 Months Ended

Dec. 31, 2018

Commitments and Contingencies Disclosure [Abstract]

Schedule of Future Minimum Rental Payments for Operating Leases [Table Text Block]

As of December 31, 2018, undiscounted future minimum lease payments under our non-cancelable operating leases are as follows over each of the next five years and thereafter (in millions):



2019	$	8.3
2020	8.6
2021	6.5
2022	5.9
2023	5.6
Thereafter	13.2
Total	$	48.1

Selected Quarterly Financial Data - Unaudited (Tables)

12 Months Ended

Dec. 31, 2018

Quarterly Financial Data - Unaudited [Abstract]

Schedule of Quarterly Financial Information [Table Text Block]



	Quarter Ended
	Mar. 31		Jun. 30			Sept. 30		Dec. 31
	(in thousands except per share data)
2018
Total revenue	$	372,033	$	360,460		$	327,169	$	340,378
Gross profit	$	149,001	$	151,800		$	134,587	$	134,640
Net income (loss)	$	4,875	$	31,054		$	219	$	(7,355	)
Net income (loss) per share:
Basic	$	0.24	$	1.53		$	0.01	$	(0.36	)
Diluted	$	0.23	$	1.44		$	0.01	$	(0.36	)
2017
Total revenue	$	247,739	$	331,514		$	343,236	$	370,124
Gross profit	$	88,945	$	88,062		$	111,598	$	137,490
Net income (loss)	$	55,863	$	(37,060	)	$	136	$	49,705
Net income (loss) per share:
Basic	$	3.03	$	(1.87	)	$	0.01	$	2.47
Diluted	$	2.86	$	(1.87	)	$	0.01	$	2.33

______________________________________

On February 3, 2017, we acquired HIS, see Note 2, Acquisitions, Strategic Transaction and Integration Costs.

General and Summary of Significant Accounting Policies Inventory (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Accounting Policies [Abstract]
Raw Materials	$ 104,104	$ 82,397
Work in Process	52,909	42,304
Finished Goods	154,150	163,956
Total	$ 311,163	$ 288,657

General and Summary of Significant Accounting Policies Property and Equipment #1 (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 694,864	$ 608,823
Accumulated Depreciation	262,223	210,139
Net property and equipment	432,641	398,684
Machinery and Equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	203,431	220,999
Land, Buildings and Improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	212,283	206,846
Molds [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	59,700	56,253
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	80,420	44,408
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	7,409	7,361
Instruments Placed with Customers [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	60,757	15,812
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 70,864	$ 57,144

General and Summary of Significant Accounting Policies Property and Equipment #2 (Details)	12 Months Ended
	Dec. 31, 2018
Building [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	15
Building [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	30
Building Improvements [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	15
Building Improvements [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	30
Machinery and Equipment [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	2
Machinery and Equipment [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	15
Furniture, fixtures and molds [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	2
Furniture, fixtures and molds [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	5
Computer Equipment and Software [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	3
Computer Equipment and Software [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	5
Instruments Placed with Customers [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	3
Instruments Placed with Customers [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	7

General and Summary of Significant Accounting Policies Property and Equipment #3 (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Accounting Policies [Abstract]
Depreciation	$ 58.1	$ 51.6	$ 16.3

General and Summary of Significant Accounting Policies Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Goodwill [Roll Forward]
GOODWILL	$ 12,357	$ 5,577
Goodwill, Acquired During Period	1,300	6,536	$ 0
Goodwill, Foreign Currency Translation Gain (Loss)	(2,462)
Goodwill, Purchase Accounting Adjustments		244
GOODWILL	11,195	12,357	$ 5,577
Fannin [Member]
Goodwill [Roll Forward]
Goodwill, Acquired During Period		1,000
Medical Australia Limited [Member]
Goodwill [Roll Forward]
Goodwill, Acquired During Period		$ 5,500
Goodwill, Purchase Accounting Adjustments	1,900
Tru Process [Member]
Goodwill [Roll Forward]
Goodwill, Acquired During Period	$ 1,300

General and Summary of Significant Accounting Policies Intangible Assets #1 (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Finite-Lived Intangible Assets [Line Items]
Cost	$ 173,372	$ 167,044
Accumulated Amortization	48,186	31,516
Finite-Lived Intangible Assets, Net	125,186	135,528
Intangible Assets, Gross (Excluding Goodwill)	181,607	175,269
INTANGIBLE ASSETS, net	$ 133,421	$ 143,753
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	10 years	10 years
Cost	$ 19,399	$ 17,064
Accumulated Amortization	12,147	10,970
Finite-Lived Intangible Assets, Net	$ 7,252	$ 6,094
Customer Contracts [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	9 years	9 years
Cost	$ 5,319	$ 5,319
Accumulated Amortization	5,272	4,892
Finite-Lived Intangible Assets, Net	$ 47	$ 427
Customer-Related Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	9 years	9 years
Cost	$ 57,916	$ 55,080
Accumulated Amortization	13,363	6,562
Finite-Lived Intangible Assets, Net	$ 44,553	$ 48,518
Trademarks [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	4 years	4 years
Cost	$ 425	$ 425
Accumulated Amortization	425	425
Finite-Lived Intangible Assets, Net	$ 0	$ 0
Trade Names [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	15 years	15 years
Cost	$ 7,456	$ 7,310
Accumulated Amortization	1,618	1,096
Finite-Lived Intangible Assets, Net	$ 5,838	$ 6,214
Developed Technology Rights [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	11 years	11 years
Cost	$ 82,857	$ 81,846
Accumulated Amortization	15,361	7,571
Finite-Lived Intangible Assets, Net	67,496	74,275
In Process Research and Development [Member]
Finite-Lived Intangible Assets [Line Items]
Cost	$ 8,235	$ 8,225

General and Summary of Significant Accounting Policies Intangible Assets #2 (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Accounting Policies [Abstract]
Amortization of Intangible Assets	$ 16.6	$ 15.0	$ 2.8

General and Summary of Significant Accounting Policies Future Estimated Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Acquired Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Amortization Expense, Next Twelve Months	$ 17,103
Finite-Lived Intangible Assets, Amortization Expense, Year Two	16,126
Finite-Lived Intangible Assets, Amortization Expense, Year Three	15,825
Finite-Lived Intangible Assets, Amortization Expense, Year Four	15,681
Finite-Lived Intangible Assets, Amortization Expense, Year Five	15,532
Finite-Lived Intangible Assets, Amortization Expense, after Year Five	44,919
Finite-Lived Intangible Assets, Net	$ 125,186	$ 135,528

