0000883984-22-000014 | 10-K | XBRL Viewer

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Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
CURRENT ASSETS:
Cash and cash equivalents	$ 552,827	$ 396,097
Short-term investment securities	14,420	14,687
TOTAL CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENT SECURITIES	567,247	410,784
Accounts receivable, net of allowance for doubtful accounts of $7,038 at December 31, 2021 and $21,490 at December 31, 2020	105,894	124,093
Inventories	290,235	314,928
Prepaid income taxes	19,586	29,480
Prepaid expenses and other current assets	46,847	41,492
Total current assets	1,029,809	920,777
PROPERTY AND EQUIPMENT, net	468,365	466,628
Operating Lease, Right-of-Use Asset	39,847	46,571
Long-term Investment Securities	4,620	12,974
GOODWILL	43,439	33,001
INTANGIBLE ASSETS, net	188,311	197,231
Deferred Income Tax Assets, Net	42,604	31,034
Other Assets	63,743	55,475
TOTAL ASSETS	1,880,738	1,763,691
CURRENT LIABILITIES:
Accounts payable	81,128	71,864
Accrued liabilities	118,195	97,021
Accrued Income Taxes, Current	1,454	303
Contingent earn-out liability	0	26,300
Total current liabilities	200,777	195,488
Contingent earn-out liability, Noncurrent	2,589	0
Other Liabilities	41,830	47,835
Deferred Income Tax Liabilities, Net	1,490	1,663
Accrued Income Taxes, Noncurrent	18,021	16,440
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 21,280 and 21,058 shares at December 31, 2021 and 2020, respectively, and outstanding 21,280 and 21,058 shares at December 31, 2021 and 2020, respectively.	2,128	2,106
Additional paid-in capital	721,412	693,068
Treasury Stock, Value	(27)	(39)
Retained earnings	911,787	808,652
Accumulated other comprehensive loss	(19,269)	(1,522)
Total stockholders' equity	1,616,031	1,502,265
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY	$ 1,880,738	$ 1,763,691

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
REVENUES:
Revenues	$ 1,316,308	$ 1,271,004	$ 1,266,208
Cost of Goods Sold	824,818	809,507	794,344
Gross profit	491,490	461,497	471,864
OPERATING EXPENSES:
Selling, general and administrative	302,583	283,953	276,982
Research and development	47,498	42,948	48,611
Restructuring, strategic transaction and integration expenses	18,037	28,409	80,574
Change in fair value of contingent earn-out	0	9,000	(47,400)
Contractsettlements	127	(975)	5,737
Total operating expenses	368,245	363,335	364,504
Income from operations	123,245	98,162	107,360
Interest Expense	(858)	(1,753)	(549)
OTHER INCOME,NET	799	1,085	7,896
Income before income taxes	123,186	97,494	114,707
Provision for income taxes	(20,051)	(10,624)	(13,672)
Net Income	$ 103,135	$ 86,870	$ 101,035
Basic	$ 4.86	$ 4.16	$ 4.90
Diluted	$ 4.74	$ 4.02	$ 4.69
WEIGHTED AVERAGE NUMBER OF SHARES
Basic (in shares)	21,206	20,907	20,629
Diluted (in shares)	21,781	21,591	21,545

Statement of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
Statement of Comprehensive Income - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Net income	$ 103,135	$ 86,870	$ 101,035
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), after Reclassification and Tax	(3,021)	904	1,242
Foreign currency translation adjustment, net of taxes of $0 for all periods	(14,664)	12,929	372
Other adjustments, net of taxes of $0 for all periods	(62)	47	(71)
Other Comprehensive Income (Loss), Net of Tax	(17,747)	13,880	1,543
Comprehensive income	$ 85,388	$ 100,750	$ 102,578

- Definition

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

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- Definition

Amount after tax and reclassification adjustments of other comprehensive income (loss).

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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, 2018		20,491,000
Balance at Dec. 31, 2018	$ 1,263,655		$ 2,049	$ 657,899	$ (95)	$ 620,747	$ (16,945)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of restricted stock and exercise of stock options, shares issued		331,000
Issuance of restricted stock and exercise of stock options, including excess income tax benefits	7,732		25	(10,870)	18,577
Treasury Stock, Shares		(80,000)
Purchase of treasury stock,treasury stock acquired in lieu of cash payment on stock option exercises and income tax withholding obligations	(18,639)			0	(18,639)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	21,918			21,918
Other comprehensive income, net of tax	1,543						1,543
Net Income	101,035					101,035
Balance at Dec. 31, 2019	1,377,244		2,074	668,947	(157)	721,782	(15,402)
Balance, Shares at Dec. 31, 2019		20,742,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of restricted stock and exercise of stock options, shares issued		383,000
Issuance of restricted stock and exercise of stock options, including excess income tax benefits	13,193		32	167	12,994
Treasury Stock, Shares		(67,000)
Purchase of treasury stock,treasury stock acquired in lieu of cash payment on stock option exercises and income tax withholding obligations	(12,876)			0	(12,876)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	23,954			23,954
Other comprehensive income, net of tax	13,880						13,880
Net Income	86,870					86,870
Balance at Dec. 31, 2020	$ 1,502,265		2,106	693,068	(39)	808,652	(1,522)
Balance, Shares at Dec. 31, 2020	21,058,000	21,058,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of restricted stock and exercise of stock options, shares issued		262,000
Issuance of restricted stock and exercise of stock options, including excess income tax benefits	$ 9,372		22	1,003	8,347
Treasury Stock, Shares		(40,000)
Purchase of treasury stock,treasury stock acquired in lieu of cash payment on stock option exercises and income tax withholding obligations	(8,335)			0	(8,335)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	27,341			27,341
Other comprehensive income, net of tax	(17,747)						(17,747)
Net Income	103,135					103,135
Balance at Dec. 31, 2021	$ 1,616,031		$ 2,128	$ 721,412	$ (27)	$ 911,787	$ (19,269)
Balance, Shares at Dec. 31, 2021	21,280,000	21,280,000

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
CASH FLOWS FROM OPERATING ACTIVITIES:
Net Income	$ 103,135	$ 86,870	$ 101,035
Depreciation and amortization	89,698	85,631	76,916
Operatingleaserightofuseassetamortization	9,594	9,216	8,294
Provision for doubtful accounts	345	7,137	14,882
Provision for warranty and returns	831	(1,576)	(134)
Stock compensation	27,341	23,954	21,918
Gain (Loss) on Disposition of Property Plant Equipment	1,652	(1,789)	12,872
Bond premium amortization	655	231	135
Debt issuance cost amortization	240	288	288
Change in fair value of contingent earn-out	0	9,000	(47,400)
Production Related Impairments or Charges	3,380	2,626	0
Sparepartsusage	13,046	11,191	24,301
Other	2,582	6,939	447
Increase (Decrease) in Accounts Receivable	13,755	78,049	(23,684)
Increase (Decrease) in Inventories	20,815	19,196	(24,997)
Increase (Decrease) in Prepaid Expense and Other Assets	(7,973)	(4,311)	8,588
Increase (Decrease) in Other Operating Assets	(21,038)	(16,069)	(29,837)
Accounts payable	2,347	(46,415)	(2,697)
Accrued liabilities	6,259	(29,379)	(43,689)
Income taxes, including excess tax benefits and deferred income taxes	874	(18,037)	4,680
Net cash provided by operating activities	267,538	222,752	101,918
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property and equipment	(68,542)	(92,005)	(97,312)
Proceeds from Sale of Other Property, Plant, and Equipment	218	6,176	33
Intangible asset additions	(12,627)	(8,385)	(8,728)
Business acquisitions, net of cash acquired	(14,452)	0	(76,133)
Payments to Acquire Equity Method Investments	(3,250)	0	0
Purchases of investment securities	(10,034)	(32,825)	(26,040)
Proceeds from sale of investment securities	18,000	28,900	41,292
Net cash (used in) provided by investing activities	(90,687)	(98,139)	(166,888)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from Long-term Lines of Credit	0	150,000	0
Repayments of Long-term obligations	0	(150,000)	0
Proceeds from exercise of stock options	9,372	13,193	7,732
Finance Lease, Principal Payments	(607)	(357)	0
Payment for Contingent Consideration Liability, Financing Activities	(17,300)	0	0
Purchase of treasury stock	(8,335)	(12,876)	(18,639)
Net cash (used in) provided by financing activities	(16,870)	(40)	(10,907)
Effect of Exchange Rate on Cash [Abstract]
Effect of exchange rate changes on cash	(3,251)	2,854	(234)
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect, Total	156,730	127,427	(76,111)
CASH AND CASH EQUIVALENTS, beginning of period	396,097	268,670	344,781
CASH AND CASH EQUIVALENTS, end of period	552,827	396,097	268,670
SUPPLEMENTAL DISCLSOURE OF CASH FLOW INFORMATION
Cash paid during the year for income taxes	19,562	31,628	9,675
Interest Paid, Excluding Capitalized Interest, Operating Activities	858	1,753	549
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Accounts payable for property and equipment	9,338	2,211	13,912
Goodwill, Acquired During Period	10,626		20,026
International Distributor
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Liabilities Assumed	2,589	$ 0	0
Pursuit Vascular LLC
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Goodwill, Acquired During Period			19,100
Foreign Infusion System Supplier
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Fair value of assets acquired	4,592
Cash paid for acquisitions, net of cash acquired	(14,452)
Contingent consideration	0
Goodwill, Period Increase (Decrease)	10,626
Goodwill, Acquired During Period	10,600
Liabilities Assumed	$ 766
Total Acquisitions
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Fair value of assets acquired			91,019
Cash paid for acquisitions, net of cash acquired			(76,133)
Contingent consideration			(17,300)
Goodwill, Acquired During Period			20,026
Liabilities Assumed			$ 17,612

Consolidated Balance Sheets (Parenthetical) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 7,038,000	$ 21,490,000
Convertible preferred stock, par value	$ 1.00	$ 1.00
Convertible preferred stock, authorized shares	500,000	500,000
Convertible preferred stock, outstanding shares	0	0
Common stock, par value	$ 0.10	$ 0.10
Common stock, shares authorized	80,000,000	80,000,000
Common stock, shares issued	21,280,000	21,058,000
Common stock, shares issued	21,280,000	21,058,000
Treasury Stock, Shares	119	209

Statement of Comprehensive Income (Parenthetical) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement of Comprehensive Income [Abstract]
Other Comprehensive Income (Loss), Foreign Currency Translation Adjustment, Tax	$ 0	$ 0	$ 0
Other Comprehensive (Income) Loss, Other Adjustments, Tax	0	0	0
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), after Reclassification, Tax	$ (954,000)	$ 285,000	$ 392,000

General and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

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

BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Basis of Presentation and Preparation

ICU Medical, Inc. ("ICU" or "we"), a Delaware corporation, operates in one business segment engaged in the development, manufacturing and sale of innovative medical devices used in infusion therapy and critical care applications. We are one of the world's leading pure-play infusion therapy companies with a wide-ranging product portfolio that includes IV solutions, IV smart pumps with pain management and safety software technology, dedicated and non-dedicated IV sets and needlefree connectors designed to help meet clinical, safety and workflow goals. 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 U.S. ("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.

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.

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 our products.

Inventories consist of the following (in thousands):


	As of December 31,
	2021		2020
Raw materials	$	135,528	$	126,499
Work in process	36,490		33,053
Finished goods	118,217		155,376
Total	$	290,235	$	314,928

Property, Plant and Equipment

Property, plant and equipment consists of the following (in thousands):


	As of December 31,
	2021		2020
Machinery and equipment	$	321,078	$	291,331
Land, building and building improvements	243,377		241,199
Molds	60,463		60,381
Computer equipment and software	102,979		98,311
Furniture and fixtures	7,670		7,767
Instruments placed with customers(1)	97,384		90,383
Construction in progress	72,153		53,724
Total property, plant and equipment, cost	905,104		843,096
Accumulated depreciation	(436,739)		(376,468)
Property, plant and equipment, net	$	468,365	$	466,628

_______________________________

(1) Instruments placed with customers consist of drug-delivery and monitoring systems placed with customers 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 customers			3 - 10 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 $65.9 million, $62.4 million and $59.3 million in 2021, 2020 and 2019, respectively.

Goodwill

We test goodwill for impairment on an annual basis in the month of November, or more frequently if an event occurs or circumstances change that would indicate that impairment may exist. Generally, we first perform a qualitative assessment to determine whether it is more likely than not that the fair value of the reporting unit is less than its carrying amount. If, based on an assessment of relevant qualitative factors, we determine that this is not the case, then the quantitative impairment test is not required to be performed. Conversely, if we determine based on the qualitative assessment that it is more likely than not that the fair value of the reporting unit is less than its carrying amount, we will perform the quantitative impairment test. For the quantitative impairment test, we calculate the estimated fair value of the reporting unit. If the estimated fair value of the reporting unit is less than its carrying amount, the goodwill of the reporting unit is determined to be impaired. An impairment charge is recorded in an amount equal to the excess of the carrying amount over its estimated fair value, limited to the total amount of goodwill allocated to the reporting unit. For our annual impairment test for the year ended December 31, 2021, we performed a qualitative assessment and concluded that it was more likely than not that the fair value of our reporting unit exceeded its carrying amount, and therefore, no further impairment testing was required. There were no accumulated impairment losses as of December 31, 2021, 2020 and 2019.

The following table presents the changes in the carrying amount of our goodwill for 2021, 2020 and 2019 (in thousands):


	Total
Balance as of January 1, 2019	$	11,195
Goodwill acquired(1)	20,026
Other	24
Balance as of December 31, 2019	$	31,245

Other(2)	1,756
Balance as of December 31, 2020	33,001
Goodwill(3)	10,626
Currency translation	(188)
Balance as of December 31, 2021	$	43,439

_______________________________

(1) In 2019, we acquired Pursuit Vascular, Inc. ("Pursuit"), which resulted in $19.1 million of goodwill. We also acquired a small foreign distributor, which resulted in $0.9 million of goodwill.

(2) In 2020, "Other" relates to a $1.3 million measurement period adjustment to deferred taxes related to the Pursuit acquisition and foreign currency translation.

(3) In 2021, we acquired a small foreign infusion systems supplier, which resulted in $10.6 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, 2021
		Cost		Accumulated Amortization		Net
Patents	10	$	27,429	$	16,764	$	10,665
Customer contracts	12	10,412		6,196		4,216
Non-contractual customer relationships	9	57,316		33,004		24,312
Trademarks	4	425		425		—
Trade name	15	18,260		4,731		13,529
Developed technology	13	152,893		49,406		103,487
Non-compete	3	9,100		2,356		6,744
Total amortized intangible assets		$	275,835	$	112,882	$	162,953

Internally developed software*		$	25,358			$	25,358

Total intangible assets		$	301,193	$	112,882	$	188,311

_______________________________

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


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

Internally developed software*		$	19,363			$	19,363

Total intangible assets		$	286,674	$	89,443	$	197,231

_______________________________

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

Amortization expense was $23.8 million, $23.2 million and $17.7 million in 2021, 2020 and 2019, respectively.

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


2022	$	25,668
2023	24,191
2024	23,551
2025	16,057
2026	15,324
Thereafter	58,162
Total	$	162,953

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. We did not have any intangible asset impairments in 2021, 2020 or 2019.

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. We did not have any long-lived asset impairments in 2021, 2020 or 2019.

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.

Investments in Available-for-sale Securities

Our investment securities are considered available-for-sale and currently consist of short-term and long-term corporate bonds. These securities are considered “investment grade” and are carried at fair value. We assess our investment in available-for-sale debt securities for impairment each reporting period. If an unrealized loss exists, we determine whether any portion of the decline in fair value below the carrying value is credit-related by reviewing several factors, including, but not limited to, the extent of the fair value decline and changes in the financial condition of the issuer. We record an impairment for credit-related losses through an allowance, limited to the amount of the unrealized loss. If we either intend to sell or it is more likely than not we will be required to sell the debt security before its anticipated recovery, any allowance is written off and the amortized cost basis is written down to fair value through a charge against net earnings. Unrealized gains and non-credit-related unrealized losses are recorded, net of tax, in other comprehensive income (loss). We did not have any investments in available-for-sale debt securities in unrealized loss positions as of December 31, 2021 or 2020.

The amortized cost of the debt securities is adjusted for the amortization of premiums computed under the effective interest method. Such amortization is included in other income, net in the consolidated statements of operations. Realized gains and losses are accounted for on the specific identification method. There have been no realized gains or losses on the disposal of these investments. The scheduled maturities of the debt securities are between 2022 and 2024. All short-term investment securities are callable within one year.

Our short-term and long-term investments in available-for-sale securities consist of the following (in thousands):


	As of December 31, 2021
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	14,420	$	—	$	14,420
Long-term corporate bonds	4,620		—		4,620
Total investment securities	$	19,040	$	—	$	19,040

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

Investments in Non-Marketable Equity Securities

In the third quarter of 2021, we acquired approximately a 20.0% non-marketable equity interest in a nonpublic company and entered into a three-year distribution agreement where we have the exclusive rights to market, sell and distribute the company's products in exchange for a cash payment of $3.3 million. In addition, we were granted an exclusive license for all of the seller's intellectual property. At the expiration of the distribution agreement we have the right but not the obligation to acquire the remaining interest in the business.

proportionate share of the investee's income or (loss) resulting from this investment in other income, net in our consolidated statements of operations. The carrying value of our equity method investment is reported in other assets on the consolidated balance sheets. We assess our equity method investments for impairment on an annual basis or whenever events or circumstances indicate that the carrying value of the investment may not be recoverable. During 2021, there were no indications that our non-marketable equity method investment was impaired. Our recorded share of the investee's loss was not material for the year ended December 31, 2021. We did not receive any dividend distributions from this investment during 2021.