General and Summary of Significant Accounting Policies Investments (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Debt Securities, Available-for-sale [Line Items]
Available-for-sale Equity Securities, Amortized Cost Basis	$ 39,354	$ 24,640
Other Comprehensive Income (Loss), Securities, Available-for-sale, Adjustment, before Tax	0	0
Available-for-sale Securities	$ 39,354	24,640
Investment Contract Settlement Date Range End	Jul. 22, 2020
Investment Contract Settlement Date Range Start	Jan. 09, 2019
Long-term Investments [Domain]
Debt Securities, Available-for-sale [Line Items]
Available-for-sale Equity Securities, Amortized Cost Basis	$ 2,025	14,579
Other Comprehensive Income (Loss), Securities, Available-for-sale, Adjustment, before Tax	0	0
Available-for-sale Securities	2,025	14,579
Short-term Investments [Member]
Debt Securities, Available-for-sale [Line Items]
Available-for-sale Equity Securities, Amortized Cost Basis	37,329	10,061
Other Comprehensive Income (Loss), Securities, Available-for-sale, Adjustment, before Tax	0	0
Available-for-sale Securities	$ 37,329	$ 10,061

General and Summary of Significant Accounting Policies Foreign Currency (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Foreign Currency [Abstract]
Foreign Currency Transaction Gain (Loss), Realized	$ 7.9	$ 1.8	$ 0.3

General and Summary of Significant Accounting Policies Advertising Expenses (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Accounting Policies [Abstract]
Advertising Expense	$ 0.6	$ 0.2	$ 0.1

General and Summary of Significant Accounting Policies Post-retirement and Post-employment Benefits (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Accounting Policies [Abstract]
Pension and Other Postretirement Benefits Cost (Reversal of Cost)	$ 11.4	$ 10.3	$ 1.5

General and Summary of Significant Accounting Policies Net Income Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
NET INCOME PER SHARE
Net Income	$ (7,355)	$ 219	$ 31,054	$ 4,875	$ 49,705	$ 136	$ (37,060)	$ 55,863	$ 28,793	$ 68,644	$ 63,084
Weighted average number of common shares outstanding (basic)									20,394,000	19,614,000	16,168,000
Weighted Average Number Diluted Shares Outstanding Adjustment									1,207,000	1,244,000	1,086,000
Weighted Average common and common equivalent shares outstandding (diluted)									21,601,000	20,858,000	17,254,000
Basic	$ (0.36)	$ 0.01	$ 1.53	$ 0.24	$ 2.47	$ 0.01	$ (1.87)	$ 3.03	$ 1.41	$ 3.50	$ 3.90
Diluted	$ (0.36)	$ 0.01	$ 1.44	$ 0.23	$ 2.33	$ 0.01	$ (1.87)	$ 2.86	$ 1.33	$ 3.29	$ 3.66
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount									5,300	337	0
Stock Issued During Period, Shares, Acquisitions									3,200,000

- Definition

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

+ References

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-Name Accounting Standards Codification
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+ Details

- 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.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
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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

General and Summary of Significant Accounting Policies New Accounting Pronouncements (Details) - Accounting Standards Update 2016-02 [Member] $ in Millions	12 Months Ended
	Dec. 31, 2018 USD ($)
Minimum [Member]
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification	$ 35.0
Maximum [Member]
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification	$ 50.0

Acquisitions, Strategic Transaction and Integration Expenses Tangent (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Business Acquisition [Line Items]
Bargain Purchase Gain	$ 0	$ 70,890	$ 1,456

Acquisitions, Strategic Transaction and Integration Expenses EXC (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Business Acquisition [Line Items]
Goodwill, Acquired During Period	$ 1,300	$ 6,536	$ 0
Liabilities Assumed			$ (734)
Excelsior [Member]
Business Acquisition [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life			14 years
Customer Relationships [Member] \| Excelsior [Member]
Business Acquisition [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life			15 years
Developed Technology Rights [Member] \| Excelsior [Member]
Business Acquisition [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life			10 years
Trade Names [Member] \| Excelsior [Member]
Business Acquisition [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life			15 years

Acquisitions, Strategic Transaction and Integration Expenses MLA (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
contingent consideration gross	$ 225	$ 225

Acquisitions, Strategic Transaction and Integration Expenses Hospira (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Business Acquisition [Line Items]
Proceeds from Issuance of Debt		$ 75,000	$ 0
Business Combination, Contingent Consideration, Liability, Noncurrent		19,000	0
contingent consideration gross	$ 225,000	225,000
Issuance of common stock for acquisitions		413,139	0
Bargain Purchase Gain	$ 0	70,890	$ 1,456
Hospira [Member]
Business Acquisition [Line Items]
Payment to acquire business, net of working capital adjustments		$ 180,785
Business Acquisition, Percentage of Voting Interests Acquired		100.00%
Payments to Acquire Businesses, Gross		$ 260,000
Proceeds from Issuance of Debt		75,000
Business Combination, Contingent Consideration, Liability, Noncurrent		$ 19,000
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares	3,200	3,200
contingent consideration gross		$ 225,000
Earn out Target		$ 1,000,000
Business Acquisition, Share Price		$ 140.75
Business Combination, Consideration Transferred, Equity Interests Issued and Issuable		$ 450,400
Discount on equity issued as consideration		37,261
Issuance of common stock for acquisitions		413,139
Business Combination, Consideration Transferred		687,924
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Cash and Equivalents		31,082
Business Combination, Acquired Receivable, Fair Value		362
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Inventory		417,622
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense and Other Assets		13,911
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Property, Plant, and Equipment		288,134
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles		131,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Deferred Tax Liabilities Noncurrent		25,080
Bargain Purchase Gain		70,890
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Noncurrent Assets		29,270
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accounts Payable		12,381
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Other		47,936
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Noncurrent Liabilities		67,170
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net		783,894
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	9 years
Customer Relationships [Member] \| Hospira [Member]
Business Acquisition [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles		48,000
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	8 years
Pumps and dedicated sets [Domain] \| Hospira [Member]
Business Acquisition [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles		44,000
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	10 years
developed technology-consumables [Domain] \| Hospira [Member]
Business Acquisition [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles		34,000
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	12 years
In Process Research and Development [Member] \| Hospira [Member]
Business Acquisition [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Indefinite-Lived Intangible Assets		5,000
Minimum [Member]
Business Acquisition [Line Items]
Adjusted EBITDA		35,000
Maximum [Member]
Business Acquisition [Line Items]
Adjusted EBITDA		$ 40,000

Acquisitions, Strategic Transaction and Integration Expenses Pro Forma (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Business Acquisition, Pro Forma Information, Nonrecurring Adjustment [Line Items]
Bargain Purchase Gain	$ 0	$ 70,890	$ 1,456
Revenues		1,062
Business Acquisition, Pro Forma Revenue		1,373	1,418
Business Acquisition, Pro Forma Net Income (Loss)		91	$ 99
Fair Value Adjustment to Inventory [Member]
Business Acquisition, Pro Forma Information, Nonrecurring Adjustment [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Inventory		66,300
Acquisition-related Costs [Member]
Business Acquisition, Pro Forma Information, Nonrecurring Adjustment [Line Items]
Business Acquisition, Transaction Costs		$ 59,200

Acquisitions, Strategic Transaction and Integration Expenses Strategic Transaction and Integration Expenses (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Business Combinations [Abstract]
Strategic Transaction Costs	$ 100.9	$ 59.2	$ 14.3

Restructuring Charges (Details 1) - USD ($) $ in Millions	12 Months Ended
Restructuring Charges (Details 1) - USD ($) $ in Millions	Dec. 31, 2016	Dec. 31, 2018
Restructuring Cost and Reserve [Line Items]
Restructuring and Related Cost, Cost Incurred to Date		$ 23.1
Restructuring Charges	$ 0.8
Other Restructuring Costs	$ 0.2

Restructuring Charges (Details 2) - USD ($) $ in Thousands	12 Months Ended
Restructuring Charges (Details 2) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	$ 1,416	$ 2,029	$ 1,530
Restructuring Costs	4,471	18,772
Payments for Restructuring	(5,077)	(18,256)
Restructuring Reserve, Accrual Adjustment	(7)	(17)
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	677	915	53
Restructuring Costs	4,311	15,983
Payments for Restructuring	(4,549)	(15,104)
Restructuring Reserve, Accrual Adjustment	0	(17)
Special Termination Benefits [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	739	1,114	1,477
Restructuring Costs	0	0
Payments for Restructuring	(368)	(363)
Restructuring Reserve, Accrual Adjustment	(7)	0
Facility Closing [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	0	0	$ 0
Restructuring Costs	160	2,789
Payments for Restructuring	(160)	(2,789)
Restructuring Reserve, Accrual Adjustment	$ 0	$ 0

Revenue (Details) $ in Millions	12 Months Ended
Revenue (Details) $ in Millions	Dec. 31, 2018 USD ($)
Revenue Recognition and Deferred Revenue [Abstract]
Cumulative Effect on Retained Earnings, Net of Tax	$ 6.3

Revenue Impact of ASC 606 in Current Period Income Statement (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Revenues	$ 340,378	$ 327,169	$ 360,460	$ 372,033	$ 370,124	$ 343,236	$ 331,514	$ 247,739	$ 1,400,040	$ 1,292,613	$ 379,372
Increase (Decrease) in Revenue									(11,117)
Cost of Revenue									830,012
Increase (Decrease) Cost of Goods Sold									3,405
Gross Profit	$ 134,640	$ 134,587	$ 151,800	$ 149,001	$ 137,490	$ 111,598	$ 88,062	$ 88,945	570,028	$ 426,095	$ 201,398
Increase (Decrease) Gross Profit									7,712
Calculated under Revenue Guidance in Effect before Topic 606 [Member]
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Revenues									1,388,923
Cost of Revenue									826,607
Gross Profit									$ 562,316

Revenue Impact of ASC 606 in Current Period Balance Sheet (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Prepaid expenses and other current assets	$ 25,980	$ 41,286
Increase (Decrease) in Prepaid Expenses, Other	(6,507)
Accrued liabilities	128,820	132,064
Increase (Decrease) in Other Accrued Liabilities	(22,588)
DEFERRED INCOME TAXES	38,654	$ 24,775
Increase (Decrease) in Deferred Income Taxes	(1,999)
Calculated under Revenue Guidance in Effect before Topic 606 [Member]
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Prepaid expenses and other current assets	32,487
Accrued liabilities	151,408
DEFERRED INCOME TAXES	$ 40,653

Revenue Disaggregation of Revenue by Geography (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Disaggregation of Revenue [Line Items]
Revenues	$ 340,378	$ 327,169	$ 360,460	$ 372,033	$ 370,124	$ 343,236	$ 331,514	$ 247,739	$ 1,400,040	$ 1,292,613	$ 379,372
EMEA [Member]
Disaggregation of Revenue [Line Items]
Revenues									134,363	119,934	50,105
Other foreign countries [Member]
Disaggregation of Revenue [Line Items]
Revenues									210,996	192,640	67,573
Foreign [Member]
Disaggregation of Revenue [Line Items]
Revenues									$ 345,359	$ 312,574	$ 117,678
UNITED STATES
Disaggregation of Revenue [Line Items]
Percent of total revenue									75.00%	76.00%	69.00%
Revenues									$ 1,054,681	$ 980,039	$ 261,694
International Sales [Domain]
Disaggregation of Revenue [Line Items]
Percent of total revenue									25.00%	24.00%	31.00%

Revenue Disaggregation of Revenue - Product Line (Details) - USD ($)	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Disaggregation of Revenue [Line Items]
Revenues	$ 340,378,000	$ 327,169,000	$ 360,460,000	$ 372,033,000	$ 370,124,000	$ 343,236,000	$ 331,514,000	$ 247,739,000	$ 1,400,040,000	$ 1,292,613,000	$ 379,372,000
Percentage of revenue									100.00%	100.00%	100.00%
Infusion Consumables [Member]
Disaggregation of Revenue [Line Items]
Revenues									$ 483,039,000	$ 365,665,000	$ 324,868,000
Percentage of revenue									35.00%	28.00%	86.00%
IV Solutions [Member]
Disaggregation of Revenue [Line Items]
Revenues									$ 507,985,000	$ 521,963,000	$ 0
Percentage of revenue									36.00%	40.00%	0.00%
Infusion Systems [Member]
Disaggregation of Revenue [Line Items]
Revenues									$ 355,484,000	$ 290,207,000	$ 0
Percentage of revenue									25.00%	23.00%	0.00%
Critical Care [Member]
Disaggregation of Revenue [Line Items]
Revenues									$ 53,532,000	$ 49,961,000	$ 53,601,000
Percentage of revenue									4.00%	4.00%	14.00%
Other Revenue [Member]
Disaggregation of Revenue [Line Items]
Revenues									$ 0	$ 64,817,000	$ 903,000
Percentage of revenue									0.00%	5.00%	0.00%