Our non-marketable equity method investment consists of the following (in thousands):


	As of December 31,
	2021		2020
Equity method investment	$	3,238	$	—

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 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 consolidated statements of operations in other income, net. Foreign currency transaction losses (gains), net were $1.0 million, $7.2 million and $(0.7) million in 2021, 2020 and 2019, respectively.

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 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. Rebates are offered on both a fixed and tiered/variable basis. In both cases, we use information available at the time and our historical experience with each customer to estimate the most likely rebate amount. We also provide chargebacks to distributors that sell to end customers at prices determined under a contract between us and the end customer. Chargebacks are the difference between prices we charge our distribution customers and contracted prices we have with the end customer which are processed as credits to our distribution customers. In estimating the expected value of chargeback amounts for use in determining the transaction price, we use information available at the time, including 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, Infusion Systems, IV Solutions 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 $0.2 million, $0.2 million and $0.1 million in 2021, 2020 and 2019, respectively.

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 $11.0 million, $10.7 million and $11.4 million in 2021, 2020 and 2019, respectively. We also have 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. Restricted stock units that are anti-dilutive are not included in the treasury stock method. There were 12,354, 12,083 and 10,760 anti-dilutive shares in 2021, 2020 and 2019, respectively.

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,
	2021		2020		2019
Net income	$	103,135	$	86,870	$	101,035
Weighted-average number of common shares outstanding (basic)	21,206		20,907		20,629
Dilutive securities	575		684		916
Weighted-average common and common equivalent shares outstanding (diluted)	21,781		21,591		21,545
EPS — basic	$	4.86	$	4.16	$	4.90
EPS — diluted	$	4.74	$	4.02	$	4.69

New Accounting Pronouncements

Recently Issued Accounting Standards

In March 2020, the Financial Accounting Standards Board ("FASB") issued ASU No. 2020-04, Reference Rate Reform (Topic 848) - Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The amendments in this update provide optional guidance for a limited period of time to ease the potential burden for reference rate reform on financial reporting. Due to concerns about structural risks of interbank offered rates and, particularly, the risk of cessation of the London Interbank Offered Rate ("LIBOR"), regulators around the world have undertaken reference rate reform initiatives to identify alternative reference rates that are more observable or transaction based and less susceptible to manipulation. The amendments in this update apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued as a result of reference rate reform. Optional expedients may be applied to contracts that are modified as a result of the reference rate reform. Modifications of contracts within the scope of Topic 470, Debt, should be accounted for by prospectively adjusting the effective interest rate. Modifications of contracts within the scope of ASC 842, Leases, should be accounted for as a continuation of the existing contracts with no reassessments of the lease classification and the discount rate (incremental borrowing rate). Exceptions to Topic 815, Derivatives and Hedging, results in not having a dedesignation of a hedging relationship if certain criteria are met. The amendments in this ASU are effective for all entities as of March 12, 2020 through December 31, 2022. In November 2021, we entered into two forward-starting swaps whereby the variable leg of the swap references LIBOR, these swaps will be amended in early 2022 to transition to an alternative reference rate (see Note 7: Derivatives and Hedging Activities). The amendments in this ASU allow for certain expedients that will allow us to assume that our hedged interest payments are probable of occurring regardless of any expected modification in their terms related to reference rate reform and will allow us to continue hedge accounting for a cash flow hedge for which the hedged interest rate risk changes if the hedge is highly effective under ASC 815, Derivatives and Hedging or the optional expedient under this ASU is elected. The impact of this ASU on our contracts has not been and is not expected to be material.

Acquisitions (Notes)

12 Months Ended

Dec. 31, 2021

Business Combinations [Abstract]

Business Combination Disclosure [Text Block]

ACQUISITIONS

2019 Acquisitions

On November 2, 2019, we acquired 100% interest in Pursuit for cash consideration of approximately $75.0 million. Additionally, Pursuit's equity holders were potentially entitled up to $50.0 million in additional cash consideration contingent upon the achievement of certain sales and gross profit targets for specific customers. The earn-out paid was calculated as a percentage of gross profit achieved during the earn-out period against a pre-determined target gross profit, not to exceed $50.0 million. As of June 30, 2021, the earn-out measurement period ended and based on the actual sales and gross profit achieved during the measurement period, we calculated the actual earn-out amount to be $26.3 million. The $26.3 million earn-out calculation was finalized and accepted by Pursuit's former equity holders and was paid out in during the fourth quarter of 2021. The acquisition of Pursuit and their ClearGuard HD is a natural extension of our needlefree IV connector and other infection control technologies, which together provides us the best of breed solutions.

Final 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):


Cash consideration for acquired assets, net	$	71,533
Fair value of contingent consideration	17,300
Total Consideration	$	88,833

Final Purchase Price Allocation:
Trade receivables	$	973
Inventories	2,464
Prepaid expenses and other current assets	74
Property, plant and equipment	609
Intangible assets(1)	82,300
Accounts payable	(215)
Accrued liabilities	(2,065)
Total identifiable net assets acquired	$	84,140
Goodwill - not tax deductible	20,462
Deferred tax liability	(15,769)
Purchase Consideration	$	88,833

_______________________________________________

(1) Identifiable intangible assets included $69.0 million of developed technology, $10.8 million of trade name and $2.5 million of non-compete agreement. The weighted-average amortization periods for the identifiable intangible assets are as follows: approximately fifteen years for developed technology, fifteen years for trade name and three years for the non-compete agreement.

The identifiable intangible 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; 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 and finished goods inventory was valued at estimated sales proceeds less a nominal profit and costs to sell. The trade receivables, 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.

During 2019, we also acquired a small foreign distributor for approximately $4.6 million in cash.

2021 Acquisitions

During November 2021, we acquired a small foreign infusion systems supplier and paid an initial gross cash payment of approximately $15.4 million. The total consideration and purchase price allocation is preliminary pending the finalization of the valuation. In addition to the initial cash consideration, total consideration for the acquisition includes an additional holdback of $0.5 million, to be paid two years from the completion date of the acquisition, and also a potential earn-out payment of up to $2.5 million, consisting of (i) a cash payment of $1.0 million contingent on the achievement of certain revenue targets for the annual period ending December 31, 2022 and, separately, (ii) a cash payment of $1.5 million contingent on certain product-related regulatory certifications obtained by May 26, 2024.

Restructuring, Strategic Transaction and Integration (Notes)

12 Months Ended

Dec. 31, 2021

Restructuring and Related Activities [Abstract]

Restructuring and Related Activities Disclosure [Text Block]

RESTRUCTURING, STRATEGIC TRANSACTION AND INTEGRATION

Restructuring, strategic transaction and integration expenses were $18.0 million, $28.4 million and $80.6 million in 2021, 2020 and 2019, respectively.

Restructuring

Restructuring charges were $(1.8) million, $7.9 million and $8.4 million in 2021, 2020 and 2019, respectively, and are included in the above restructuring, strategic transaction and integration expenses in our consolidated statement of operations.

In 2021, we adjusted certain facility restructuring liabilities by $2.0 million, shown in the table below under "Other adjustments," to reflect actual amounts owed which resulted in net restructuring credits of $(1.8) million.

In 2020, restructuring charges were primarily related to severance and costs related to office and other facility closures.

In 2019, restructuring charges were primarily related to severance and facility closure costs. These charges were primarily related to a one-time charge to move our U.S. pump service depot to our existing Salt Lake City facility and other plant restructuring.

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, was paid in equal monthly installments until December 2020. This has been fully paid as of December 31, 2020.

The following table summarizes the activity in our restructuring-related accrual by major type of cost (in thousands):


	Severance Pay and Benefits		Employment Agreement Buyout		Retention and Facility Closure Costs		Total
Accrued balance, January 1, 2020	$	3,878	$	460	$	1,211	$	5,549
Charges incurred	4,288		—		3,641		7,929
Payments	(6,331)		(460)		(3,570)		(10,361)
Currency translation	23		—		281		304
Accrued balance, December 31, 2020	$	1,858	$	—	$	1,563	$	3,421
Charges incurred	140		—		—		140
Payments	(969)		—		—		(969)
Currency translation	(2)		—		31		29
Other adjustments(1)	(528)		—		(1,429)		(1,957)
Accrued balance, December 31, 2021	$	499	$	—	$	165	$	664

_______________________________________________

(1) The estimated liabilities related to a prior year's facility closure restructuring were adjusted to actual amounts owed.

Strategic Transaction and Integration ExpensesWe incurred $19.8 million, $20.5 million and $72.2 million in strategic transaction and integration expenses in 2021, 2020 and 2019, respectively, which are included in restructuring, strategic transaction and integration expenses in our consolidated statement of operations. The strategic transaction and integration expenses during 2021 were related to integration costs associated with acquisitions, the Hospira Infusion Systems ("HIS") earn-out dispute with Pfizer, one-time costs incurred to comply with regulatory initiatives and transaction expenses incurred in connection with entering into a definitive agreement to acquire Smiths Medical 2020 Limited ("Smiths Medical") (see Note 17: Subsequent Events). The integration expenses during 2020 were related to the integration of HIS and included expenses for the migration of IT systems at our Austin facility. The strategic transaction and integration expenses during 2019 were primarily related to HIS, including a one-time strategic supply chain restructuring charge of $22.1 million, which reduced our contracted commitments to our third party manufacturer and charges related to our Pfizer separation costs, which included a $12.7 million non-cash write-off of related assets.

Revenue (Notes)

12 Months Ended

Dec. 31, 2021

Revenue from Contract with Customer [Abstract]

Revenue from Contract with Customer [Text Block]

REVENUE

Revenue Recognition

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

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

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

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 a directly observable method or calculated on a cost plus margin basis method.

Revenue disaggregated

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


	Year ended December 31,
	2021				2020				2019
Product line	Revenue		% of Revenue		Revenue		% of Revenue		Revenue		% of Revenue
Infusion Consumables	$	555,189	42	%	$	473,740	37	%	$	477,611	37	%
Infusion Systems	352,321		27	%	359,691		28	%	328,282		26	%
IV Solutions	359,477		27	%	388,971		31	%	414,971		33	%
Critical Care	49,321		4	%	48,602		4	%	45,344		4	%

Total Revenues	$	1,316,308	100	%	$	1,271,004	100	%	$	1,266,208	100	%

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):


	Year ended December 31,
Geography	2021		2020		2019
Europe, the Middle East and Africa	$	147,488	$	132,763	$	130,530
Other Foreign	227,011		227,614		212,336
Total Foreign	374,499		360,377		342,866
United States	941,809		910,627		923,342
Total Revenues	$	1,316,308	$	1,271,004	$	1,266,208

Domestic sales accounted for 72%, 72% and 73% of total revenue in 2021, 2020 and 2019, respectively. International sales accounted for 28%, 28% and 27% of total revenue in 2021, 2020 and 2019, respectively.

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 and Other Long-term Liabilities). The following table presents the changes in our contract balances for the years ended December 31, 2021 and 2020, (in thousands):


	Contract Liabilities
Beginning balance, January 1, 2020	$	(4,855)
Equipment revenue recognized	14,408
Equipment revenue deferred due to implementation	(14,341)
Software revenue recognized	5,721
Software revenue deferred due to implementation	(7,363)
Ending balance, December 31, 2020	$	(6,430)
Equipment revenue recognized	10,048
Equipment revenue deferred due to implementation	(13,725)
Software revenue recognized	7,261
Software revenue deferred due to implementation	(4,615)
Ending balance, December 31, 2021	$	(7,461)

During 2021, we recognized $5.1 million in revenue that was included in the opening contract balances as of December 31, 2020. As of December 31, 2021, revenue from remaining performance obligations related to implementation of software and equipment is $5.6 million. We expect to recognize substantially all of this revenue within the next three to six months dependent on implementation restrictions due to the novel coronavirus and its variants ("COVID-19"). Revenue from remaining performance obligations related to annual software licenses is $1.9 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.

- Definition

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

+ References

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

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

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

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

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

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

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

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

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

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

+ Details

Leases (Notes)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Lessee, Operating and Finance Lease

LEASES

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

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

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

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


	Year ended December 31,
	2021		2020
Operating lease cost	$	11,251	$	11,284
Finance lease cost — interest	122		91
Finance lease cost — reduction of ROU asset	648		383
Short-term lease cost	14		263
Total lease cost	$	12,035	$	12,021

Interest expense on our finance leases is included in other income (expense), net in our consolidated statements of operations. The reduction of the operating and finance ROU assets is included as noncash lease expense in selling, general and administrative expenses in our consolidated statements of operations.

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


	Year ended December 31,
	2021		2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	11,256	$	10,185
Operating cash flows from finance leases	$	122	$	91

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	2,589	$	20,847
Finance leases	$	558	$	3,062

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


	As of December 31,
	2021			2020
Operating leases
Operating lease right-of-use assets	$	39,847		$	46,571

Accrued liabilities	$	9,009		$	8,740
Other long-term liabilities	33,971			41,019
Total operating lease liabilities	$	42,980		$	49,759

Weighted-Average Remaining Lease Term
Operating leases	5.9 years			6.7 years

Weighted-Average Discount Rate
Operating leases	4.98		%	5.02		%

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


	As of December 31,
	2021			2020
Finance leases
Finance lease right-of-use assets	$	2,673		$	2,915

Accrued liabilities	$	643		$	554
Other long-term liabilities	2,067			2,388
Total finance lease liabilities	$	2,710		$	2,942

Weighted-Average Remaining Lease Term
Finance leases	5.6 years			6.4 years

Weighted-Average Discount Rate
Finance leases	4.28		%	4.27		%

As of December 31, 2021, the maturities of our operating and finance lease liabilities for each of the next five years are approximately (in thousands):


	Operating Leases		Finance Leases
2022	$	10,887	$	749
2023	9,453		749
2024	8,488		458
2025	5,129		267
2026	4,842		214
Thereafter	10,577		615
Total Lease Payments	49,376		3,052
Less imputed interest	(6,396)		(342)
Total	$	42,980	$	2,710

Share Based Award Share awards (Notes)

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [Abstract]

Share-based Payment Arrangement [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"), which was suspended in 2017. We receive a tax benefit on stock compensation expense and direct tax benefits from the exercise of stock options and vesting of restricted stock units. We also have indirect tax benefits upon exercise of stock options and vesting of restricted stock units 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)	2021		2020		2019
Stock compensation expense	$	27,341	$	23,954	$	21,918
Tax benefit from stock-based compensation cost	$	6,391	$	5,564	$	4,840
Indirect tax benefit	$	285	$	1,203	$	680

As of December 31, 2021, we had $31.2 million of unamortized stock compensation cost which we will recognize as an expense over a weighted-average period of approximately 0.9 years.

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 and any shares that were forfeited, terminated or expired that would have otherwise returned to 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. As of December 31, 2021, 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.

Time-based Stock Options

To date, all options granted under 2011 Plan and 2003 Plan have been non-statutory stock options. The majority of the time-based outstanding employee option grants vested 25% after one year from the grant date and the balance vested ratably on a monthly basis over 36 months. The outstanding employee option grants are all fully vested. 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,
	2021			2020			2019
Number of time-based options granted	7,910			7,190			6,265
Grant-date fair value of options granted (in thousands)	$	528		$	425		$	424
Weighted-average assumptions for stock option valuation:
Expected term (years)	5.5			5.5			5.5
Expected stock price volatility	35.0		%	35.0		%	28.0		%
Risk-free interest rate	0.9		%	0.4		%	2.2		%
Expected dividend yield	—		%	—		%	—		%
Weighted-average grant-price per option	$	200.07		$	181.99		$	225.27
Weighted-average grant-date fair value per option	$	66.78		$	59.09		$	67.73

A summary of our stock option activity as of and for the year ended December 31, 2021 is as follows:


	Shares	Weighted-Average Exercise Price Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding at December 31, 2020	817,800	$	70.13
Granted	7,910	$	200.07
Exercised	(162,612)	$	57.64
Forfeited or expired	—	$	—
Outstanding at December 31, 2021	663,098	$	74.75	2.6	$	108,003
Exercisable at December 31, 2021	656,483	$	73.48	2.5	$	107,761
Vested and expected to vest, December 31, 2021	663,098	$	74.75	2.6	$	108,003

The intrinsic values for options exercisable, outstanding and vested or expected to vest at December 31, 2021 are based on our closing stock price of $237.34 at December 31, 2021 and are before applicable taxes.

The following table presents information regarding stock option activity:


	Year ended December 31,
(In thousands)	2021		2020		2019
Intrinsic value of options exercised	$	27,534	$	32,915	$	22,976
Cash received from exercise of stock options	$	9,372	$	13,193	$	7,732
Tax benefit from stock option exercises	$	5,092	$	5,179	$	9,653

Stock Awards

In 2021, we granted PRSUs to our executive officers. For the executive officers other than the Chief Executive Officer ("CEO"), Chief Operations Officer ("COO") and the Chief Financial Officer ("CFO"), 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 years. For the CEO, COO and the CFO, the performance shares will cliff-vest ending on March 6, 2024 and further be subject to the achievement of minimum three-year cumulative revenue and EPS targets, commencing on January 1, 2021 and ending on December 31, 2023, which when reviewed against a predetermined vesting matrix could result in 0% to 250% of the awarded units that could vest.