Revenue Contract Liabilities (Details) $ in Thousands	12 Months Ended
Revenue Contract Liabilities (Details) $ in Thousands	Dec. 31, 2018 USD ($)
COntract Liability Rollforward [Roll Forward]
Contract with Customer, Liability	$ 7,066
Contract with Customer, Liability	4,282
Equipment revenue [Member]
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(6,696)
Deferred Revenue, Additions	4,196
Software revenue [Member]
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(6,553)
Deferred Revenue, Additions	$ 6,269

Revenue Contract Liabilities Text (Details) $ in Millions	Dec. 31, 2018 USD ($)
Equipment revenue [Member]
Contract asset and liability balances [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ 2.9
Software revenue [Member]
Contract asset and liability balances [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ 1.6

Impairment on assets held for sale (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Impairment of assets held for sale [Abstract]
Impairment of assets held for sale	$ 0	$ 0	$ 728
Proceeds from Sale of Buildings			$ 3,300

Share Based Award Stock Based Compensation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock compensation	$ 24,241	$ 19,352	$ 15,242
Tax benefit from stock-based compensation cost	5,706	7,247	5,682
Indirect tax benefit	2,199	$ 1,374	$ 0
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized	$ 28,000
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized, Period for Recognition	11 months

Share Based Award Stock Option Plans (Details) - shares	12 Months Ended
Share Based Award Stock Option Plans (Details) - shares	Dec. 31, 2018	Dec. 31, 2011
2011 Plan [Member]
Stock Incentive Plans [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized	3,925,000	650,000
Share-based Compensation Arrangement by Share-based Payment Award, Number of Additional Shares Authorized	3,275,000
Shares transferred from superseded plan	263,300.0
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant	4,188,300
2003 Plan [Member]
Stock Incentive Plans [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant	248,700
2001 Director's Plan [Member]
Stock Incentive Plans [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized	750,000
Employee Stock Option [Member] \| 2014 Inducement Plan [Member]
Stock Incentive Plans [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized	182,366
Restricted Stock Units (RSUs) [Member] \| 2014 Inducement Plan [Member]
Stock Incentive Plans [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized	68,039

Share Based Award Stock Options Granted and Valuation (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Time-based stock option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of options granted	5,815	8,825	13,405
Time based options grant date fair value	$ 425	$ 375	$ 413
Expected term (years)	5 years 6 months	5 years 6 months	5 years 6 months
Expected stock price volatility	24.00%	27.00%	31.80%
Risk-Free Interest Rate	2.30%	1.10%	0.70%
Expected Dividend Yield	0.00%	0.00%	0.00%
Weighted Average Exercise Price	$ 269.80	$ 158.20	$ 101.32
Weighted Average Grant Date Fair Value per option	$ 73.14	$ 42.51	$ 30.78
Performance stock options [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Performance Shares Earned			244,825

Share Based Award Stock Option Activity (Details) - Employee Stock Option [Member] $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2018 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, Outstanding, Number \| shares	1,416,727
Granted \| shares	5,815
Exercised \| shares	(235,614)
Forfeited or expired \| shares	0
Options, Outstanding, Number \| shares	1,186,928
Exercisable \| shares	1,181,113
Vested and Expected to Vest \| shares	1,186,928
Options, Outstanding, Weighted Average Exercise Price \| $ / shares	$ 62.30
Weighted Average Exercise Price \| $ / shares	269.80
Options, Exercises in Period, Weighted Average Exercise Price \| $ / shares	60.60
Options, Nonvested Options Forfeited, Weighted Average Grant Date Fair Value \| $ / shares	0.00
Options, Outstanding, Weighted Average Exercise Price \| $ / shares	63.66
Exercise Price Range, Exercisable Options, Weighted Average Exercise Price \| $ / shares	62.64
Options, Vested and Expected to Vest, Outstanding, Weighted Average Exercise Price \| $ / shares	$ 63.66
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Expected Term	4 years 11 months
Options, Exercisable, Weighted Average Remaining Contractual Term	4 years 10 months
Options, Vested and Expected to Vest, Outstanding, Weighted Average Remaining Contractual Term	4 years 11 months
Options, Outstanding, Intrinsic Value \| $	$ 197,232
Options, Exercisable, Intrinsic Value \| $	197,232
Options, Vested and Expected to Vest, Outstanding, Aggregate Intrinsic Value \| $	$ 197,232

Share Based Award Share Award data (Details)	Dec. 31, 2018 $ / shares
Share award data [Abstract]
Share Price	$ 229.63

Share Based Award Options exercised data (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Intrinsic value of options exercised	$ 51,105	$ 71,283	$ 25,065
Cash received from exercise of stock options	14,275	32,003	17,346
Tax benefit from stock option exercises	$ 12,617	$ 20,004	$ 7,556

Share Based Award Restricted Stock Units (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Restricted Stock and Performance Restricted Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Nonvested and expected to vest	285,503
Shares granted	93,442
Change in units due to performance expectations	41,372
Vested	(71,868)
Forfeited	(7,745)
Nonvested and expected to vest	340,704	285,503
Nonvested, Weighted Average Grant Date Fair Value	$ 155.27	$ 116.28
Grants in period, Grant date fair value per share	251.19
Change in units due to performance expectations	154.75
Vested Intrinsic Value, Amount Per Share	122.00
Forfeited, Weighted Average Grant Date Fair Value	$ 181.07
Remaining Contractual Terms	1 year
Aggregate intrinsic value	$ 78,236
Performance Restricted Stock Units (PRSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted	30,348	20,686	36,370
Grants in period, Grant date fair value per share	$ 248.65	$ 154.75	$ 86.47
Grant date fair value performance restricted stock units	$ 7,546	$ 3,201	$ 3,145
Intrinsic value vested	$ 0	$ 0	$ 0
Performance Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Performance Shares Earned	0	0	0
Restricted Stock Units (RSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted	63,094	107,678	60,377
Grants in period, Grant date fair value per share	$ 252.42	$ 156.49	$ 87.47
Grant date fair value of restricted stock units granted	$ 15,926	$ 16,851	$ 5,281
Intrinsic value vested	$ 17,086	$ 9,813	$ 4,680

Share Based Award ESPP Narrative (Details)	Dec. 31, 2018 shares
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
ESPP Original Issuance	750,000
ESPP Annual Issuance Increase Limit	300,000
Shares available in employee stock purchase plan	133,487