In 2020, we granted PRSUs to our executive officers. For the executive officers other than the CEO, COO and the CFO, 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 years. For the CEO, COO and the CFO, the performance shares will cliff-vest ending on March 6, 2023 and further be subject to the achievement of minimum three-year cumulative revenue and EPS targets, which when reviewed against a predetermined vesting matrix could result in 0% to 250% of the awarded units that could vest. On February 15, 2021, the Compensation Committee made the determination that the executive officers other than the CEO, COO and CFO met their individual performance goals for 2021, therefore one-third of their 2020 PRSU shares awarded vested during 2021. Additionally, during February 2021, the Compensation Committee, modified the potential vesting percentages related to the 2020 PRSU awards for the CEO, COO and CFO, as the original potential percentages were established immediately before the onset of the COVID-19 pandemic. The Compensation Committee determined to adjust the CEO, COO and CFO's potential to earn from between 0% and 250% of the award granted, to an increased potential to earn between 50% and 300% of the award granted, subject to the same minimum threshold revenue and EPS targets to be achieved by the Company. The additional compensation expense as a result of modifying the 2020 PRSUs granted to our CEO, COO and CFO totaled $2.1 million recognized over the remaining amortization period from the date of modification.

In 2019, we granted PRSUs to our executive officers. For the executive officers other than the CEO and the 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 years. For the CEO and the COO, the performance shares will cliff-vest ending on March 6, 2022 and further subject to the achievement of a minimum Cumulative Adjusted EBITDA. If for the three year period ending on December 31, 2021 the Cumulative Adjusted EBITDA has a growth of at least 6% to 8%, 50% of the awarded units will vest. If on the vesting date the Cumulative Adjusted EBITDA has a growth of between 8% to 10%, 100% of the awarded units will vest. If on the vesting date the Cumulative Adjusted EBITDA has a growth of over 10%, 200% of the awarded units will vest. In 2019, we also granted PRSUs to one of our non-executive employees. These PRSUs will vest at the end of a three-year period ending on March 31, 2022, if certain minimum performance goals are met. On February 15, 2021, the Compensation Committee made the determination that the executive officers other than the CEO and COO met their individual performance goals for 2021, therefore one-third of their 2019 PRSU shares awarded vested during 2021. The performance period related to the 2019 CEO and COO PRSUs ended on December 31, 2021 and based on the Cumulative Adjusted EBITDA achieved during the performance period zero payout is expected, subject to Compensation Committee review and determination.

In 2018, we granted PRSUs to our executive officers. For the executive officers other than the CEO and the COO, the PRSUs were to 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 were to 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 vesting date the Cumulative Adjusted EBITDA has a growth of between 8% to 10%, 100% of the awarded units will vest. If on the vesting date the Cumulative Adjusted EBITDA has a growth of over 10%, 200% of the awarded units will vest. On February 15, 2021, the Compensation Committee made the determination that the executive officers other than the CEO and COO met their individual performance goals for 2021, therefore one-third of their 2018 PRSU shares awarded vested during 2021. Also on February 15, 2021, the Compensation Committee determined that the CEO and COO's 2018 PRSUs were earned at 100% of the awards granted.

In 2017, we granted PRSUs to our executive officers. The PRSUs were scheduled to 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. On January 17, 2020, the Compensation Committee made the determination that the 2017 PRSU shares were earned by our executive officers at the 300% achievement level.

In 2016, we granted PRSUs to our executive officers, which vested on December 31, 2018. During the first quarter of 2019, the Compensation Committee determined the award granted vested at 300%, as a minimum specified compound annual growth rate ("CAGR") in adjusted EBITDA per share of greater than 12% was reached for the 3-year performance period January 1, 2016 through December 31, 2018.

Restricted stock units are granted annually to our Board of Directors and vest on the first anniversary of the grant date, or the date of our annual meeting, whichever occurs first.

In 2021, 2020 and 2019, 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 grant-date fair market value of our PRSUs and RSUs is determined by our stock price on the grant date.

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


	Year ended December 31,
(In thousands, except shares and per share amounts)	2021		2020		2019
PRSU
Shares granted	53,246		38,633		37,657
Shares earned (a)	32,013		80,654		114,032
Grant-date fair value per share	$	198.16	$	188.34	$	231.63
Grant-date fair value	$	10,551	$	7,276	$	8,723
Intrinsic value vested	$	6,777	$	15,627	$	26,445

RSU
Shares granted	84,388		87,830		61,856
Grant-date fair value per share	$	199.13	$	188.13	$	227.42
Grant-date fair value	$	16,804	$	16,523	$	14,067
Intrinsic value vested	$	13,681	$	12,314	$	16,753

_______________________________

(a) PRSU shares earned in 2019 were related to performance awards granted to executives in 2016 and 2018, PRSU shares earned in 2020 were related to performance awards granted to executives in 2017, 2018 and 2019. PRSU shares earned in 2021 were related to performance awards granted to executives in 2018, 2019 and 2020.

The table below provides a summary of our PRSU and RSU activity as of and for the year ended December 31, 2021:


	Number of Units	Grant-Date Fair Value Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Non-vested at December 31, 2020	220,760	$	209.77
Change in units due to performance expectations (a)	24,601	$	209.64
Granted	137,634	$	198.75
Vested	(99,363)	$	219.77
Forfeited	(7,871)	$	196.01
Non-vested and expected to vest at December 31, 2021	275,761	$	201.05	1.0	$	65,449

_______________________________

(a) Relates to 2019-2021 PRSUs granted to a non-executive employee and 2021 and 2020 CEO, COO and CFO PRSUs granted, assumes attainment of an increased payout rate based on performance expectations.

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, 2021, 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. We suspended our ESPP in 2017.

Derivatives and Hedging Activities (Notes)

12 Months Ended

Dec. 31, 2021

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Derivative Instruments and Hedging Activities Disclosure [Text Block]

DERIVATIVES AND HEDGING ACTIVITIES

Hedge Accounting and Hedging Program

The purposes of our cash flow hedging programs are to manage the foreign currency exchange rate risk on forecasted expenses denominated in currencies other than the functional currency of the operating unit, and to manage floating interest rate risk associated with future interest payments on variable-rate term loans issued in January 2022 subsequent to our fiscal year end. We do not issue derivatives for trading or speculative purposes.

To receive hedge accounting treatment, all hedging relationships are formally documented at the inception of the hedge, and the hedges must be highly effective in offsetting changes to future cash flows on hedged transactions. The par forward contract and forward-starting interest rate swaps are designated and qualify as cash flow hedges. Our derivative instruments are recorded at fair value on the consolidated balance sheets and are classified based on the instrument's maturity date. We record changes in the fair value of the effective portion of the gain or loss on the derivative instrument as a component of other comprehensive income (loss) 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.

Foreign Currency Exchange Rate Risk

We began hedging a portion of our Mexico forecasted expenses denominated in Pesos ("MXN") in May 2017 by entering into a two-year cross-currency par forward contract. The term of this currency forward contract was May 1, 2017 to May 1, 2019. The derivative instrument had a fixed forward rate of 20.01 MXN/USD over the term of the two-year contract.

In January 2018, we entered into a six-month cross-currency par forward contract. The term of this six-month contract was May 1, 2019 to November 1, 2019. The derivative instrument had 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. The term of the one-year hedge was November 1, 2019 to November 3, 2020. The derivative instrument matured in equal monthly amounts at a fixed forward rate of 22.11 MXN/USD.

In March 2020, we entered into a one-year cross-currency par forward contract. The total notional amount of this outstanding derivative as of December 31, 2020 was approximately 436.8 million MXN. The term of this one-year contract was November 3, 2020 to December 1, 2021. The derivative instrument matured in equal monthly amounts at a fixed forward rate of 24.26 MXN/USD.

In November 2021, we entered into a one-year cross-currency par forward contract. The total notional amount of this outstanding derivative as of December 31, 2021 was approximately 413.1 million MXN. The term of this one-year contract is December 1, 2021 to December 1, 2022. The derivative instrument matures in equal monthly amounts at a fixed forward rate of 21.60 MXN/USD.

Floating Interest Rate Risk

In November 2021, in anticipation of entering into new senior secured credit facilities in January 2022, which includes a variable-rate term loan A and a variable-rate term loan B (see Note 17: Subsequent Events for additional information), we entered into two forward-starting interest rate swaps. Under the interest rate swap agreements we exchange, at specified intervals, the difference between fixed and floating interest amounts calculated by reference to an agreed-upon notional amount. The term loan A swap has an initial notional amount of $300.0 million, reducing to $150.0 million evenly on a quarterly basis through its final maturity in April 2027. We will pay a fixed rate of 1.49% and will receive the greater of 3-month USD LIBOR or 0%. The term loan B swap has an initial notional amount of $750.0 million, reducing to $46.9 million evenly on a quarterly basis through its final maturity in April 2026. We will pay a fixed rate of 1.31% and will receive the greater of 3-month USD LIBOR or 0.50%. These forward-starting swaps will effectively convert the relevant portion of the floating-rate term loans to fixed rates.

The following table presents the fair values of our derivative instruments included within the consolidated balance sheets (in thousands):


	Derivatives Designated as Cash Flow Hedging Instruments
Consolidated Balance Sheet Location	Foreign Exchange Forward Contracts		Forward-Starting Interest Rate Swaps		Gross Derivatives

(In thousands)
As of December 31, 2021
Prepaid expenses and other current assets	$	1,061	$	—	$	1,061
Other assets	—		—		—
Total assets	$	1,061	$	—	$	1,061

Accrued liabilities	$	—	$	—	$	—
Other long-term liabilities	—		1,480		1,480
Total liabilities	$	—	$	1,480	$	1,480

As of December 31, 2020
Prepaid expenses and other current assets	$	3,555	$	—	$	3,555
Other assets	—		—		—
Total assets	$	3,555	$	—	$	3,555

Accrued liabilities	$	—	$	—	$	—
Other long-term liabilities	—		—		—
Total liabilities	$	—	$	—	$	—

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


	Location of Gain in the Consolidated Statements of Operations	Year Ended December 31,
		2021		2020		2019
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	Cost of goods sold	$	3,444	$	790	$	916
Forward-starting interest rate swaps	Interest expense	$	—	$	—	$	—

We recognized the following gains (losses) on our derivative instruments designated as cash flow hedges (in thousands):


	Amount of Gain (Loss) Recognized in Other Comprehensive Income						Amount of Gain Reclassified From Accumulated Other Comprehensive Income into Income
	Year Ended December 31,							Year Ended December 31,
	2021		2020		2019		Location of Gain Reclassified From Accumulated Other Comprehensive Income into Income	2021		2020		2019
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	$	950	$	1,980	$	2,550	Cost of goods sold	$	3,444	$	790	$	916
Forward-starting interest rate swaps	(1,480)		—		—		Interest expense	—		—		—
Total derivatives designated as cash flow hedging instruments	$	(530)	$	1,980	$	2,550		$	3,444	$	790	$	916

As of December 31, 2021, we expect an estimated $1.1 million in deferred gains on the outstanding foreign exchange forward contract and an estimated $5.6 million in deferred losses on the forward-starting interest rate swaps will be reclassified from accumulated other comprehensive loss to net income during the next 12 months concurrent with the underlying hedged transactions also being reported in net income.

Fair Value Measurement (Notes)

12 Months Ended

Dec. 31, 2021

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.

Contingent earn-out liabilities

In the fourth quarter of 2019, we recognized an earn-out liability related to the acquisition of Pursuit (see Note 2: Acquisitions). Pursuit's former equity holders were entitled up to $50.0 million in additional cash consideration contingent upon the achievement of certain sales and gross profit targets for specific customers. The earn-out was calculated as a percentage of gross profit achieved during the earn-out period against a pre-determined target gross profit, not to exceed $50.0 million. During the earn-out period, we used a Monte Carlo simulation model to determine the fair value of the earn-out liability. The Monte Carlo simulation model utilized multiple input variables to determine the value of the earn-out liability including historical volatility, a risk-free interest rate, counter party credit risk and projected future gross profit (see the simulation input table below related to Pursuit). The historical volatility was based on the median of ICU and a certain peer group. The risk-free interest rate was equal to the yield, as of the valuation date, of the zero-coupon U.S. Treasury bill that was commensurate with the term of the earn-out. The counter party credit risk was based on a synthetic credit rating of B1. As of June 30, 2021, the

earn-out measurement period ended. Based on the actual sales and gross profit achieved during the measurement period, we calculated the actual earn-out amount to be $26.3 million. The $26.3 million earn-out calculation was finalized and accepted by Pursuit's former equity holders and was paid out in the fourth quarter of 2021.

In August 2021, we entered into an agreement with one of our international distributors whereby that distributor would not compete with us in a specific territory for a three-year period that will end in September 2024. The terms of the agreement include a contingent earn-out payment. The contingent earn-out payment shall not exceed $6.0 million, which will be earned based on certain revenue targets over a twelve-month measurement period determined by the highest four consecutive quarters commencing over a two-year period starting on the closing date of the agreement and provided that the distributor is in compliance with its obligations under the agreement. As of December 31, 2021, the fair value of the contingent earn-out was estimated at $2.6 million. The estimated fair value of the contingent earn-out is calculated using a probability-weighted cash flow model based on historical revenue streams and the likelihood that the revenue targets will be met.

During November 2021, we acquired a small foreign infusion systems supplier. Total consideration for the acquisition includes a potential earn-out payment of up to $2.5 million, consisting of (i) a cash payment of $1.0 million contingent on the achievement of certain revenue targets for the annual period ending December 31, 2022 and, separately, (ii) a cash payment of $1.5 million contingent on certain product-related regulatory certifications obtained by May 26, 2024. The initial estimated fair value of the contingent consideration related to this acquisition is immaterial.

Our contingent earn-out liabilities are separately stated on our consolidated balance sheets.

The following table provides a reconciliation of our Level 3 earn-out liabilities measured at estimated fair value based on an initial valuation and updated quarterly for the years ended December 31, 2021, 2020 and 2019 (in thousands):


	Earn-out Liability
Contingent earn-out liability, January 1, 2019	$	47,400
Acquisition date fair value estimate of earn-out(1)	17,300
Change in fair value of contingent earn-out (included in income from operations as a separate line item)(2)	(47,400)
Contingent earn-out liability, December 31, 2019	$	17,300

Change in fair value of contingent earn-out (included in income from operations as a separate line item)(3)	9,000
Contingent earn-out liability, December 31, 2020	$	26,300
Contingent earn-out — non-compete arrangement	2,589

Transfer of Pursuit earn-out liability into Level 2(4)	(26,300)
Contingent earn-out liability, December 31, 2021	$	2,589

_______________________________

(1) Relates to our acquisition of Pursuit (see Note 2: Acquisitions).

(2) The change in the fair value of the HIS earn-out related to our 2017 acquisition of HIS from Pfizer which was based on actual results as compared to the earn-out performance targets. This adjustment reduced the HIS earn-out to zero.

(3) The fair value of the Pursuit earn-out increased during 2020 primarily due to changes in the probabilities within the valuation model.

(4) The Pursuit earn-out was transferred out of Level 3 and into Level 2 in the third quarter of 2021 when the amount of the actual payment was known, and subsequently settled during the fourth quarter of 2021.

The following table provides quantitative information about Level 3 inputs for fair value measurement of the Pursuit earn-out liability as of the acquisition date to December 31, 2020:

Pursuit Earn-out


	As of December 31, 2020		At Acquisition November 2, 2019
Simulation Input
Revenue/Gross Profit Volatility	25.00	%	20.00	%
Discount Rate	12.50	%	15.00	%
Risk-free rate	0.09	%	1.55	%
Counter Party Risk	3.10	%	6.00	%

Investments, Foreign Currency Contracts and Interest Rate Contracts

The fair value of our investments, which consist 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 contracts 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 fair value of our Level 2 forward-starting interest rate swaps is estimated using a pricing model that reflects the terms of the contracts, including the period to maturity, and relies on observable market inputs such as known notional value amounts and USD interest rate curves.

Other than the Pursuit earn-out liability described above, there were no transfers between levels in 2021 or 2020.

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 as of December 31, 2021
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available-for-sale debt securities:
Short-term	$	14,420	$	—	$	14,420	$	—
Long-term	4,620		—		4,620		—
Foreign exchange forwards:
Prepaid expenses and other current assets	1,061		—		1,061		—


Total Assets	$	20,101	$	—	$	20,101	$	—

Liabilities:
Contingent earn-out liability - LT	$	2,589	$	—	$	—	$	2,589



Forward-starting interest rate swaps:
Other long-term liabilities	1,480		—		1,480		—
Total Liabilities	$	4,069	$	—	$	1,480	$	2,589


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

Total Assets	$	31,216	$	—	$	31,216	$	—

Liabilities:
Earn-out liability	$	26,300	$	—	$	—	$	26,300



Total Liabilities	$	26,300	$	—	$	—	$	26,300

- 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, 2021

Prepaid Expense and Other Assets, Current [Abstract]

Other Current Assets [Text Block]

PREPAID EXPENSES AND OTHER CURRENT ASSETS AND OTHER ASSETS

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


	As of December 31,
	2021		2020
Other prepaid expenses and receivables	$	14,763	$	14,964
Deferred costs	12,746		6,402
Prepaid insurance and property taxes	6,310		6,178
VAT/GST receivable	4,156		3,676
Deferred tax charge	4,241		3,542
Foreign exchange forward contract	1,061		3,555
Deposits	1,343		1,353
Other	2,227		1,822
	$	46,847	$	41,492

Other assets consist of the following (in thousands):


	As of December 31,
	2021		2020
Pump lease receivables	$	25,941	$	28,948
Spare parts	28,538		22,725
Equity method investments	3,238		—

Deferred debt issuance costs	2,827		—
Finance lease right-of-use assets	2,673		2,915
Other	526		887
	$	63,743	$	55,475

Accrued Liabilities an Other Long-term Liabilities

12 Months Ended

Dec. 31, 2021

Accrued Liabilities [Abstract]

Accounts Payable and Accrued Liabilities Disclosure [Text Block]

ACCRUED LIABILITIES AND OTHER LONG-TERM LIABILITIES

Accrued liabilities consist of the following (in thousands):


	As of December 31,
	2021		2020
Salaries and benefits	$	27,304	$	25,786
Incentive compensation	33,107		27,023

Operating lease liability-ST	9,009		8,740
Accrued professional fees	773		1,273



Legal accrual	3,897		900
Accrued sales taxes	1,980		2,146
Warranties and returns	532		1,027
Deferred revenue	12,646		5,566

Accrued other taxes	4,337		3,540
Distribution fees	5,645		5,300
Accrued freight	9,194		6,784
Restructuring accrual	664		3,421





Other	9,107		5,515
	$	118,195	$	97,021

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


	As of December 31,
	2021		2020
Operating lease liability-LT	$	33,971	$	41,019
Finance lease liability-LT	2,067		2,388
Contract liabilities(1)	202		337

Forward-starting interest rate swaps	1,480		—
Benefits	1,369		1,183

Accrued rent	1,262		1,462

Other	1,479		1,446
	$	41,830	$	47,835

_______________________________

(1) Consists of contracts with customers and suppliers that were valued at below market at the time of the HIS acquisition.