Share Based Award ESPP Table (Details) - Employee Stock [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock Issued During Period, Shares, Employee Stock Purchase Plans	23,426	31,227
Stock Issued During Period, Value, Employee Stock Purchase Plan	$ 986	$ 955
Expected stock price volatility	28.10%	32.50%
Risk-Free Interest Rate	0.60%	0.30%
Expected Dividend Yield	0.00%	0.00%
Expected term (years)	6 months	6 months

Derivatives and Hedging Activities (Details) $ in Millions, $ in Millions	Dec. 31, 2018 USD ($)	Dec. 31, 2018 MXN ($)
Derivative [Line Items]
Foreign Currency Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months	$ (0.2)
Hedge 1 [Member]
Derivative [Line Items]
Derivative, Notional Amount		$ 150.1
Derivative, Forward Exchange Rate	20.01	20.01
Hedge 2 [Member]
Derivative [Line Items]
Derivative, Notional Amount		$ 183.9
Derivative, Forward Exchange Rate	20.43	20.43
Hedge 3 [Member] [Member]
Derivative [Line Items]
Derivative, Notional Amount		$ 398.0
Derivative, Forward Exchange Rate	22.109	22.109

Derivatives and Hedging Activities Derivative Balance Sheet Location (Details) - Foreign Exchange Forward [Member] - Designated as Hedging Instrument [Member] - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	$ 187	$ 0
Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	545	0
Accrued Liabilities [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	0	187
Other Noncurrent Liabilities [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	0	402
Derivative Financial Instruments, Liabilities [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	$ 732	$ 589

Derivatives and Hedging Activities Derivative Instruments and Hedging Activities - Amounts Affecting Consolidated Statements of Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative, Gain (Loss) on Derivative, Net	$ 743	$ 885

Derivatives and Hedging Activities Derivative Instruments and Hedging Activities - Cash Flow Hedge Activity Included in Accumulated Other Comprehensive Income (Loss) (Details) - Cash Flow Hedging [Member] - Cost of Sales [Member] - Foreign Exchange Forward [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, before Tax	$ 2,063	$ 296
Derivative Instruments, Gain Reclassified from Accumulated OCI into Income, Effective Portion	$ 743	$ 885

Fair Value Measurements Fair Value Measurement (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Fair Value Disclosures [Abstract]
contingent consideration gross	$ 225	$ 225

Fair Value Measurements Fair Value Liabilities Measured on Recurring Basis, Unobservable Inputs (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent Earn-out Liability	$ 27,000	$ 0
Acquisition date fair value estimate of earn-out		19,000
Change in fair value of contingent earn-out (included in income from operations as a separate line item)	20,400	8,000
Contingent Earn-out Liability	$ 47,400	$ 27,000

Fair Value Measurements Fair Value Inputs, Liabilities, Quantitative Information (Details)		12 Months Ended
	Feb. 03, 2017	Dec. 31, 2018	Dec. 31, 2017
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Adjusted EBITDA Volatility	29.00%	30.00%	26.00%
Market price of risk	6.93%	5.24%	5.99%
Cost of debt	4.16%	5.25%	4.08%
Measurement Input, Discount Rate [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.1000	0.0825	0.0875
Measurement Input, Risk Free Interest Rate [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.0282	0.0287	0.0258

Fair Value Measurements Fair Value Measurements, Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	$ 37,329	$ 10,061
LONG-TERM INVESTMENT SECURITIES	2,025	14,579
Assets, Fair Value Disclosure	40,086	24,640
Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	0	0
LONG-TERM INVESTMENT SECURITIES	0	0
Assets, Fair Value Disclosure	0	0
Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	37,329	10,061
LONG-TERM INVESTMENT SECURITIES	2,025	14,579
Assets, Fair Value Disclosure	40,086	24,640
Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	0	0
LONG-TERM INVESTMENT SECURITIES	0	0
Assets, Fair Value Disclosure	0	0
Earn-out liability [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	47,400	27,000
Earn-out liability [Member] \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	0
Earn-out liability [Member] \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	0
Earn-out liability [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	47,400	27,000
Liabilities, Total [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	47,400	27,589
Liabilities, Total [Member] \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	0
Liabilities, Total [Member] \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	589
Liabilities, Total [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	47,400	27,000
Prepaid Expenses and Other Current Assets [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	187
Prepaid Expenses and Other Current Assets [Member] \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0
Prepaid Expenses and Other Current Assets [Member] \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	187
Prepaid Expenses and Other Current Assets [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0
Other Assets [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	545
Other Assets [Member] \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0
Other Assets [Member] \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	545
Other Assets [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	$ 0
Accrued Liabilities [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure		187
Accrued Liabilities [Member] \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure		0
Accrued Liabilities [Member] \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure		187
Accrued Liabilities [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure		0
Other Noncurrent Liabilities [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure		402
Other Noncurrent Liabilities [Member] \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure		0
Other Noncurrent Liabilities [Member] \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure		402
Other Noncurrent Liabilities [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure		$ 0

Fair Value Measurements Fair Value Nonrecurring Basis (Details) $ in Thousands	Dec. 31, 2018 USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets Held-for-sale, Long Lived, Fair Value Disclosure	$ 12,489
Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets Held-for-sale, Long Lived, Fair Value Disclosure	0
Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets Held-for-sale, Long Lived, Fair Value Disclosure	0
Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets Held-for-sale, Long Lived, Fair Value Disclosure	$ 12,489

Prepaids and Other Current Assets Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Prepaid Expense and Other Assets, Current [Abstract]
Deposit Assets	$ 1,087	$ 21,940
Other Prepaid Expense, Current	12,476	4,208
Deferred Costs and Other Assets	1,951	1,301
Prepaid insurance and property taxes	2,666	2,580
Prepaid other taxes	5,072	8,097
Deferred tax charge	1,180	1,326
Other Assets, Current	1,548	1,834
Prepaid expenses and other current assets	$ 25,980	$ 41,286

Prepaids and Other Current Assets Related Party (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Related Party Transaction [Line Items]
Related-party receivable	$ 20,137	$ 98,807
Accounts Receivable [Member]
Related Party Transaction [Line Items]
Related-party receivable	4,904	36,425
Prepaid Expenses and Other Current Assets [Member]
Related Party Transaction [Line Items]
Related-party receivable	$ 15,233	$ 62,382

Prepaids and Other Current Assets Related Party Text (Details) - USD ($) shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Related Party Transaction [Line Items]
CommonSharesSoldbyPfizer	2,500
Payments for Other Fees	$ 8.0
ICU Medical MSA Revenue	81.0	$ 70.2
Pfizer MSA Product Costs	$ 78.2	$ 72.4
Hospira [Member]
Related Party Transaction [Line Items]
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares	3,200	3,200