Long-Term Obligations (Notes)

12 Months Ended

Dec. 31, 2021

Long-Term Debt Disclosure [Abstract]

Debt Disclosure [Text Block]

LONG-TERM OBLIGATIONS

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

On November 8, 2017, we entered into a five-year Revolving Credit Facility ("Credit Facility") with various lenders for $150.0 million, with Wells Fargo Bank, N.A. as the administrative agent, swingline lender and issuing lender. During March 2020, as a result of market uncertainty caused by the COVID-19 pandemic, we preemptively borrowed $150.0 million on our Credit Facility as a conservative measure to manage any potential short-term liquidity risk. As of December 31, 2020, we had fully repaid all amounts borrowed. As of December 31, 2021 and 2020, we had no borrowings and $150.0 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) $100.0 million and (ii) 2.00x Total Leverage.

In connection with the Credit Facility, during 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 on 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.

On January 6, 2022, we completed the acquisition of Smiths Medical which was partially financed by entering into Senior Secured Credit Facilities consisting of a term loan A facility of $850.0 million, a term loan B facility of $850.0 million and a revolving credit facility of $500.0 million.

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 entered into Senior Secured Credit Facilities in January 2022, which terminated our existing Credit Facility (see Note 17: Subsequent Events).

- Definition

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

+ References

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+ Details

Income Taxes:

12 Months Ended

Dec. 31, 2021

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,
	2021		2020		2019
United States	$	81,484	$	41,194	$	32,849
Foreign	41,702		56,300		81,858
	$	123,186	$	97,494	$	114,707

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


	Year Ended December 31,
	2021		2020		2019
Current:
Federal	$	20,646	$	6,032	$	6,851
State	3,444		2,422		2,532
Foreign	7,236		7,290		7,994
	$	31,326	$	15,744	$	17,377
Deferred:
Federal	$	(8,154)	$	(5,319)	$	(6,720)
State	(1,815)		(1,850)		(325)
Foreign	(1,306)		2,049		3,340
	(11,275)		(5,120)		(3,705)
	$	20,051	$	10,624	$	13,672

We have accrued for tax contingencies for potential tax assessments, and in 2021 we recognized a $3.0 million net increase, most of which related to various federal, state and foreign tax reserves.

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,
	2021				2020				2019
	Amount		Percent		Amount		Percent		Amount		Percent
Federal tax at the expected statutory rate	$	25,869	21.0	%	$	20,474	21.0	%	$	24,088	21.0	%
State income tax, net of federal effect	2,907		2.4	%	2,099		2.2	%	1,269		1.1	%
Tax credits	(2,443)		(2.0)	%	(3,269)		(3.4)	%	(2,896)		(2.5)	%

Global intangible low-taxed income	711		0.6	%	163		0.2	%	6,634		5.8	%
Foreign income tax differential	(2,983)		(2.4)	%	(3,888)		(4.0)	%	(5,939)		(5.2)	%
Stock-based compensation	(4,263)		(3.5)	%	(4,686)		(4.8)	%	(8,446)		(7.4)	%
Foreign-derived intangible income	(3,775)		(3.1)	%	(2,718)		(2.8)	%	(516)		(0.5)	%
IP installment sale and repatriation	—		—	%	—		—	%	(2,118)		(1.8)	%
Contingent consideration	(29)		—	%	1,566		1.6	%	—		—	%
Section 162(m)	1,812		1.5	%	1,079		1.1	%	203		0.2	%
Other	2,245		1.8	%	(196)		(0.2)	%	1,393		1.2	%
	$	20,051	16.3	%	$	10,624	10.9	%	$	13,672	11.9	%

Tax credits in 2021, 2020 and 2019 consist principally of research and developmental tax credits.

Certain intellectual property and assets were repatriated in 2019 from a liquidation of foreign subsidiaries to the U.S. parent. The tax effect of the repatriation is included as IP installment sale and repatriation.

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


	As of December 31,
	2021		2020
Deferred tax asset:


Accruals/other	$	6,866	$	4,406



Acquired future tax deductions	5,440		7,781
Stock-based compensation	7,283		7,138
Foreign currency translation adjustments	3,360		2,406
Tax credits	11,953		12,444

Inventory reserves	8,199		8,493
Allowance for doubtful accounts	926		4,460
Accrued restructuring	131		1,293
Chargebacks, discounts, customer concessions	27,970		22,874
Valuation allowance	(2,934)		(3,891)
	$	69,194	$	67,404
Deferred tax liability:
State income taxes	$	2,724	$	2,398
Foreign	—		776

Depreciation and amortization	20,483		25,113
Section 481(a) adjustment - change in accounting method	4,873		9,746



	$	28,080	$	38,033

Deferred tax asset, net	$	41,114	$	29,371

Tax Holidays and Carryforwards

Net operating loss ("NOL") carryforwards consist of: (a) federal NOL carryforwards of $2.5 million which will expire at various dates from 2023 to indefinite carryforward periods, (b) state NOL carryforwards of $8.2 million which will expire at various dates from 2022 to indefinite carryforward periods and (c) foreign NOL carryforwards of $15.0 million which will expire at various dates from 2022 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 state research and development (“R&D”) tax credit carryforwards of $16.9 million, which have an indefinite carryforward period.

A substantial portion of our manufacturing operations in Costa Rica operate under various tax holiday and tax incentive programs due to 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 holiday and tax incentives was an increase to our net earnings by $9.8 million or $0.45 per diluted share in 2021 and by $8.0 million or $0.37 per diluted share in 2020.

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, 2021, we have estimated $98.6 million of undistributed foreign earnings and profits. Such earnings were previously subject to U.S. tax as a result of the Tax Act and much of any future remittances would generally be subject to no U.S. tax as a result of dividends received deductions and/or foreign tax credit relief. We intend to invest substantially all of our foreign subsidiary earnings, as well as our capital in our foreign subsidiaries, indefinitely outside of the U.S. in those jurisdictions in which we incur significant additional costs upon repatriation of such amounts.

We are subject to taxation in the U.S. and various states and foreign jurisdictions. Our U.S. federal income tax returns for tax years 2018 and forward are subject to examination by the Internal Revenue Service. Our principal state income tax returns for tax years 2012 and forward are subject to examination by the state tax authorities. The total gross amount of unrecognized tax benefits as of December 31, 2021 was $21.5 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, 2021, 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, 2021 or 2020.

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


	Year Ended December 31,
	2021		2020		2019
Beginning balance	$	18,443	$	15,027	$	10,824
Increases to prior year tax positions	231		502		138

Increases to current year tax positions	3,242		2,987		4,231

Decreases to prior year tax positions	—		(15)		(3)

Decrease related to lapse of statute of limitations	(31)		(58)		(163)
Decrease related to settlements with tax authorities	(348)		—		—
Ending balance	$	21,537	$	18,443	$	15,027

- Definition

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

+ References

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+ Details

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

12 Months Ended

Dec. 31, 2021

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. We do not currently derive a significant portion of our revenues from any one customer.

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,
	2021		2020
Costa Rica	$	115,187	$	104,015
Mexico	79,567		76,004
Other LATAM	36,907		37,485
Canada	4,716		4,672
Italy	12,435		11,098



Spain	13,295		8,701
Other Europe	4,171		3,795
APAC	20,452		19,836
Total Foreign	$	286,730	$	265,606
United States	618,374		577,490
Worldwide Total	$	905,104	$	843,096

Stockholders' Equity

12 Months Ended

Dec. 31, 2021

Stockholders' Equity Note [Abstract]

Stockholders' Equity Note Disclosure [Text Block]

STOCKHOLDERS' EQUITY

Treasury Stock

In August 2019, our Board of Directors approved a common stock purchase plan to purchase up to $100.0 million of our common stock. This plan has no expiration date. We have $100.0 million remaining on this purchase plan. We did not purchase any of our common stock under our common stock purchase plan in 2021, 2020 or 2019. We are limited on share purchases in accordance with the terms and conditions of our Credit Facility (see Note 11: Long-Term Obligations).

In 2021, we withheld 40,350 shares of our common stock from employee vested restricted stock units in consideration for $8.3 million in payments for the employees' share award income tax withholding obligations. We had 119 shares remaining in treasury at December 31, 2021.

In 2020, we withheld 67,041 shares of our common stock from employee vested restricted stock units in consideration for $12.9 million in payments for the employees' share award income tax withholding obligations. We had 209 shares remaining in treasury at December 31, 2020.

In 2019, we withheld 80,186 shares of our common stock from employee vested restricted stock units in consideration for $18.6 million in payments for the employees' share award income tax withholding obligations. We had 850 shares remaining in treasury at December 31, 2019.

We use treasury stock to issue shares for stock option exercises and restricted stock grants.

Accumulated Other Comprehensive (Loss) Income ("AOCI")

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


	Foreign Currency Translation Adjustments		Unrealized Gains (Losses) on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2019	$	(17,682)	$	638	$	99	$	(16,945)
Other comprehensive income (loss) before reclassifications	372		1,938		(71)		2,239
Amounts reclassified from AOCI	—		(696)		—		(696)
Other comprehensive income (loss)	372		1,242		(71)		1,543
Balance as of December 31, 2019	$	(17,310)	$	1,880	$	28	$	(15,402)
Other comprehensive income before reclassifications	12,929		1,505		47		14,481
Amounts reclassified from AOCI	—		(601)		—		(601)
Other comprehensive income	12,929		904		47		13,880
Balance as of December 31, 2020	$	(4,381)	$	2,784	$	75	$	(1,522)
Other comprehensive loss before reclassifications	(14,664)		(403)		(62)		(15,129)
Amounts reclassified from AOCI	—		(2,618)		—		(2,618)
Other comprehensive loss	(14,664)		(3,021)		(62)		(17,747)
Balance as of December 31, 2021	$	(19,045)	$	(237)	$	13	$	(19,269)

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

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+ Details

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies Disclosure [Text Block]	COMMITMENTS AND CONTINGENCIES Legal Proceedings From time to time, we are involved in various legal proceedings, most of which are routine litigation, in the normal course of business. Our management does not believe that the resolution of the unsettled legal proceedings that we are involved with will have a material adverse impact on our financial position or results of operations. Off Balance Sheet Arrangements In the normal course of business, we have agreed to indemnify our officers and directors to the maximum extent permitted under Delaware law and to indemnify customers as to certain intellectual property matters 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 In 2017, we recognized an earn-out liability in connection with our acquisition of HIS from Pfizer. Pfizer was entitled to receive between $191.3 million and $225.0 million in additional cash consideration based on the achievement of certain performance targets for the combined company for the three years ending December 31, 2019. As of December 31, 2019, we determined we did not meet the necessary performance targets that would require payout of any of the HIS earn-out liability. Pfizer disputed our determination that the performance targets requiring payout of the HIS earn-out liability were not met, therefore the dispute entered into binding arbitration. In August 2021, the arbitrator concluded that the necessary performance targets that would require payout of the HIS earn-out were not met, and as a result Pfizer is not entitled to any payments in connection with the HIS earn-out liability. During November 2019, we acquired Pursuit (see Note 2: Acquisitions). Total consideration for the acquisition included a potential contractual earn-out of up to $50.0 million to be paid to former Pursuit equity holders, calculated based upon the achievement of certain performance targets during the earn-out period. As of June 30, 2021, the earn-out measurement period had ended and based on the actual sales and gross profit achieved during the measurement period we calculated the actual earn-out to be $26.3 million. In October 2021, the $26.3 million earn-out was finalized and paid to the former Pursuit equity holders (see Note 8: Fair Value Measurements). In August 2021, we entered into an agreement with one of our international distributors whereby that distributor would not compete with us in a specific territory for a three-year period that will end in September 2024. The terms of the agreement include a contingent earn-out payment. The contingent earn-out shall not exceed $6.0 million, which will be earned based on certain revenue targets over a twelve-month measurement period determined by the highest four consecutive quarters commencing over a two-year period starting on the closing date of the agreement and provided that the distributor is in compliance with its obligations under the agreement. As of December 31, 2021, the fair value of the contingent earn-out was estimated at $2.6 million (see Note 8: Fair Value Measurements). During November 2021, we acquired a small foreign infusion systems supplier. Total consideration for the acquisition includes a potential earn-out payment of up to $2.5 million, consisting of (i) a cash payment of $1.0 million contingent on the achievement of certain revenue targets for the annual period ending December 31, 2022 and, separately, (ii) a cash payment of $1.5 million contingent on certain product-related regulatory certifications obtained by May 26, 2024. The initial estimated fair value of the contingent consideration related to this acquisition is immaterial. Commitments We have non-cancelable operating lease agreements where we are contractually obligated to pay certain lease payment amounts (see Note 5: Leases).

Collaborative and Other Arrangements (Notes)	12 Months Ended
Collaborative and Other Arrangements (Notes)	Dec. 31, 2021
Collaborative and Other Arrangements [Abstract]
Collaborative Arrangement Disclosure [Text Block]	COLLABORATIVE AND OTHER ARRANGEMENTS On February 3, 2017, we entered into two Manufacturing and Supply Agreements ("MSAs") whereby (i) 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) we will manufacture and supply Pfizer certain agreed upon products for a term of five or ten years depending on the product, also with a one-time two-year option to extend. The MSAs provide each party with mutually beneficial interests and both of the MSAs are to be jointly managed by both Pfizer and ICU. The initial supply price, which will be annually updated, is in full consideration for all costs associated with the manufacture, documentation, packaging and certification of the products. On January 1, 2021, we amended our MSA with Pfizer, whereby we manufacture and supply certain agreed upon products to Pfizer. The amendments included a change to the term of the agreement to end on December 31, 2024 with Pfizer's unilateral election to extend through December 31, 2025. Other changes to the terms of the MSA included (i) amendments to our level of supply of products to Pfizer, (ii) certain changes to our manufacturing lines, (iii) updates to our supply price with added volume price tiers for annual periods and (iv) certain minimum purchase requirements for certain products. On February 1, 2022, effective as of January 1, 2022, upon our request, Pfizer executed a Product Addendum (the "Product Addendum") to our MSA agreement, whereby Pfizer manufactures and supplies to us certain agreed upon products. The Product Addendum includes the supply of additional product to us subject to certain time and pricing terms and conditions. The Product Addendum includes a minimum purchase obligation of $29.6 million. The Product Addendum expires on November 30, 2022.

Subsequent Events

12 Months Ended

Dec. 31, 2021

Subsequent Events [Abstract]

Subsequent Events

SUBSEQUENT EVENTS

Acquisition of Smiths Medical 2020 Limited

On January 6, 2022, we completed the acquisition of Smiths Medical, the holding company of Smiths Group plc's global medical device business, from Smiths Group International Holdings Limited (the “Seller”). In accordance with the Share Sale and Purchase Agreement (the "Purchase Agreement"), we purchased 100% of the equity interests of Smiths Medical for approximately $1.9 billion in cash and issued of 2.5 million of fully paid and non-assessable shares of our common stock, par value $0.10 per share. The Purchase Agreement also includes a potential contingent earn-out payment of $100.0 million in cash, which is to be based upon our common stock achieving a certain volume-weighted average price for certain periods from closing to the third or fourth anniversary of closing. The acquisition of Smiths Medical adds to and complements our current product portfolio and the combining of both businesses allows us to be a scaled U.S.-based global competitor that increases the stability of the medical supply chain and allows for future growth.

At closing, in connection with the issuance of the stock consideration to the Seller, we entered into a Shareholders Agreement (the “Shareholders Agreement”). The Shareholders Agreement imposes certain restrictions on the Seller including prohibiting certain transfers of the shares of our common stock issued (i) for 6 months following the closing of the acquisition transaction and (ii) to certain of our competitors and certain other parties, as well as customary standstill limitations. Under the Shareholders Agreement, the Seller has the right to designate one individual for election to our board of directors so long as the Seller beneficially owns at least 5.0% of the total outstanding shares of our common stock.

We expect to account for the Smiths acquisition as a business combination, however the initial accounting for the business combination is incomplete. We are unable to provide preliminary estimates of asset and liability fair market values as the external valuation of the assets acquired and liabilities assumed is incomplete. We plan to file the required historical financial statements and the required pro forma financial statements of the combined results of ICU and Smiths Medical in a Form 8-K/A to amend the Current Report on Form 8-K filed on January 7, 2022 by March 22, 2022.

Issuance of Senior Secured Credit Facilities

On January 6, 2022, to partially finance the acquisition of Smiths Medical, we entered into a credit agreement (the "Credit Agreement") with Wells Fargo Bank, National Association, Wells Fargo Securities, LLC, Barclays Bank PLC and certain other financial institutions (the “Lenders”), pursuant to which, among other things, the Lenders provided us with credit facilities in the aggregate amount of $2.2 billion consisting of (i) a five-year term loan A of $850.0 million, (ii) a seven-year Term Loan B of $850.0 million and (iii) a five-year Revolving Credit Facility of $500.0 million.

Principal Payments

Principal payments on the term loan A and term loan B Facilities are due on the last day of each calendar quarter commencing on June 30, 2022. The term loan A Facility will amortize in an amount equal to 2.50% of the original principal amount in the first two years, 5.00% in the third and fourth years and 7.50% in the fifth year, with a final payment of the outstanding principal balance due on the respective maturity date. The term loan B Facility will mature in twenty-seven consecutive quarterly installments in an amount equal to 0.25% of the aggregate principal amount of the term loan B outstanding on the Closing Date, with a final payment of the outstanding principal balance due on the respective maturity date. All outstanding revolving loans over the term of the revolver are to be paid by the applicable maturity date.

Interest Rate Terms

In general, U.S. dollar revolving and term loans under the credit facilities may bear interest, at our option, on either (1) the Base Rate, as defined in the Credit Agreement, plus the applicable margin, as indicated below or (2) Adjusted Term secured overnight financing rate, as defined in the Credit Agreement, plus applicable margin as indicated below.

Revolving Credit Facility Commitment Fee

The revolving credit facility has a per annum commitment fee at an initial rate of 0.25% which is applied to the available amount of the revolving credit facility. The commitment fee after the quarter ending June 30, 2022 is calculated based on the leverage ratio as indicated below.

Applicable Interest Margins

The applicable interest margins with respect to revolving loans and the term loan A Facility shall initially be 1.75% for RFR Loans, as defined in the Credit Agreement. The following pricing grid for the revolving credit facility and the term loan A Facility will become effective after the quarter ending June 30, 2022 and will be based on changes in the Leverage Ratio as follows:


Leverage Ratio	Applicable Margin for RFR Loans	Applicable Margin for Base Rate Loans	Commitment Fee Rate
>4.00 to 1.0	2.25%	1.25%	0.35%
<4.00 to 1.0 but >3.00 to 1.0	2.00%	1.00%	0.30%
<3.00 to 1.0 but >2.50 to 1.0	1.75%	0.75%	0.25%
<2.50 to 1.0 but >2.00 to 1.0	1.50%	0.50%	0.20%
<2.00 to 1.0	1.25%	0.25%	0.15%

The applicable interest margins for the term loan B Facility shall initially be set at 2.50% for Eurocurrency Rate Loans. The following pricing grid will become effective on the Adjustment Date and will be based on changes in the Leverage Ratio as follows:


Leverage Ratio	Applicable Margin for Eurocurrency Rate Loans	Applicable Margin for Base Rate Loans
>2.75 to 1.0	2.50%	1.50%
<2.75 to 1.0	2.25%	1.25%

The Credit Agreement contains customary representations and warranties and customary affirmative and negative covenants applicable to the Loan Parties and the restricted subsidiaries of the Company, including, without limitation, restrictions on liens, indebtedness, investments, fundamental changes, dispositions, restricted payments and prepayment of junior indebtedness. The Credit Agreement contains financial covenants on the revolving credit facility and term loan A Facility that require the Loan Parties and the restricted subsidiaries of the Company to (i) not exceed a maximum secured net leverage ratio initially set at 4.50 to 1.00, with stepdowns to 4.00 to 1.00 on June 30, 2024 and (ii) a minimum interest coverage ratio of 3.00 to 1.00.

The Credit Agreement contains customary events of default, including, without limitation, payment defaults, covenant defaults, breaches of certain representations and warranties, cross defaults and cross-acceleration to certain material indebtedness, certain events of bankruptcy and insolvency, impairment of security, certain events under ERISA, material judgments and a change of control. If an event of default occurs and is not cured within any applicable grace period or is not waived, the administrative agent and the lenders are entitled to take various actions, including, without limitation, the acceleration of amounts due thereunder and termination of commitments under the Facilities.

SEC Schedule, Article 12-09, Valuation and Qualifying Accounts

12 Months Ended

Dec. 31, 2021

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

SEC Schedule, 12-09, Schedule of Valuation and Qualifying Accounts Disclosure


			Additions
(Amounts in thousands) Description	Balance at Beginning of Period		Charged to Costs and Expenses		Charged to Other Accounts		Write-off/ Disposals		Balance at End of Period
For the year ended December 31, 2019:
Allowance for doubtful accounts	$	5,768	$	14,882	$	(431)	$	—	$	20,219
Warranty and return reserve - accounts receivable	$	6,752	$	83	$	(458)	$	—	$	6,377
Warranty and return reserve - inventory	$	(2,538)	$	(217)	$	(722)	$	—	$	(3,477)
Deferred tax asset valuation allowance	$	5,436	$	—	$	(1,584)	$	(175)	$	3,677

For the year ended December 31, 2020:
Allowance for doubtful accounts	$	20,219	$	7,137	$	(5,866)	$	—	$	21,490
Warranty and return reserve - accounts receivable	$	6,377	$	(3,609)	$	(61)	$	—	$	2,707
Warranty and return reserve - inventory	$	(3,477)	$	2,033	$	(169)	$	—	$	(1,613)
Deferred tax asset valuation allowance	$	3,677	$	—	$	214	$	—	$	3,891

For the year ended December 31, 2021:
Allowance for doubtful accounts	$	21,490	$	345	$	(14,797)	$	—	$	7,038
Warranty and return reserve - accounts receivable	$	2,707	$	568	$	(790)	$	—	$	2,485
Warranty and return reserve - inventory	$	(1,613)	$	263	$	(533)	$	—	$	(1,883)
Deferred tax asset valuation allowance	$	3,891	$	—	$	(957)	$	—	$	2,934

General and Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2021

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]

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.

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 customers			3 - 10 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

Investments in Available-for-sale Securities

Income Tax, Policy [Policy Text Block]

Income Taxes

Foreign Currency Transactions and Translations Policy [Policy Text Block]

Foreign Currency

Revenue [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

Advertising Cost [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 ShareNet 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. Restricted stock units that are anti-dilutive are not included in the treasury stock method.

Equity Method Investments

We apply the equity method of accounting for investments when we determine we have a significant influence, but not a controlling interest in the investee. We determine whether we have significant influence by considering key factors such as ownership interest, representation on the board of directors, participation in policy making decisions, business relationship and material intra-entity transactions, among other factors. Our equity method investment is reported at cost and adjusted each period for our share of the investee's income or (loss) and dividend paid, if any. We eliminate any intra-entity profits to the extent of our beneficial interest. We record our share of the investee's income or (loss) on a one quarter lag. We report our proportionate share of the investee's income or (loss) resulting from this investment in other income, net in our consolidated statements of operations. The carrying value of our equity method investment is reported in other assets on the consolidated balance sheets. We assess our equity method investments for impairment on an annual basis or whenever events or circumstances indicate that the carrying value of the investment may not be recoverable.

General and Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Schedule of Inventory, Current [Table Text Block]

Inventories consist of the following (in thousands):


	As of December 31,
	2021		2020
Raw materials	$	135,528	$	126,499
Work in process	36,490		33,053
Finished goods	118,217		155,376
Total	$	290,235	$	314,928

Property, Plant and Equipment [Table Text Block]

Property, plant and equipment consists of the following (in thousands):


	As of December 31,
	2021		2020
Machinery and equipment	$	321,078	$	291,331
Land, building and building improvements	243,377		241,199
Molds	60,463		60,381
Computer equipment and software	102,979		98,311
Furniture and fixtures	7,670		7,767
Instruments placed with customers(1)	97,384		90,383
Construction in progress	72,153		53,724
Total property, plant and equipment, cost	905,104		843,096
Accumulated depreciation	(436,739)		(376,468)
Property, plant and equipment, net	$	468,365	$	466,628

_______________________________

(1) Instruments placed with customers consist of drug-delivery and monitoring systems placed with customers 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 customers			3 - 10 years

Schedule of Goodwill

The following table presents the changes in the carrying amount of our goodwill for 2021, 2020 and 2019 (in thousands):


	Total
Balance as of January 1, 2019	$	11,195
Goodwill acquired(1)	20,026
Other	24
Balance as of December 31, 2019	$	31,245

Other(2)	1,756
Balance as of December 31, 2020	33,001
Goodwill(3)	10,626
Currency translation	(188)
Balance as of December 31, 2021	$	43,439

_______________________________

(1) In 2019, we acquired Pursuit Vascular, Inc. ("Pursuit"), which resulted in $19.1 million of goodwill. We also acquired a small foreign distributor, which resulted in $0.9 million of goodwill.

(2) In 2020, "Other" relates to a $1.3 million measurement period adjustment to deferred taxes related to the Pursuit acquisition and foreign currency translation.

(3) In 2021, we acquired a small foreign infusion systems supplier, which resulted in $10.6 million of goodwill.

Schedule of Indefinite-Lived 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, 2021
		Cost		Accumulated Amortization		Net
Patents	10	$	27,429	$	16,764	$	10,665
Customer contracts	12	10,412		6,196		4,216
Non-contractual customer relationships	9	57,316		33,004		24,312
Trademarks	4	425		425		—
Trade name	15	18,260		4,731		13,529
Developed technology	13	152,893		49,406		103,487
Non-compete	3	9,100		2,356		6,744
Total amortized intangible assets		$	275,835	$	112,882	$	162,953

Internally developed software*		$	25,358			$	25,358

Total intangible assets		$	301,193	$	112,882	$	188,311

_______________________________

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


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

Internally developed software*		$	19,363			$	19,363

Total intangible assets		$	286,674	$	89,443	$	197,231

_______________________________

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

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

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


2022	$	25,668
2023	24,191
2024	23,551
2025	16,057
2026	15,324
Thereafter	58,162
Total	$	162,953

Debt Securities, Available-for-sale

Our short-term and long-term investments in available-for-sale securities consist of the following (in thousands):


	As of December 31, 2021
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	14,420	$	—	$	14,420
Long-term corporate bonds	4,620		—		4,620
Total investment securities	$	19,040	$	—	$	19,040

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

Equity Method Investments

Our non-marketable equity method investment consists of the following (in thousands):


	As of December 31,
	2021		2020
Equity method investment	$	3,238	$	—

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,
	2021		2020		2019
Net income	$	103,135	$	86,870	$	101,035
Weighted-average number of common shares outstanding (basic)	21,206		20,907		20,629
Dilutive securities	575		684		916
Weighted-average common and common equivalent shares outstanding (diluted)	21,781		21,591		21,545
EPS — basic	$	4.86	$	4.16	$	4.90
EPS — diluted	$	4.74	$	4.02	$	4.69

Acquisitions Pursuit Vascular (Tables)

12 Months Ended

Dec. 31, 2021

Pursuit Vascular, Inc. [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):


Cash consideration for acquired assets, net	$	71,533
Fair value of contingent consideration	17,300
Total Consideration	$	88,833

Final Purchase Price Allocation:
Trade receivables	$	973
Inventories	2,464
Prepaid expenses and other current assets	74
Property, plant and equipment	609
Intangible assets(1)	82,300
Accounts payable	(215)
Accrued liabilities	(2,065)
Total identifiable net assets acquired	$	84,140
Goodwill - not tax deductible	20,462
Deferred tax liability	(15,769)
Purchase Consideration	$	88,833

_______________________________________________

Restructuring, Strategic Transaction and Integration Schedule of Restructuring and Related Costs (Tables)

12 Months Ended

Dec. 31, 2021

Restructuring and Related Activities [Abstract]

Restructuring and Related Costs [Table Text Block]

The following table summarizes the activity in our restructuring-related accrual by major type of cost (in thousands):


	Severance Pay and Benefits		Employment Agreement Buyout		Retention and Facility Closure Costs		Total
Accrued balance, January 1, 2020	$	3,878	$	460	$	1,211	$	5,549
Charges incurred	4,288		—		3,641		7,929
Payments	(6,331)		(460)		(3,570)		(10,361)
Currency translation	23		—		281		304
Accrued balance, December 31, 2020	$	1,858	$	—	$	1,563	$	3,421
Charges incurred	140		—		—		140
Payments	(969)		—		—		(969)
Currency translation	(2)		—		31		29
Other adjustments(1)	(528)		—		(1,429)		(1,957)
Accrued balance, December 31, 2021	$	499	$	—	$	165	$	664

_______________________________________________

(1) The estimated liabilities related to a prior year's facility closure restructuring were adjusted to actual amounts owed.

Revenue (Tables)

12 Months Ended

Dec. 31, 2021

Revenue from Contract with Customer [Abstract]

Disaggregation of Revenue [Table Text Block]

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


	Year ended December 31,
	2021				2020				2019
Product line	Revenue		% of Revenue		Revenue		% of Revenue		Revenue		% of Revenue
Infusion Consumables	$	555,189	42	%	$	473,740	37	%	$	477,611	37	%
Infusion Systems	352,321		27	%	359,691		28	%	328,282		26	%
IV Solutions	359,477		27	%	388,971		31	%	414,971		33	%
Critical Care	49,321		4	%	48,602		4	%	45,344		4	%

Total Revenues	$	1,316,308	100	%	$	1,271,004	100	%	$	1,266,208	100	%

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):


	Year ended December 31,
Geography	2021		2020		2019
Europe, the Middle East and Africa	$	147,488	$	132,763	$	130,530
Other Foreign	227,011		227,614		212,336
Total Foreign	374,499		360,377		342,866
United States	941,809		910,627		923,342
Total Revenues	$	1,316,308	$	1,271,004	$	1,266,208

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


	Contract Liabilities
Beginning balance, January 1, 2020	$	(4,855)
Equipment revenue recognized	14,408
Equipment revenue deferred due to implementation	(14,341)
Software revenue recognized	5,721
Software revenue deferred due to implementation	(7,363)
Ending balance, December 31, 2020	$	(6,430)
Equipment revenue recognized	10,048
Equipment revenue deferred due to implementation	(13,725)
Software revenue recognized	7,261
Software revenue deferred due to implementation	(4,615)
Ending balance, December 31, 2021	$	(7,461)

Leases (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Lease, Cost

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


	Year ended December 31,
	2021		2020
Operating lease cost	$	11,251	$	11,284
Finance lease cost — interest	122		91
Finance lease cost — reduction of ROU asset	648		383
Short-term lease cost	14		263
Total lease cost	$	12,035	$	12,021

Supplemental Cash Flow Information Leases

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


	Year ended December 31,
	2021		2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	11,256	$	10,185
Operating cash flows from finance leases	$	122	$	91

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	2,589	$	20,847
Finance leases	$	558	$	3,062

Supplemental Balance Sheet Information Leases

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


	As of December 31,
	2021			2020
Operating leases
Operating lease right-of-use assets	$	39,847		$	46,571

Accrued liabilities	$	9,009		$	8,740
Other long-term liabilities	33,971			41,019
Total operating lease liabilities	$	42,980		$	49,759

Weighted-Average Remaining Lease Term
Operating leases	5.9 years			6.7 years

Weighted-Average Discount Rate
Operating leases	4.98		%	5.02		%

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


	As of December 31,
	2021			2020
Finance leases
Finance lease right-of-use assets	$	2,673		$	2,915

Accrued liabilities	$	643		$	554
Other long-term liabilities	2,067			2,388
Total finance lease liabilities	$	2,710		$	2,942

Weighted-Average Remaining Lease Term
Finance leases	5.6 years			6.4 years

Weighted-Average Discount Rate
Finance leases	4.28		%	4.27		%

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

As of December 31, 2021, the maturities of our operating and finance lease liabilities for each of the next five years are approximately (in thousands):


	Operating Leases		Finance Leases
2022	$	10,887	$	749
2023	9,453		749
2024	8,488		458
2025	5,129		267
2026	4,842		214
Thereafter	10,577		615
Total Lease Payments	49,376		3,052
Less imputed interest	(6,396)		(342)
Total	$	42,980	$	2,710

Share Based Award (Tables)

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [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)	2021		2020		2019
Stock compensation expense	$	27,341	$	23,954	$	21,918
Tax benefit from stock-based compensation cost	$	6,391	$	5,564	$	4,840
Indirect tax benefit	$	285	$	1,203	$	680

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,
	2021			2020			2019
Number of time-based options granted	7,910			7,190			6,265
Grant-date fair value of options granted (in thousands)	$	528		$	425		$	424
Weighted-average assumptions for stock option valuation:
Expected term (years)	5.5			5.5			5.5
Expected stock price volatility	35.0		%	35.0		%	28.0		%
Risk-free interest rate	0.9		%	0.4		%	2.2		%
Expected dividend yield	—		%	—		%	—		%
Weighted-average grant-price per option	$	200.07		$	181.99		$	225.27
Weighted-average grant-date fair value per option	$	66.78		$	59.09		$	67.73

Share-based Payment Arrangement, Option, Activity [Table Text Block]

A summary of our stock option activity as of and for the year ended December 31, 2021 is as follows:


	Shares	Weighted-Average Exercise Price Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding at December 31, 2020	817,800	$	70.13
Granted	7,910	$	200.07
Exercised	(162,612)	$	57.64
Forfeited or expired	—	$	—
Outstanding at December 31, 2021	663,098	$	74.75	2.6	$	108,003
Exercisable at December 31, 2021	656,483	$	73.48	2.5	$	107,761
Vested and expected to vest, December 31, 2021	663,098	$	74.75	2.6	$	108,003

Exercised Options Data [Table Text Block]

The following table presents information regarding stock option activity:


	Year ended December 31,
(In thousands)	2021		2020		2019
Intrinsic value of options exercised	$	27,534	$	32,915	$	22,976
Cash received from exercise of stock options	$	9,372	$	13,193	$	7,732
Tax benefit from stock option exercises	$	5,092	$	5,179	$	9,653