Accrued Liabilities an Other Long-term Liabilities (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Dec. 31, 2018	Mar. 31, 2018	Dec. 31, 2018	Dec. 31, 2017
Accrued Liabilities [Abstract]
Salaries and benefits	$ 20,538		$ 20,538	$ 20,745
Incentive compensation	42,913		42,913	40,682
Accrued Professional Fees	15,996		15,996	13,319
Accrued Product Field Action.	5,316		5,316	11,810
Consigned inventory	1,118		1,118	5,210
Third-party Inventory			1,089	4,284
Legal accrual	1,400		1,400	3,538
Accrued sales taxes	2,941		2,941	6,291
Warranties and Returns	1,124		1,124	3,360
Deferred Revenue and Credits, Current	3,814		3,814	3,326
Accrued other taxes	3,213		3,213	2,771
Outside commissions	3,977		3,977	725
Accrued freight	10,953		10,953	5,696
Restructuring Reserve, Current	1,046		1,046	1,290
Contract settlement	12,700	$ 28,900	2,083	0
Accrued research and development expense			1,451	0
Other	9,848		9,848	9,017
Accrued liabilities	$ 128,820		$ 128,820	$ 132,064

Accrued Liabilities an Other Long-term Liabilities Other Long-term Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Other Long-term Liabilities [Abstract]
Contract liabilities	$ 14,020	$ 40,148
Deferred Revenue, Noncurrent	468	7,099
Benefits	962	2,104
Accrued Rent	1,779	0
contract settlement	1,667	0
Other	1,696	5,975
OTHER LONG-TERM LIABILITIES	$ 20,592	$ 55,326

Long-Term Obligations Credit Facility (Details) $ in Millions	12 Months Ended
	Dec. 31, 2018 USD ($)
LOng-Term Obligations Disclosure [Abstract]
Line of Credit Facility, Maximum Borrowing Capacity	$ 150.0
Line of Credit Facility, Remaining Borrowing Capacity	$ 150.0
Line of Credit Facility, Expiration Date	Nov. 08, 2022
Line of Credit Accordion	$ 100.0
Debt Issuance Costs, Line of Credit Arrangements, Gross	$ 1.4
Debt Instrument, Interest Rate Terms	In general, borrowing under the Credit Facility (other than Swingline loans) bears interest, at our option, based on the Base Rate plus applicable margin or the London Interbank Offered Rate ("LIBOR") rate plus applicable margin, as defined below:
Line of Credit Facility, Collateral	Our obligations are secured by: (i) 100% of the equity interests of our guarantor subsidiaries; and (ii) all of the tangible and intangible personal property and assets related to us and our guarantor subsidiaries (including, without limitation, all accounts, equipment, inventory and other goods, all instruments, intellectual property and other general intangibles, deposit accounts, securities accounts and other investment property and cash), and (iii) all products, profits and proceeds of the foregoing. Notwithstanding the foregoing, the collateral shall not include certain excluded property
Line of Credit Facility, Covenant Terms	The Credit Facility contains certain financial covenants pertaining to Consolidated Fixed Charge Coverage and Consolidated Total Leverage Ratios. In addition, the Credit Facility has restrictions pertaining to limitations on debt, liens, negative pledges, loans, advances, acquisitions, other investments, dividends, distributions, redemptions, repurchases of equity interests, fundamental changes and asset sales and other dispositions, prepayments, redemptions and purchases of subordinated debt and other junior debt, transactions with affiliates, dividend and payment restrictions affecting subsidiaries, changes in line of business, fiscal year and accounting practices and amendment of organizational documents and junior debt documents.

Long-Term Obligations Line of Credit Pricing (Details)	12 Months Ended
Long-Term Obligations Line of Credit Pricing (Details)	Dec. 31, 2018
Line of Credit Facility [Line Items]
Debt Instrument, Interest Rate Terms	In general, borrowing under the Credit Facility (other than Swingline loans) bears interest, at our option, based on the Base Rate plus applicable margin or the London Interbank Offered Rate ("LIBOR") rate plus applicable margin, as defined below:
Pricing Level I [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.15%
LIBOR Basis Spread on Variable Rate	1.25%
Debt Instrument, Basis Spread on Variable Rate	0.25%
Pricing Level II [Member] [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.20%
LIBOR Basis Spread on Variable Rate	1.50%
Debt Instrument, Basis Spread on Variable Rate	0.50%
Pricing Level III [Member] [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.25%
LIBOR Basis Spread on Variable Rate	1.75%
Debt Instrument, Basis Spread on Variable Rate	0.75%
Pricing Level IV [Member] [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.30%
LIBOR Basis Spread on Variable Rate	2.00%
Debt Instrument, Basis Spread on Variable Rate	1.00%

Long-Term Obligations Senior Note (Details) $ in Millions	Dec. 31, 2018 USD ($)
Long-Term Obligations [Abstract]
Senior Notes	$ 75

Income Taxes Income from continuing operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Foreign Earnings Repatriated	$ 20,800
Income (Loss) from Continuing Operations before Income Taxes, Domestic	(8,600)	$ 59,872	$ 80,714
Income (Loss) from Continuing Operations before Income Taxes, Foreign	$ 30,974	$ (8,589)	$ 4,450

Income Taxes Provision for income taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Employee Service Share-based Compensation, Tax Benefit from Exercise of Stock Options	$ 12,617	$ 20,004	$ 7,556
Current Federal Tax Expense (Benefit)	492	2,774	21,123
Current State and Local Tax Expense (Benefit)	1,865	2,263	2,347
Current Foreign Tax Expense (Benefit)	9,136	3,170	1,118
Current Income Tax Expense (Benefit)	11,493	8,207	24,588
Deferred Federal Income Tax Expense (Benefit)	(9,118)	(20,878)	(2,045)
Deferred State and Local Income Tax Expense (Benefit)	(3,072)	(4,619)	(767)
Deferred Foreign Income Tax Expense (Benefit)	(5,722)	(71)	304
Deferred Income Tax Expense (Benefit)	(17,912)	(25,568)	(2,508)
PROVISION FOR INCOME TAXES	$ (6,419)	$ (17,361)	$ 22,080

Income Taxes Tax benefit from exercise of stock options (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Employee Service Share-based Compensation, Tax Benefit from Exercise of Stock Options	$ 12,617	$ 20,004	$ 7,556
Employee Service Share-based Compensation, Tax Benefit from Compensation Expense	$ 5,706	$ 7,247	$ 5,682