Share-based Payment Arrangement, Restricted Stock Unit, 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)	2021		2020		2019
PRSU
Shares granted	53,246		38,633		37,657
Shares earned (a)	32,013		80,654		114,032
Grant-date fair value per share	$	198.16	$	188.34	$	231.63
Grant-date fair value	$	10,551	$	7,276	$	8,723
Intrinsic value vested	$	6,777	$	15,627	$	26,445

RSU
Shares granted	84,388		87,830		61,856
Grant-date fair value per share	$	199.13	$	188.13	$	227.42
Grant-date fair value	$	16,804	$	16,523	$	14,067
Intrinsic value vested	$	13,681	$	12,314	$	16,753

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, 2021:


	Number of Units	Grant-Date Fair Value Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Non-vested at December 31, 2020	220,760	$	209.77
Change in units due to performance expectations (a)	24,601	$	209.64
Granted	137,634	$	198.75
Vested	(99,363)	$	219.77
Forfeited	(7,871)	$	196.01
Non-vested and expected to vest at December 31, 2021	275,761	$	201.05	1.0	$	65,449

Derivatives and Hedging Activities (Tables)

12 Months Ended

Dec. 31, 2021

Derivative Instruments and Hedging Activities Disclosure [Abstract]

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

The following table presents the fair values of our derivative instruments included within the consolidated balance sheets (in thousands):


	Derivatives Designated as Cash Flow Hedging Instruments
Consolidated Balance Sheet Location	Foreign Exchange Forward Contracts		Forward-Starting Interest Rate Swaps		Gross Derivatives

(In thousands)
As of December 31, 2021
Prepaid expenses and other current assets	$	1,061	$	—	$	1,061
Other assets	—		—		—
Total assets	$	1,061	$	—	$	1,061

Accrued liabilities	$	—	$	—	$	—
Other long-term liabilities	—		1,480		1,480
Total liabilities	$	—	$	1,480	$	1,480

As of December 31, 2020
Prepaid expenses and other current assets	$	3,555	$	—	$	3,555
Other assets	—		—		—
Total assets	$	3,555	$	—	$	3,555

Accrued liabilities	$	—	$	—	$	—
Other long-term liabilities	—		—		—
Total liabilities	$	—	$	—	$	—

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


	Location of Gain in the Consolidated Statements of Operations	Year Ended December 31,
		2021		2020		2019
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	Cost of goods sold	$	3,444	$	790	$	916
Forward-starting interest rate swaps	Interest expense	$	—	$	—	$	—

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

We recognized the following gains (losses) on our derivative instruments designated as cash flow hedges (in thousands):


	Amount of Gain (Loss) Recognized in Other Comprehensive Income						Amount of Gain Reclassified From Accumulated Other Comprehensive Income into Income
	Year Ended December 31,							Year Ended December 31,
	2021		2020		2019		Location of Gain Reclassified From Accumulated Other Comprehensive Income into Income	2021		2020		2019
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	$	950	$	1,980	$	2,550	Cost of goods sold	$	3,444	$	790	$	916
Forward-starting interest rate swaps	(1,480)		—		—		Interest expense	—		—		—
Total derivatives designated as cash flow hedging instruments	$	(530)	$	1,980	$	2,550		$	3,444	$	790	$	916

Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2021

Fair Value Measurement Inputs and Valuation Techniques [Line Items]

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, 2019	$	47,400
Acquisition date fair value estimate of earn-out(1)	17,300
Change in fair value of contingent earn-out (included in income from operations as a separate line item)(2)	(47,400)
Contingent earn-out liability, December 31, 2019	$	17,300

Change in fair value of contingent earn-out (included in income from operations as a separate line item)(3)	9,000
Contingent earn-out liability, December 31, 2020	$	26,300
Contingent earn-out — non-compete arrangement	2,589

Transfer of Pursuit earn-out liability into Level 2(4)	(26,300)
Contingent earn-out liability, December 31, 2021	$	2,589

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 as of December 31, 2021
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available-for-sale debt securities:
Short-term	$	14,420	$	—	$	14,420	$	—
Long-term	4,620		—		4,620		—
Foreign exchange forwards:
Prepaid expenses and other current assets	1,061		—		1,061		—


Total Assets	$	20,101	$	—	$	20,101	$	—

Liabilities:
Contingent earn-out liability - LT	$	2,589	$	—	$	—	$	2,589



Forward-starting interest rate swaps:
Other long-term liabilities	1,480		—		1,480		—
Total Liabilities	$	4,069	$	—	$	1,480	$	2,589


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

Total Assets	$	31,216	$	—	$	31,216	$	—

Liabilities:
Earn-out liability	$	26,300	$	—	$	—	$	26,300



Total Liabilities	$	26,300	$	—	$	—	$	26,300

Hospira [Member]

Fair Value Measurement Inputs and Valuation Techniques [Line Items]

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

The following table provides quantitative information about Level 3 inputs for fair value measurement of the Pursuit earn-out liability as of the acquisition date to December 31, 2020:

Pursuit Vascular, Inc. [Member]

Fair Value Measurement Inputs and Valuation Techniques [Line Items]

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

Pursuit Earn-out


	As of December 31, 2020		At Acquisition November 2, 2019
Simulation Input
Revenue/Gross Profit Volatility	25.00	%	20.00	%
Discount Rate	12.50	%	15.00	%
Risk-free rate	0.09	%	1.55	%
Counter Party Risk	3.10	%	6.00	%

Prepaids and Other Current Assets (Tables)

12 Months Ended

Dec. 31, 2021

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):


	As of December 31,
	2021		2020
Other prepaid expenses and receivables	$	14,763	$	14,964
Deferred costs	12,746		6,402
Prepaid insurance and property taxes	6,310		6,178
VAT/GST receivable	4,156		3,676
Deferred tax charge	4,241		3,542
Foreign exchange forward contract	1,061		3,555
Deposits	1,343		1,353
Other	2,227		1,822
	$	46,847	$	41,492

Other assets consist of the following (in thousands):


	As of December 31,
	2021		2020
Pump lease receivables	$	25,941	$	28,948
Spare parts	28,538		22,725
Equity method investments	3,238		—

Deferred debt issuance costs	2,827		—
Finance lease right-of-use assets	2,673		2,915
Other	526		887
	$	63,743	$	55,475

Accrued Liabilities an Other Long-term Liabilities (Tables)

12 Months Ended

Dec. 31, 2021

Accrued Liabilities [Abstract]

Schedule of Accrued Liabilities [Table Text Block]

Accrued liabilities consist of the following (in thousands):


	As of December 31,
	2021		2020
Salaries and benefits	$	27,304	$	25,786
Incentive compensation	33,107		27,023

Operating lease liability-ST	9,009		8,740
Accrued professional fees	773		1,273



Legal accrual	3,897		900
Accrued sales taxes	1,980		2,146
Warranties and returns	532		1,027
Deferred revenue	12,646		5,566

Accrued other taxes	4,337		3,540
Distribution fees	5,645		5,300
Accrued freight	9,194		6,784
Restructuring accrual	664		3,421





Other	9,107		5,515
	$	118,195	$	97,021

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


	As of December 31,
	2021		2020
Operating lease liability-LT	$	33,971	$	41,019
Finance lease liability-LT	2,067		2,388
Contract liabilities(1)	202		337

Forward-starting interest rate swaps	1,480		—
Benefits	1,369		1,183

Accrued rent	1,262		1,462

Other	1,479		1,446
	$	41,830	$	47,835

_______________________________

(1) Consists of contracts with customers and suppliers that were valued at below market at the time of the HIS acquisition.

Long-Term Obligations (Tables)

12 Months Ended

Dec. 31, 2021

Long-Term Debt 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, 2021

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,
	2021		2020		2019
United States	$	81,484	$	41,194	$	32,849
Foreign	41,702		56,300		81,858
	$	123,186	$	97,494	$	114,707

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

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


	Year Ended December 31,
	2021		2020		2019
Current:
Federal	$	20,646	$	6,032	$	6,851
State	3,444		2,422		2,532
Foreign	7,236		7,290		7,994
	$	31,326	$	15,744	$	17,377
Deferred:
Federal	$	(8,154)	$	(5,319)	$	(6,720)
State	(1,815)		(1,850)		(325)
Foreign	(1,306)		2,049		3,340
	(11,275)		(5,120)		(3,705)
	$	20,051	$	10,624	$	13,672

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,
	2021				2020				2019
	Amount		Percent		Amount		Percent		Amount		Percent
Federal tax at the expected statutory rate	$	25,869	21.0	%	$	20,474	21.0	%	$	24,088	21.0	%
State income tax, net of federal effect	2,907		2.4	%	2,099		2.2	%	1,269		1.1	%
Tax credits	(2,443)		(2.0)	%	(3,269)		(3.4)	%	(2,896)		(2.5)	%

Global intangible low-taxed income	711		0.6	%	163		0.2	%	6,634		5.8	%
Foreign income tax differential	(2,983)		(2.4)	%	(3,888)		(4.0)	%	(5,939)		(5.2)	%
Stock-based compensation	(4,263)		(3.5)	%	(4,686)		(4.8)	%	(8,446)		(7.4)	%
Foreign-derived intangible income	(3,775)		(3.1)	%	(2,718)		(2.8)	%	(516)		(0.5)	%
IP installment sale and repatriation	—		—	%	—		—	%	(2,118)		(1.8)	%
Contingent consideration	(29)		—	%	1,566		1.6	%	—		—	%
Section 162(m)	1,812		1.5	%	1,079		1.1	%	203		0.2	%
Other	2,245		1.8	%	(196)		(0.2)	%	1,393		1.2	%
	$	20,051	16.3	%	$	10,624	10.9	%	$	13,672	11.9	%

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

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


	As of December 31,
	2021		2020
Deferred tax asset:


Accruals/other	$	6,866	$	4,406



Acquired future tax deductions	5,440		7,781
Stock-based compensation	7,283		7,138
Foreign currency translation adjustments	3,360		2,406
Tax credits	11,953		12,444

Inventory reserves	8,199		8,493
Allowance for doubtful accounts	926		4,460
Accrued restructuring	131		1,293
Chargebacks, discounts, customer concessions	27,970		22,874
Valuation allowance	(2,934)		(3,891)
	$	69,194	$	67,404
Deferred tax liability:
State income taxes	$	2,724	$	2,398
Foreign	—		776

Depreciation and amortization	20,483		25,113
Section 481(a) adjustment - change in accounting method	4,873		9,746



	$	28,080	$	38,033

Deferred tax asset, net	$	41,114	$	29,371

Summary of Income Tax Contingencies [Table Text Block]

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


	Year Ended December 31,
	2021		2020		2019
Beginning balance	$	18,443	$	15,027	$	10,824
Increases to prior year tax positions	231		502		138

Increases to current year tax positions	3,242		2,987		4,231

Decreases to prior year tax positions	—		(15)		(3)

Decrease related to lapse of statute of limitations	(31)		(58)		(163)
Decrease related to settlements with tax authorities	(348)		—		—
Ending balance	$	21,537	$	18,443	$	15,027

Geographic Information and Significant Customers Geographic Information (Tables)

12 Months Ended

Dec. 31, 2021

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,
	2021		2020
Costa Rica	$	115,187	$	104,015
Mexico	79,567		76,004
Other LATAM	36,907		37,485
Canada	4,716		4,672
Italy	12,435		11,098



Spain	13,295		8,701
Other Europe	4,171		3,795
APAC	20,452		19,836
Total Foreign	$	286,730	$	265,606
United States	618,374		577,490
Worldwide Total	$	905,104	$	843,096

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2021

Stockholders' Equity Note [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 (Losses) on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2019	$	(17,682)	$	638	$	99	$	(16,945)
Other comprehensive income (loss) before reclassifications	372		1,938		(71)		2,239
Amounts reclassified from AOCI	—		(696)		—		(696)
Other comprehensive income (loss)	372		1,242		(71)		1,543
Balance as of December 31, 2019	$	(17,310)	$	1,880	$	28	$	(15,402)
Other comprehensive income before reclassifications	12,929		1,505		47		14,481
Amounts reclassified from AOCI	—		(601)		—		(601)
Other comprehensive income	12,929		904		47		13,880
Balance as of December 31, 2020	$	(4,381)	$	2,784	$	75	$	(1,522)
Other comprehensive loss before reclassifications	(14,664)		(403)		(62)		(15,129)
Amounts reclassified from AOCI	—		(2,618)		—		(2,618)
Other comprehensive loss	(14,664)		(3,021)		(62)		(17,747)
Balance as of December 31, 2021	$	(19,045)	$	(237)	$	13	$	(19,269)

Subsequent Events (Tables)

12 Months Ended

Dec. 31, 2021

Subsequent Events [Abstract]

Schedule of Subsequent Events


Leverage Ratio	Applicable Margin for RFR Loans	Applicable Margin for Base Rate Loans	Commitment Fee Rate
>4.00 to 1.0	2.25%	1.25%	0.35%
<4.00 to 1.0 but >3.00 to 1.0	2.00%	1.00%	0.30%
<3.00 to 1.0 but >2.50 to 1.0	1.75%	0.75%	0.25%
<2.50 to 1.0 but >2.00 to 1.0	1.50%	0.50%	0.20%
<2.00 to 1.0	1.25%	0.25%	0.15%


Leverage Ratio	Applicable Margin for Eurocurrency Rate Loans	Applicable Margin for Base Rate Loans
>2.75 to 1.0	2.50%	1.50%
<2.75 to 1.0	2.25%	1.25%

General and Summary of Significant Accounting Policies Basis of Presentation (Details)	12 Months Ended
	Dec. 31, 2021 segment
Accounting Policies [Abstract]
Number of Operating Segments	1

General and Summary of Significant Accounting Policies Inventory (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Raw Materials	$ 135,528	$ 126,499
Work in Process	36,490	33,053
Finished Goods	118,217	155,376
Total	$ 290,235	$ 314,928

General and Summary of Significant Accounting Policies Property and Equipment #1 (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 905,104	$ 843,096
Accumulated Depreciation	436,739	376,468
Net property and equipment	468,365	466,628
Machinery and Equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	321,078	291,331
Land, Buildings and Improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	243,377	241,199
Molds [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	60,463	60,381
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	102,979	98,311
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	7,670	7,767
Instruments Placed with Customers [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	97,384	90,383
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 72,153	$ 53,724

General and Summary of Significant Accounting Policies Property and Equipment #2 (Details)	12 Months Ended
	Dec. 31, 2021
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	10

General and Summary of Significant Accounting Policies Property and Equipment #3 (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Depreciation	$ 65.9	$ 62.4	$ 59.3

General and Summary of Significant Accounting Policies Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Goodwill [Roll Forward]
GOODWILL	$ 33,001	$ 31,245	$ 11,195
Goodwill, Acquired During Period	10,626		20,026
Goodwill, Purchase Accounting Adjustments			24
Goodwill, Foreign Currency Translation Gain (Loss)	(188)	1,756
GOODWILL	43,439	33,001	31,245
Pursuit Vascular LLC
Goodwill [Roll Forward]
Goodwill, Acquired During Period			19,100
Goodwill, Purchase Accounting Adjustments		$ 1,300
Foreign Distibutor [Member]
Goodwill [Roll Forward]
Goodwill, Acquired During Period			$ 900
Foreign Infusion System Supplier
Goodwill [Roll Forward]
Goodwill, Acquired During Period	$ 10,600

General and Summary of Significant Accounting Policies Intangible Assets #1 (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Cost	$ 275,835	$ 267,311
Accumulated Amortization	112,882	89,443
Finite-Lived Intangible Assets, Net	162,953	177,868
Intangible Assets, Gross (Excluding Goodwill)	301,193	286,674
INTANGIBLE ASSETS, net	$ 188,311	$ 197,231
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	10 years	10 years
Cost	$ 27,429	$ 24,797
Accumulated Amortization	16,764	15,056
Finite-Lived Intangible Assets, Net	$ 10,665	$ 9,741
Customer Contracts [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	12 years	12 years
Cost	$ 10,412	$ 10,365
Accumulated Amortization	6,196	5,852
Finite-Lived Intangible Assets, Net	$ 4,216	$ 4,513
Customer-Related Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	9 years	9 years
Cost	$ 57,316	$ 58,061
Accumulated Amortization	33,004	26,711
Finite-Lived Intangible Assets, Net	$ 24,312	$ 31,350
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	$ 18,260	$ 18,270
Accumulated Amortization	4,731	3,500
Finite-Lived Intangible Assets, Net	$ 13,529	$ 14,770
Developed Technology Rights [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	13 years	13 years
Cost	$ 152,893	$ 152,893
Accumulated Amortization	49,406	36,927
Finite-Lived Intangible Assets, Net	$ 103,487	$ 115,966
Noncompete Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	3 years	3 years
Cost	$ 9,100	$ 2,500
Accumulated Amortization	2,356	972
Finite-Lived Intangible Assets, Net	6,744	1,528
In Process Research and Development [Member]
Finite-Lived Intangible Assets [Line Items]
Cost	$ 25,358	$ 19,363

General and Summary of Significant Accounting Policies Intangible Assets #2 (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Amortization of Intangible Assets	$ 23.8	$ 23.2	$ 17.7

General and Summary of Significant Accounting Policies Future Estimated Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Acquired Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Amortization Expense, Next Twelve Months	$ 25,668
Finite-Lived Intangible Assets, Amortization Expense, Year Two	24,191
Finite-Lived Intangible Assets, Amortization Expense, Year Three	23,551
Finite-Lived Intangible Assets, Amortization Expense, Year Four	16,057
Finite-Lived Intangible Assets, Amortization Expense, Year Five	15,324
Finite-Lived Intangible Assets, Amortization Expense, after Year Five	58,162
Finite-Lived Intangible Assets, Net	$ 162,953	$ 177,868