Income Taxes Tax Reform (Details) - USD ($) $ in Thousands	12 Months Ended
Income Taxes Tax Reform (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Foreign Earnings Repatriated	$ 20,800
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent	21.00%	35.00%	35.00%
RepatriationTollCharge	$ 600	$ 2,000
Transitiontaxadjustment	600
IncomeTaxExpenseDeferredTaxAccountRevaluation	200	1,100
Taxreformdeferredtaxrevaluationadjustment	200
GILTItaxexpense	$ 2,363	$ 0	$ 0

Income Taxes Change in taxes payable (Details) $ in Millions	12 Months Ended
	Dec. 31, 2018 USD ($)
Income Tax Disclosure [Abstract]
Increase (Decrease) in Income Taxes Payable	$ 4.3

Income Taxes Effective tax rate (Details) $ in Thousands	12 Months Ended
Income Taxes Effective tax rate (Details) $ in Thousands	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)
Effective Income Tax Rate Reconciliation, Percent [Abstract]
GILTItaxexpense	$ 2,363	$ 0	$ 0
GILTItaxexpensepercent	10.60%	0.00%	0.00%
Income (Loss) from Continuing Operations before Equity Method Investments, Income Taxes, Noncontrolling Interest	$ 22,374	$ 51,283	$ 85,164
Income Tax Reconciliation, Income Tax Expense (Benefit), at Federal Statutory Income Tax Rate	4,699	17,950	29,807
Income Tax Reconciliation, State and Local Income Taxes	927	(403)	1,795
Income Tax Reconciliation, Tax Credits	(4,961)	(2,783)	(1,014)
Income Tax Reconciliation, Foreign Income Tax Rate Differential	$ (2,944)	$ 3,481	$ (135)
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent	21.00%	35.00%	35.00%
Effective Income Tax Rate Reconciliation, State and Local Income Taxes	4.10%	(0.80%)	2.10%
Effective Income Tax Rate Reconciliation, Tax Credits	(22.20%)	(5.40%)	(1.20%)
Effective Income Tax Rate Reconciliation, Foreign Income Tax Rate Differential	(13.20%)	6.80%	(0.10%)
Effective Income Tax Rate Reconciliation, Share-based Compensation, Excess Tax Benefit, Amount	$ (11,040)	$ (18,958)	$ (7,720)
Effective Income Tax Rate Reconciliation, Share-based Compensation, Excess Tax Benefit, Percent	(49.30%)	(37.00%)	(9.10%)
Effective Income Tax Rate, Continuing Operations	(28.70%)	(33.80%)	25.90%
Tax reform	$ 826	$ 3,076	$ 0
EffectiveIncomeTaxRateREconciliationTaxReform	0.037	0.060	0.000
EffectiveIncomeTaxRateReconciliationIPMigration	$ 3,252	$ 3,367	$ 0
EffectiveTaxRateReconciliationIPMigrationPercent	0.145	0.066	0.000
Effective Income Tax Rate Reconciliation, Other Adjustments, Amount	$ 3	$ 1,125	$ (1,786)
Effective Income Tax Rate Reconciliation, Other Adjustments, Percent	0.10%	2.20%	(2.10%)
EffectiveIncomeTaxRateReconciliationBargainPurchaseGain	$ 0	$ (24,811)	$ 0
EffectiveTaxRateReconciliationBargainPurchaseGainPercent	(0.000)	(0.484)	(0.000)
Effectiveincometaxreconciliation,nondeductiblecompensation	$ 456	$ 595	$ 1,133
Effectivetaxratereconciliationnondeductiblecomppercent	2.00%	1.20%	1.30%

Income Taxes Deferred income tax provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Components of deferred tax provision [Line Items]
Deferred Income Tax Expense (Benefit)	$ (17,912)	$ (25,568)	$ (2,508)

Income Taxes Deferred income tax assets (liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Deferred tax assets and liabilities [Line Items]
Deferred Tax Assets, Operating Loss Carryforwards	$ 12,686	$ 0
Non-current deferred tax asset	76,571	46,135
Deferred Tax Assets, Net	37,933	23,288
Non-current deferred tax asset, gross total [Member]
Deferred tax assets and liabilities [Line Items]
Deferred Tax Assets, Tax Deferred Expense, Reserves and Accruals, Other	11,291	956
Deferred Tax Assets, Other	12,451	7,412
Noncurrent deferred tax asset - acquired future tax deductions	10,722	10,580
Deferred Tax Assets, Tax Deferred Expense, Compensation and Benefits, Share-based Compensation Cost	10,775	8,633
Deferred Tax Assets, Unrealized Currency Losses	3,108	3,425
Noncurrent deferred tax asset - tax credits state	14,470	11,220
Deferred Tax Assets, Inventory	5,674	10,658
Deferred Tax Assets, Tax Deferred Expense, Reserves and Accruals, Allowance for Doubtful Accounts	830	636
Deferred Tax Assets, Valuation Allowance, Noncurrent	(5,436)	(7,385)
Noncurrent deferred tax liability [Member]
Deferred tax assets and liabilities [Line Items]
Noncurrent deferred tax liability - depreciation and amortization	35,387	21,005
Noncurrent deferred tax liability - state income taxes	2,639	1,640
Noncurrent deferred tax liability - foreign	612	202
Deferred Tax Liabilities, Net	$ 38,638	$ 22,847

Income Taxes Operating Loss Carryforwards (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Operating loss carryforwards [Abstract]
Employee Service Share-based Compensation, Tax Benefit from Exercise of Stock Options	$ 12,617	$ 20,004	$ 7,556
UNITED STATES \| Tax Year 2017 [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	68,900
Foreign Tax Authority [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	21,400
State and Local Jurisdiction [Member] \| Tax Year 2018 [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	$ 20,200

Income Taxes Unrecognized tax benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Unrecognized tax benefits [Abstract]
Unrecognized Tax Benefits, Increases Resulting from Prior Period Tax Positions	$ 0	$ 77	$ 77
Unrecognized Tax Benefits, Increase Resulting from Acquisition	0	640	0
Unrecognized Tax Benefits, Increases Resulting from Current Period Tax Positions	4,536	3,992	345
Unrecognized Tax Benefits, Decrease Resulting from Prior Period Tax Positions	(146)	(12)	(46)
Unrecognized Tax Benefits, Reductions Resulting from Lapse of Applicable Statute of Limitations	(93)	(170)	(148)
Unrecognized Tax Benefits	$ 10,824	$ 6,527	$ 2,000	$ 1,772