General and Summary of Significant Accounting Policies Investments (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Debt Securities, Available-for-sale [Line Items]
Investment Securities, Amortized Cost	$ 19,040	$ 27,661
Other Comprehensive Income (Loss), Securities, Available-for-sale, Adjustment, before Tax	0	0
Investment Securities	19,040	27,661
Short-term Investments [Member]
Debt Securities, Available-for-sale [Line Items]
Investment Securities, Amortized Cost	14,420	14,687
Other Comprehensive Income (Loss), Securities, Available-for-sale, Adjustment, before Tax	0	0
Investment Securities	14,420	14,687
Long-term Investments [Domain]
Debt Securities, Available-for-sale [Line Items]
Investment Securities, Amortized Cost	4,620	12,974
Other Comprehensive Income (Loss), Securities, Available-for-sale, Adjustment, before Tax	0	0
Investment Securities	$ 4,620	$ 12,974

General and Summary of Significant Accounting Policies Investments-Equity Method (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Equity Method Investment, Ownership Percentage	20.00%
Payments to Acquire Equity Method Investments	$ 3,250	$ 0	$ 0
Equity Method Investment, Aggregate Cost	$ 3,300

General and Summary of Significant Accounting Policies Foreign Currency (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Foreign Currency [Abstract]
Foreign Currency Transaction Gain (Loss), Realized	$ 1.0	$ 7.2	$ (0.7)

General and Summary of Significant Accounting Policies Advertising Expenses (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Advertising Expense	$ 0.2	$ 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, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Pension and Other Postretirement Benefits Cost (Reversal of Cost)	$ 11.0	$ 10.7	$ 11.4

General and Summary of Significant Accounting Policies Net Income Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
NET INCOME PER SHARE
Net Income	$ 103,135	$ 86,870	$ 101,035
Weighted average number of common shares outstanding (basic)	21,206,000	20,907,000	20,629,000
Weighted Average Number Diluted Shares Outstanding Adjustment	575,000	684,000	916,000
Weighted Average common and common equivalent shares outstandding (diluted)	21,781,000	21,591,000	21,545,000
Basic	$ 4.86	$ 4.16	$ 4.90
Diluted	$ 4.74	$ 4.02	$ 4.69
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	12,354	12,083	10,760

- Definition

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

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- Definition

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

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

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General and Summary of Significant Accounting Policies New Accounting Pronouncements (Details)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Accounting Standards Update and Change in Accounting Principle	Recently Issued Accounting Standards In March 2020, the Financial Accounting Standards Board ("FASB") issued ASU No. 2020-04, Reference Rate Reform (Topic 848) - Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The amendments in this update provide optional guidance for a limited period of time to ease the potential burden for reference rate reform on financial reporting. Due to concerns about structural risks of interbank offered rates and, particularly, the risk of cessation of the London Interbank Offered Rate ("LIBOR"), regulators around the world have undertaken reference rate reform initiatives to identify alternative reference rates that are more observable or transaction based and less susceptible to manipulation. The amendments in this update apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued as a result of reference rate reform. Optional expedients may be applied to contracts that are modified as a result of the reference rate reform. Modifications of contracts within the scope of Topic 470, Debt, should be accounted for by prospectively adjusting the effective interest rate. Modifications of contracts within the scope of ASC 842, Leases, should be accounted for as a continuation of the existing contracts with no reassessments of the lease classification and the discount rate (incremental borrowing rate). Exceptions to Topic 815, Derivatives and Hedging, results in not having a dedesignation of a hedging relationship if certain criteria are met. The amendments in this ASU are effective for all entities as of March 12, 2020 through December 31, 2022. In November 2021, we entered into two forward-starting swaps whereby the variable leg of the swap references LIBOR, these swaps will be amended in early 2022 to transition to an alternative reference rate (see Note 7: Derivatives and Hedging Activities). The amendments in this ASU allow for certain expedients that will allow us to assume that our hedged interest payments are probable of occurring regardless of any expected modification in their terms related to reference rate reform and will allow us to continue hedge accounting for a cash flow hedge for which the hedged interest rate risk changes if the hedge is highly effective under ASC 815, Derivatives and Hedging or the optional expedient under this ASU is elected. The impact of this ASU on our contracts has not been and is not expected to be material.

- Definition

The entire disclosure for change in accounting principle. Includes, but is not limited to, nature, reason, and method of adopting amendment to accounting standards or other change in accounting principle.

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Reference 34: http://www.xbrl.org/2003/role/disclosureRef
-Topic 848
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Publisher FASB
-Subparagraph (c)

+ Details

Acquisitions Text (Details) - USD ($) $ in Thousands	12 Months Ended
Acquisitions Text (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Contingent Earn-out Liability	$ 2,589	$ 26,300	$ 17,300	$ 47,400
Pursuit Vascular, Inc. [Member]
Business Acquisition [Line Items]
Business Acquisition, Percentage of Voting Interests Acquired	100.00%
Payments to Acquire Businesses, Gross	$ 75,000
contingent consideration gross	50,000
Foreign Distibutor [Member]
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross		$ 4,600
contingent consideration gross	6,000
Contingent Earn-out Liability	2,600
Pursuit Vascular LLC
Business Acquisition [Line Items]
Contingent Earn-out Liability	$ 26,300

Acquisitions Pursuit Vascular Table (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Contingent earn-out liability, Noncurrent	$ 2,589	$ 0
Pursuit Vascular, Inc. [Member]
Business Acquisition [Line Items]
Payment to acquire business, net of working capital adjustments	71,533
Contingent earn-out liability, Noncurrent	17,300
Business Combination, Consideration Transferred	88,833
Business Combination, Acquired Receivable, Fair Value	973
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Inventory	2,464
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense and Other Assets	74
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Property, Plant, and Equipment	609
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	82,300
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accounts Payable	(215)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Other	(2,065)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net	84,140
Business Acquisition, Goodwill, Expected Tax Deductible Amount	20,462
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Deferred Tax Liabilities Noncurrent	$ (15,769)

Acquisitions Pursuit Vascular Intangible (Details) - Pursuit Vascular, Inc. [Member] $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($)
Acquired Finite-Lived Intangible Assets [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 82,300
Developed Technology Rights [Member]
Acquired Finite-Lived Intangible Assets [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 69,000
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	15 years
Trade Names [Member]
Acquired Finite-Lived Intangible Assets [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 10,800
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	15 years
Noncompete Agreements [Member]
Acquired Finite-Lived Intangible Assets [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 2,500
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	3 years

Acquisitions Foreign Infusion Systems Supplier (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($)
Business Acquisition [Line Items]
Short-term contingent consideration-gross	$ 1,000
Long-term contingent consideration-gross	1,500
Foreign Infusion System Supplier
Business Combination and Asset Acquisition [Abstract]
contingent consideration gross	2,500
Business Acquisition [Line Items]
contingent consideration gross	2,500
Payments to Acquire Businesses, Gross	15,400
business combination consideration - cash holdback	$ 500

Restructuring, Strategic Transaction and Integration (Details 1) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Restructuring and Related Activities [Abstract]
Restructuring, strategic transaction and integration expenses	$ 18,037	$ 28,409	$ 80,574
Restructuring Charges	(1,800)	$ 7,900	$ 8,400
Restructuring Reserve, Accrual Adjustment	1,957
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve, Accrual Adjustment	1,957
Restructuring Adjustments - Severance and Facility	2,000
Facility Closing [Member]
Restructuring and Related Activities [Abstract]
Restructuring Reserve, Accrual Adjustment	1,429
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve, Accrual Adjustment	$ 1,429

Restructuring, Strategic Transaction and Integration (Details 2) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	$ 664,000	$ 3,421,000	$ 5,549,000
Restructuring Costs	140,000	7,929,000
Payments for Restructuring	(969,000)	(10,361,000)
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	(29,000)	(304,000)
Restructuring Reserve, Accrual Adjustment	(1,957,000)
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	499,000	1,858,000	3,878,000
Restructuring Costs	140,000	4,288,000
Payments for Restructuring	(969,000)	(6,331,000)
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	2,000	(23,000)
Restructuring Reserve, Accrual Adjustment	(528,000)
Special Termination Benefits [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	0	0	460,000
Restructuring Costs	0	0
Payments for Restructuring	0	(460,000)
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	0	0
Restructuring Reserve, Accrual Adjustment	0
Facility Closing [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	165,000	1,563,000	$ 1,211,000
Restructuring Costs	0	3,641,000
Payments for Restructuring	0	(3,570,000)
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	(31,000)	$ (281,000)
Restructuring Reserve, Accrual Adjustment	$ (1,429,000)

Restructuring, Strategic Transaction and Integration Strategic Transaction and Integration Expenses (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Restructuring and Related Activities [Abstract]
Strategic Transaction and Integration	$ 19.8	$ 20.5	$ 72.2
Supplychainrestructuringcosts			22.1
Cleanupcosts			$ 12.7

Revenue Disaggregation of Revenue - Product Line (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Revenues	$ 1,316,308	$ 1,271,004	$ 1,266,208
Percentage of revenue	100.00%	100.00%	100.00%
Infusion Consumables [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 555,189	$ 473,740	$ 477,611
Percentage of revenue	42.00%	37.00%	37.00%
Infusion Systems [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 352,321	$ 359,691	$ 328,282
Percentage of revenue	27.00%	28.00%	26.00%
IV Solutions [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 359,477	$ 388,971	$ 414,971
Percentage of revenue	27.00%	31.00%	33.00%
Critical Care [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 49,321	$ 48,602	$ 45,344
Percentage of revenue	4.00%	4.00%	4.00%

- Definition

Amount of revenue recognized from goods sold, services rendered, insurance premiums, or other activities that constitute an earning process. Includes, but is not limited to, investment and interest income before deduction of interest expense when recognized as a component of revenue, and sales and trading gain (loss).

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (a)
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 323
-SubTopic 10
-Section 50
-Paragraph 3
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=114001798&loc=d3e33918-111571

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 825
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-Section 50
-Paragraph 28
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 470
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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Reference 19: http://www.xbrl.org/2003/role/disclosureRef
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Reference 20: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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Reference 22: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
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Reference 23: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
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-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(1))
-URI http://asc.fasb.org/extlink&oid=123367319&loc=SL114868664-224227

+ Details

Revenue Disaggregation of Revenue by Geography (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Revenues	$ 1,316,308	$ 1,271,004	$ 1,266,208
EMEA [Member]
Disaggregation of Revenue [Line Items]
Revenues	147,488	132,763	130,530
Other foreign countries [Member]
Disaggregation of Revenue [Line Items]
Revenues	227,011	227,614	212,336
Foreign [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 374,499	$ 360,377	$ 342,866
UNITED STATES
Disaggregation of Revenue [Line Items]
Percent of total revenue	72.00%	72.00%	73.00%
Revenues	$ 941,809	$ 910,627	$ 923,342
International Sales [Domain]
Disaggregation of Revenue [Line Items]
Percent of total revenue	28.00%	28.00%	27.00%

- Definition

+ References

+ Details

Revenue Contract Liabilities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
COntract Liability Rollforward [Roll Forward]
Contract with Customer, Liability	$ (6,430)	$ (4,855)
Contract with Customer, Liability	(7,461)	(6,430)
Equipment revenue [Member]
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(10,048)	(14,408)
Deferred Revenue, Additions	13,725	14,341
Software revenue [Member]
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(7,261)	(5,721)
Deferred Revenue, Additions	$ 4,615	$ 7,363

Revenue Contract Liabilities Text (Details) $ in Thousands	12 Months Ended
Revenue Contract Liabilities Text (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Contract asset and liability balances [Line Items]
Contract with Customer, Liability, Revenue Recognized	$ 5,100
Equipment revenue [Member]
Contract asset and liability balances [Line Items]
Revenue, Remaining Performance Obligation, Amount	5,600
Software revenue [Member]
Contract asset and liability balances [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ 1,900

Leases (Details)	12 Months Ended
Leases (Details)	Dec. 31, 2021
Lessee, Lease, Description [Line Items]
Optiontoextendinyears	5 years
Minimum [Member]
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Term of Contract	1 year
Maximum [Member]
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Term of Contract	15 years

Leases Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
Leases Lease Cost (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating Lease, Cost	$ 11,251	$ 11,284
Finance Lease, Interest Expense	122	91
Finance Lease, Right-of-Use Asset, Amortization	648	383
Short-term Lease, Cost	14	263
Lease, Cost	$ 12,035	$ 12,021

Leases Supplemental Cash Flow Lease Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating Lease, Payments	$ 11,256	$ 10,185
Finance Lease, Interest Payment on Liability	122	91
Right-of-Use Asset Obtained in Exchange for Operating Lease Liability	2,589	20,847
Right-of-Use Asset Obtained in Exchange for Finance Lease Liability	$ 558	$ 3,062

Leases Supplemental Balance Sheet Lease information (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating Lease, Right-of-Use Asset	$ 39,847	$ 46,571
Operating Lease, Liability, Current	9,009	8,740
Operating Lease, Liability, Noncurrent	33,971	41,019
Operating Lease, Liability	$ 42,980	$ 49,759
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Accrued liabilities	Accrued liabilities
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other Liabilities	Other Liabilities
Operating Lease, Weighted Average Remaining Lease Term	5 years 10 months 24 days	6 years 8 months 12 days
Operating Lease, Weighted Average Discount Rate, Percent	4.98%	5.02%

Finance Leases Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Finance Lease, Right-of-Use Asset, after Accumulated Amortization	$ 2,673	$ 2,915
Finance Lease, Liability, Current	643	554
Finance Lease, Liability, Noncurrent	2,067	2,388
Finance Lease, Liability	$ 2,710	$ 2,942
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Other Assets	Other Assets
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Accrued liabilities	Accrued liabilities
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Other Liabilities	Other Liabilities
Finance Lease, Weighted Average Remaining Lease Term	5 years 7 months 6 days	6 years 4 months 24 days
Finance Lease, Weighted Average Discount Rate, Percent	4.28%	4.27%

Leases Lease Maturity (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Lessee, Operating Lease, Liability, Payments, Remainder of Fiscal Year	$ 10,887
Lessee, Operating Lease, Liability, Payments, Due Year Two	9,453
Lessee, Operating Lease, Liability, Payments, Due Year Three	8,488
Lessee, Operating Lease, Liability, Payments, Due Year Four	5,129
Lessee, Operating Lease, Liability, Payments, Due Year Five	4,842
Lessee, Operating Lease, Liability, Payments, Due after Year Five	10,577
Lessee, Operating Lease, Liability, Payments, Due	49,376
Lessee, Operating Lease, Liability, Undiscounted Excess Amount	(6,396)
Operating Lease, Liability	$ 42,980	$ 49,759

Leases Finance Lease Maturity (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Finance Lease, Liability, to be Paid, Year One	$ 749
Finance Lease, Liability, to be Paid, Year Two	749
Finance Lease, Liability, to be Paid, Year Three	458
Finance Lease, Liability, to be Paid, Year Four	267
Finance Lease, Liability, to be Paid, Year Five	214
Finance Lease, Liability, to be Paid, after Year Five	615
Finance Lease, Liability, Payment, Due	3,052
Finance Lease, Liability, Undiscounted Excess Amount	(342)
Finance Lease, Liability	$ 2,710	$ 2,942

Share Based Award Stock Based Compensation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Stock compensation	$ 27,341	$ 23,954	$ 21,918
Tax benefit from stock-based compensation cost	6,391	5,564	4,840
Indirect tax benefit	285	$ 1,203	$ 680
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount	$ 31,200
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition	10 months 24 days

Share Based Award Stock Option Plans (Details) - shares	12 Months Ended
Share Based Award Stock Option Plans (Details) - shares	Dec. 31, 2021	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
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

Share Based Award Stock Options Granted and Valuation (Details) - Time-based stock option [Member] - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of options granted	7,910	7,190	6,265
Time based options grant date fair value	$ 528	$ 425	$ 424
Expected term (years)	5 years 6 months	5 years 6 months	5 years 6 months
Expected stock price volatility	35.00%	35.00%	28.00%
Risk-Free Interest Rate	0.90%	0.40%	2.20%
Expected Dividend Yield	0.00%	0.00%	0.00%
Weighted Average Exercise Price	$ 200.07	$ 181.99	$ 225.27
Weighted Average Grant Date Fair Value per option	$ 66.78	$ 59.09	$ 67.73

Share Based Award Stock Option Activity (Details) - Share-based Payment Arrangement, Option [Member] $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, Outstanding, Number \| shares	817,800
Granted \| shares	7,910
Exercised \| shares	(162,612)
Forfeited or expired \| shares	0
Options, Outstanding, Number \| shares	663,098
Exercisable \| shares	656,483
Vested and Expected to Vest \| shares	663,098
Options, Outstanding, Weighted Average Exercise Price \| $ / shares	$ 70.13
Weighted Average Exercise Price \| $ / shares	200.07
Options, Exercises in Period, Weighted Average Exercise Price \| $ / shares	57.64
Options, Nonvested Options Forfeited, Weighted Average Grant Date Fair Value \| $ / shares	0
Options, Outstanding, Weighted Average Exercise Price \| $ / shares	74.75
Exercise Price Range, Exercisable Options, Weighted Average Exercise Price \| $ / shares	73.48
Options, Vested and Expected to Vest, Outstanding, Weighted Average Exercise Price \| $ / shares	$ 74.75
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Expected Term	2 years 7 months 6 days
Options, Exercisable, Weighted Average Remaining Contractual Term	2 years 6 months
Options, Vested and Expected to Vest, Outstanding, Weighted Average Remaining Contractual Term	2 years 7 months 6 days
Options, Outstanding, Intrinsic Value \| $	$ 108,003
Options, Exercisable, Intrinsic Value \| $	107,761
Options, Vested and Expected to Vest, Outstanding, Aggregate Intrinsic Value \| $	$ 108,003