Income Taxes Tax Carryforwards (Details) $ in Millions	Dec. 31, 2018 USD ($)
CALIFORNIA
Tax Credit Carryforward [Line Items]
Tax Credit Carryforward, Amount	$ 7.4
UTAH
Tax Credit Carryforward [Line Items]
Tax Credit Carryforward, Amount	$ 13.6

Income Taxes Tax Holiday (Details) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2018 USD ($) $ / shares
Income Tax Holiday [Line Items]
Income Tax Holiday, Aggregate Dollar Amount \| $	$ 8.8
Income Tax Holiday, Income Tax Benefits Per Share \| $ / shares	$ 0.41

Geographic Information and Significant Customers Geographic Information (Details) - Hospira [Member]	12 Months Ended
	Dec. 31, 2016
Market Segment Revenue as a % of Total Revenue [Line Items]
Concentration Risk, Percentage	30.00%
Percentage of total accounts receivable	23.00%

Geographic Information and Significant Customers Long Lived Assets by Geographic Location (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	$ 694,864	$ 608,823
COSTA RICA
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	81,920	80,956
Mexico Property and Equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	64,242	61,008
Other LATAM [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	22,828	19,432
CANADA
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	4,545	4,362
Italy Property and Equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	7,819	6,860
SPAIN
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	6,516	5,601
Europe [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	2,427	2,625
Asia Pacific [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	15,152	5,169
Foreign [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	205,449	186,013
United States property and equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	$ 489,415	$ 422,810

Stockholders' Equity (Details) - USD ($) $ in Millions	12 Months Ended
Stockholders' Equity (Details) - USD ($) $ in Millions	Dec. 31, 2018	Dec. 31, 2017
Equity, Class of Treasury Stock [Line Items]
Treasury stock purchase plan	$ 40.0
Treasury stock purchase plan remaining available	$ 7.2
Stock Repurchased and Retired During Period, Shares		$ 15.4
Shares Paid for Tax Withholding for Share Based Compensation	26,307	27,636
Payments Related to Tax Withholding for Share-based Compensation	$ 6.3	$ 4.1
Treasury Stock, Common, Shares	408	0

Stockholders' Equity Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated Other Comprehensive Income (Loss), Net of Tax	$ (14,959)	$ (21,272)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(1,421)	6,862
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(565)	(549)
Other Comprehensive Income (Loss), Net of Tax	(1,986)	6,313	$ (514)
Accumulated Other Comprehensive Income (Loss), Net of Tax	(16,945)	(14,959)	(21,272)
Accumulated Foreign Currency Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated Other Comprehensive Income (Loss), Net of Tax	(14,578)	(21,272)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(3,104)	6,694
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0
Other Comprehensive Income (Loss), Net of Tax	(3,104)	6,694
Accumulated Other Comprehensive Income (Loss), Net of Tax	(17,682)	(14,578)	(21,272)
Accumulated Net Gain (Loss) from Cash Flow Hedges Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated Other Comprehensive Income (Loss), Net of Tax	(365)	0
Other Comprehensive Income (Loss), Unrealized Gain (Loss) on Derivatives Arising During Period, Net of Tax	1,568	184
Other Comprehensive Income (Loss), Reclassification Adjustment from AOCI on Derivatives, Net of Tax	(565)	(549)
Other Comprehensive Income (Loss), Derivatives Qualifying as Hedges, Net of Tax, Portion Attributable to Parent	1,003	(365)
Accumulated Other Comprehensive Income (Loss), Net of Tax	638	(365)	0
Accumulated Defined Benefit Plans Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated Other Comprehensive Income (Loss), Net of Tax	(16)	0
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	115	(16)
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0
Other Comprehensive Income (Loss), Net of Tax	115	(16)
Accumulated Other Comprehensive Income (Loss), Net of Tax	$ 99	$ (16)	$ 0

Commitments and Contingencies Lease Commitments (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Leases [Abstract]
Operating Leases, Rent Expense	$ 11.0	$ 7.9	$ 0.6
Operating Leases, Future Minimum Payments Due, Next Twelve Months	8.3
Operating Leases, Future Minimum Payments, Due in Two Years	8.6
Operating Leases, Future Minimum Payments, Due in Three Years	6.5
Operating Leases, Future Minimum Payments, Due in Four Years	5.9
Operating Leases, Future Minimum Payments, Due in Five Years	5.6
Operating Leases, Future Minimum Payments, Due Thereafter	13.2
Operating Leases, Future Minimum Payments Due	$ 48.1
Lessee, Operating Lease, Term of Contract	6 years 3 months

Commitments and Contingencies Contingencies (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Dec. 31, 2018	Mar. 31, 2018	Dec. 31, 2018	Dec. 31, 2017
Commitments and Contingencies Disclosure [Abstract]
Contract settlement	$ 12,700	$ 28,900	$ 2,083	$ 0
contingent consideration gross			$ 225,000	$ 225,000

Collaborative and Other Arrangements (Details) $ in Millions	12 Months Ended
	Dec. 31, 2018 USD ($)
Collaborative and Other Arrangements [Abstract]
Fee Cap Six months subsequent to first twelve months	$ 31.3
Transitional Service Agreement Set-up Costs	22.0
Fee Cap - First Twelve Months	$ 62.5

Selected Quarterly Financial Data - Unaudited (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Revenues	$ 340,378	$ 327,169	$ 360,460	$ 372,033	$ 370,124	$ 343,236	$ 331,514	$ 247,739	$ 1,400,040	$ 1,292,613	$ 379,372
Gross Profit	134,640	134,587	151,800	149,001	137,490	111,598	88,062	88,945	570,028	426,095	201,398
Net Income	$ (7,355)	$ 219	$ 31,054	$ 4,875	$ 49,705	$ 136	$ (37,060)	$ 55,863	$ 28,793	$ 68,644	$ 63,084
Basic	$ (0.36)	$ 0.01	$ 1.53	$ 0.24	$ 2.47	$ 0.01	$ (1.87)	$ 3.03	$ 1.41	$ 3.50	$ 3.90
Diluted	$ (0.36)	$ 0.01	$ 1.44	$ 0.23	$ 2.33	$ 0.01	$ (1.87)	$ 2.86	$ 1.33	$ 3.29	$ 3.66
Restructuring, strategic transaction and integration expenses	$ 41,100								$ 105,390	$ 77,967	$ 15,348
Contractsettlements	$ 8,600								$ 41,613	$ 0	$ 0

- Definition

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

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

+ References + Details