Share Based Award Share Award data (Details)	Dec. 31, 2021 $ / shares
Share award data [Abstract]
Share Price	$ 237.34

Share Based Award Options exercised data (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Intrinsic value of options exercised	$ 27,534	$ 32,915	$ 22,976
Cash received from exercise of stock options	9,372	13,193	7,732
Tax benefit from stock option exercises	$ 5,092	$ 5,179	$ 9,653

Share Based Award RSU and PRSU (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Modified PRSU Incremental Expense	$ 2,100
Performance Restricted Stock Units (PRSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period	53,246	38,633	37,657
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 198.16	$ 188.34	$ 231.63
Grant date fair value performance restricted stock units	$ 10,551	$ 7,276	$ 8,723
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Aggregate Intrinsic Value, Vested	$ 6,777	$ 15,627	$ 26,445
Performance Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Performance Shares Earned	32,013	80,654	114,032
Restricted Stock Units (RSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period	84,388	87,830	61,856
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 199.13	$ 188.13	$ 227.42
Grant date fair value of restricted stock units granted	$ 16,804	$ 16,523	$ 14,067
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Aggregate Intrinsic Value, Vested	$ 13,681	$ 12,314	$ 16,753

Share Based Award RSU and PRSU Roll forward (Details) - Restricted Stock and Performance Restricted Stock Units [Member] - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number	275,761	220,760
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value	$ 201.05	$ 209.77
Change in units due to performance expectations	24,601
ShareBasedCompensationArrangementByShareBasedPaymentAwardEquityInstrumentsOtherThanOptionsPerformanceExpectationAdditionsIntrinsicValue	$ 209.64
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period	137,634
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 198.75
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period	(99,363)
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period, Intrinsic Value, Amount Per Share	$ 219.77
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Forfeited in Period	(7,871)
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Forfeitures, Intrinsic Value, Amount Per Share	$ 196.01
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Outstanding, Weighted Average Remaining Contractual Terms	1 year
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Aggregate Intrinsic Value, Nonvested	$ 65,449

Share Based Award ESPP Narrative (Details)	Dec. 31, 2021 shares
Share-based Payment Arrangement [Abstract]
ESPP Original Issuance	750,000
ESPP Annual Issuance Increase Limit	300,000
Shares available in employee stock purchase plan	133,487

Derivatives and Hedging Activities (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Derivative [Line Items]
Foreign Currency Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months	$ 1,100
Interest Rate Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months, Net	$ 5,600
Hedge 1 [Member]
Derivative [Line Items]
Derivative, Forward Exchange Rate	20.01
Hedge 2 [Member]
Derivative [Line Items]
Derivative, Forward Exchange Rate	20.43
Hedge 3 [Member] [Member]
Derivative [Line Items]
Derivative, Forward Exchange Rate	22.11
Hedge 4
Derivative [Line Items]
Derivative, Forward Exchange Rate	24.26
Derivative Asset, Notional Amount	$ 436,800
Hedge 5
Derivative [Line Items]
Derivative, Forward Exchange Rate	21.60
Derivative Asset, Notional Amount	$ 413,100
Interest Rate Swap
Derivative [Line Items]
Derivative, Fixed Interest Rate	1.49%
Derivative Interest Rate Floor	0.00%
Interest Rate Swap \| Maximum [Member]
Derivative [Line Items]
Derivative Liability, Notional Amount	$ 300,000
Interest Rate Swap \| Minimum [Member]
Derivative [Line Items]
Derivative Liability, Notional Amount	$ 150,000
us-gaap_InterestRateSwap 2
Derivative [Line Items]
Derivative, Fixed Interest Rate	1.31%
Derivative Interest Rate Floor	50.00%
us-gaap_InterestRateSwap 2 \| Maximum [Member]
Derivative [Line Items]
Derivative Liability, Notional Amount	$ 750,000
us-gaap_InterestRateSwap 2 \| Minimum [Member]
Derivative [Line Items]
Derivative Liability, Notional Amount	$ 46,900

Derivatives and Hedging Activities Derivative Balance Sheet Location (Details) - Designated as Hedging Instrument [Member] - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Foreign Exchange Forward [Member] \| Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	$ 1,061	$ 3,555
Foreign Exchange Forward [Member] \| Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	0	0
Foreign Exchange Forward [Member] \| Accrued Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	0	0
Foreign Exchange Forward [Member] \| Other Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	0	0
Foreign Exchange Forward [Member] \| Assets, Total
Derivatives, Fair Value [Line Items]
Derivative Asset	1,061	3,555
Foreign Exchange Forward [Member] \| Liabilities, Total [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	0	0
Interest Rate Swap \| Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	0	0
Interest Rate Swap \| Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	0	0
Interest Rate Swap \| Accrued Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	0	0
Interest Rate Swap \| Other Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	1,480	0
Interest Rate Swap \| Assets, Total
Derivatives, Fair Value [Line Items]
Derivative Asset	0	0
Interest Rate Swap \| Liabilities, Total [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	1,480	0
Derivative Financial Instruments, Assets \| Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	1,061	3,555
Derivative Financial Instruments, Assets \| Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	0	0
Derivative Financial Instruments, Assets \| Assets, Total
Derivatives, Fair Value [Line Items]
Derivative Asset	1,061	3,555
Derivative Financial Instruments, Liabilities [Member] \| Accrued Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	0	0
Derivative Financial Instruments, Liabilities [Member] \| Other Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	1,480	0
Derivative Financial Instruments, Liabilities [Member] \| Liabilities, Total [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	$ 1,480	$ 0

Derivatives and Hedging Activities Derivative Instruments and Hedging Activities - Amounts Affecting Consolidated Statements of Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative, Gain (Loss) on Derivative, Net	$ 3,444	$ 790	$ 916

Derivatives and Hedging Activities Derivative Instruments and Hedging Activities - Cash Flow Hedge Activity Included in Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain Reclassified from Accumulated OCI into Income, Effective Portion	$ 3,444	$ 790	$ 916
Other Comprehensive Income (Loss), before Tax	(530)	1,980	2,550
Cash Flow Hedging [Member] \| Foreign Exchange Forward [Member]
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	950	1,980	2,550
Cash Flow Hedging [Member] \| Interest Rate Swap
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	(1,480)	0	0
Interest Rate Cash Flow Hedge Gain (Loss) Reclassified to Earnings, Net	0	0	0
Cash Flow Hedging [Member] \| Cost of Sales [Member] \| Foreign Exchange Forward [Member]
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain Reclassified from Accumulated OCI into Income, Effective Portion	$ 3,444	$ 790	$ 916

- Definition

Amount before tax, after reclassification adjustments of other comprehensive income (loss).

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=124431353&loc=SL124442411-227067

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 830
-SubTopic 30
-Section 45
-Paragraph 20
-URI http://asc.fasb.org/extlink&oid=118261656&loc=d3e32211-110900

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 830
-SubTopic 30
-Section 50
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=6450520&loc=d3e32583-110901

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(19))
-URI http://asc.fasb.org/extlink&oid=120400993&loc=SL114874131-224263

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 323
-SubTopic 10
-Section 45
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109237563&loc=d3e33775-111570

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(23))
-URI http://asc.fasb.org/extlink&oid=120399700&loc=SL114874048-224260

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 830
-SubTopic 30
-Section 45
-Paragraph 17
-URI http://asc.fasb.org/extlink&oid=118261656&loc=d3e32136-110900

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section 50
-Paragraph 4
-URI http://asc.fasb.org/extlink&oid=124431353&loc=SL124442407-227067

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(21))
-URI http://asc.fasb.org/extlink&oid=123367319&loc=SL114868664-224227

+ Details

Fair Value Measurement Text (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent Earn-out Liability	$ 2,589	$ 26,300	$ 17,300	$ 47,400
Short-term contingent consideration-gross	1,000
Long-term contingent consideration-gross	1,500
Pursuit Vascular, Inc. [Member]
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	50,000
Pursuit Vascular LLC
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent Earn-out Liability	26,300
Foreign Distibutor [Member]
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	6,000
Contingent Earn-out Liability	2,600
Foreign Infusion System Supplier
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	$ 2,500

Fair Value Measurement (Details) - USD ($) $ in Thousands	12 Months Ended
Fair Value Measurement (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent Earn-out Liability	$ 2,589	$ 26,300	$ 17,300	$ 47,400
Fair Value, Measurement with Unobservable Inputs Reconciliation, Recurring Basis, Liability, Issuances	2,589		17,300
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)		$ 9,000	$ (47,400)
Fair Value, Measurement with Unobservable Inputs Reconciliation, Liability, Transfers out of Level 3	(26,300)
Pursuit Vascular LLC
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent Earn-out Liability	$ 26,300

Fair Value Measurement Fair Value Inputs, Liabilities, Pursuit Quantitative Information (Details) - Pursuit Vascular, Inc. [Member]	Dec. 31, 2020	Nov. 02, 2019
Revenue/Gross Profit Volatility [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.2500	0.2000
Measurement Input, Discount Rate [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.1250	0.1500
Measurement Input, Risk Free Interest Rate [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.0009	0.0155
Credit Risk [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.0310	0.0600

Fair Value Measurement Fair Value Measurements, Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, Fair Value Disclosure	$ 20,101	$ 31,216
Short-term investment securities	14,420	14,687
Debt Securities, Noncurrent	4,620	12,974
Interest Rate Derivative Liabilities, at Fair Value	1,480	0
Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, Fair Value Disclosure	0	0
Short-term investment securities	0	0
Debt Securities, Noncurrent	0	0
Interest Rate Derivative Liabilities, at Fair Value	0
Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, Fair Value Disclosure	20,101	31,216
Short-term investment securities	14,420	14,687
Debt Securities, Noncurrent	4,620	12,974
Interest Rate Derivative Liabilities, at Fair Value	1,480
Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, Fair Value Disclosure	0	0
Short-term investment securities	0	0
Debt Securities, Noncurrent	0	0
Interest Rate Derivative Liabilities, at Fair Value	0
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	1,061	3,555
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	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	1,061	3,555
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	0
Earn-out liability [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	2,589	26,300
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	2,589	26,300
Liabilities, Total [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	4,069	26,300
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	1,480	0
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	$ 2,589	$ 26,300

Prepaids and Other Current Assets Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Prepaid Expense and Other Assets, Current [Abstract]
Other Prepaid Expense, Current	$ 14,763	$ 14,964
Deferred Costs and Other Assets	12,746	6,402
Prepaid insurance and property taxes	6,310	6,178
Prepaid other taxes	4,156	3,676
Deferred tax charge	4,241	3,542
Derivative Asset, Current	1,061	3,555
Deposit Assets	1,343	1,353
Other Assets, Current	2,227	1,822
Prepaid expenses and other current assets	46,847	41,492
Lessor, Operating Lease, Payments to be Received	25,941	28,948
Spare parts	28,538	22,725
Equity Method Investments	3,238	0
Debt Issuance Costs, Noncurrent, Net	2,827	0
Finance Lease, Right-of-Use Asset, after Accumulated Amortization	2,673	2,915
Other Assets, Miscellaneous, Noncurrent	526	887
Other Assets	$ 63,743	$ 55,475

Accrued Liabilities an Other Long-term Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Accrued Liabilities [Abstract]
Salaries and benefits	$ 27,304	$ 25,786
Incentive compensation	33,107	27,023
Operating Lease, Liability, Current	9,009	8,740
Accrued Professional Fees	773	1,273
Legal accrual	3,897	900
Accrued sales taxes	1,980	2,146
Warranties and returns	532	1,027
Contract with Customer, Liability, Current	12,646	5,566
Accrued other taxes	4,337	3,540
Outside commissions	5,645	5,300
Accrued freight	9,194	6,784
Restructuring accrual	664	3,421
Other	9,107	5,515
Accrued liabilities	$ 118,195	$ 97,021

Accrued Liabilities an Other Long-term Liabilities Other Long-term Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Other Long-term Liabilities [Abstract]
Operating Lease, Liability, Noncurrent	$ 33,971	$ 41,019
Finance Lease, Liability, Noncurrent	2,067	2,388
Contract liabilities	202	337
Interest Rate Derivative Liabilities, at Fair Value	1,480	0
Benefits	1,369	1,183
Accrued rent	1,262	1,462
Other	1,479	1,446
OTHER LONG-TERM LIABILITIES	$ 41,830	$ 47,835

Long-Term Obligations (Details) - USD ($) $ in Thousands	12 Months Ended
Long-Term Obligations (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Jan. 06, 2022	Mar. 31, 2020
Debt Instrument [Line Items]
Line of Credit Facility, Maximum Borrowing Capacity	$ 150,000
Line of Credit Facility, Remaining Borrowing Capacity	$ 150,000
Line of Credit Facility, Expiration Date	Nov. 08, 2022
Line of Credit Accordion	$ 100,000
Debt Issuance Costs, Line of Credit Arrangements, Gross	$ 1,400
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, Current			$ 150,000
Term Loan A \| Subsequent Event
Debt Instrument [Line Items]
Long-term Debt		$ 850,000
Long-term Debt		850,000
Term Loan B \| Subsequent Event
Debt Instrument [Line Items]
Long-term Debt		850,000
Long-term Debt		850,000
Line of Credit \| Subsequent Event
Debt Instrument [Line Items]
Long-term Debt		500,000
Long-term Debt		$ 500,000

Long-Term Obligations Line of Credit Pricing (Details)	12 Months Ended
Long-Term Obligations Line of Credit Pricing (Details)	Dec. 31, 2021
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%

Income Taxes Income (Loss) from Continuing Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Income (Loss) from Continuing Operations before Income Taxes, Domestic	$ 81,484	$ 41,194	$ 32,849
Income (Loss) from Continuing Operations before Income Taxes, Foreign	41,702	56,300	81,858
Income before income taxes	$ 123,186	$ 97,494	$ 114,707

Income Taxes Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Current Federal Tax Expense (Benefit)	$ 20,646	$ 6,032	$ 6,851
Current State and Local Tax Expense (Benefit)	3,444	2,422	2,532
Current Foreign Tax Expense (Benefit)	7,236	7,290	7,994
Current Income Tax Expense (Benefit)	31,326	15,744	17,377
Deferred Federal Income Tax Expense (Benefit)	(8,154)	(5,319)	(6,720)
Deferred State and Local Income Tax Expense (Benefit)	(1,815)	(1,850)	(325)
Deferred Foreign Income Tax Expense (Benefit)	(1,306)	2,049	3,340
Deferred Income Tax Expense (Benefit)	(11,275)	(5,120)	(3,705)
Provision for income taxes	$ 20,051	$ 10,624	$ 13,672

Income Taxes Change in taxes payable (Details) $ in Millions	12 Months Ended
	Dec. 31, 2021 USD ($)
Income Tax Disclosure [Abstract]
Increase (Decrease) in Income Taxes Payable	$ 3.0

Income Taxes Effective tax rate (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Effective Income Tax Rate Reconciliation, Percent [Abstract]
Income Tax Reconciliation, Income Tax Expense (Benefit), at Federal Statutory Income Tax Rate	$ 25,869	$ 20,474	$ 24,088
Income Tax Reconciliation, State and Local Income Taxes	2,907	2,099	1,269
Income Tax Reconciliation, Tax Credits	(2,443)	(3,269)	(2,896)
GILTItaxexpense	711	163	6,634
Income Tax Reconciliation, Foreign Income Tax Rate Differential	(2,983)	(3,888)	(5,939)
Effective Income Tax Rate Reconciliation, Tax Expense (Benefit), Share-based Payment Arrangement, Amount	(4,263)	(4,686)	(8,446)
EffectiveIncomeTaxRateReconciliationForeignDerivedIntangibleIncome	(3,775)	(2,718)	(516)
EffectiveIncomeTaxRateReconciliationIPMigration	0	0	(2,118)
Effective Income Tax Rate Reconciliation, Contingent Consideration	(29)	1,566	0
Effectiveincometaxreconciliation,nondeductiblecompensation	1,812	1,079	203
Effective Income Tax Rate Reconciliation, Other Adjustments, Amount	2,245	(196)	1,393
Provision for income taxes	$ 20,051	$ 10,624	$ 13,672
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent	21.00%	21.00%	21.00%
Effective Income Tax Rate Reconciliation, State and Local Income Taxes	2.40%	2.20%	1.10%
Effective Income Tax Rate Reconciliation, Tax Credits	(2.00%)	(3.40%)	(2.50%)
GILTItaxexpensepercent	0.60%	0.20%	5.80%
Effective Income Tax Rate Reconciliation, Foreign Income Tax Rate Differential	(2.40%)	(4.00%)	(5.20%)
Effective Income Tax Rate Reconciliation, Tax Expense (Benefit), Share-based Payment Arrangement, Percent	(3.50%)	(4.80%)	(7.40%)
EffectiveIncomeTaxRateReconciliationForeignDerivedIntangibleIncome,Percent	(3.10%)	(2.80%)	(0.50%)
EffectiveTaxRateReconciliationIPMigrationPercent	0	0	(0.018)
Effective Income Tax Rate Reconciliation, Contingent Consideration, Percent	0.00%	1.60%	0.00%
Effectivetaxratereconciliationnondeductiblecomppercent	1.50%	1.10%	0.20%
Effective Income Tax Rate Reconciliation, Other Adjustments, Percent	1.80%	(0.20%)	1.20%
Effective Income Tax Rate, Continuing Operations	16.30%	10.90%	11.90%

Income Taxes Deferred income tax assets (liabilities) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Deferred tax assets and liabilities [Line Items]
Non-current deferred tax asset	$ 69,194	$ 67,404
Deferred Tax Assets, Net	41,114	29,371
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	6,866	4,406
Noncurrent deferred tax asset - acquired future tax deductions	5,440	7,781
Deferred Tax Assets, Tax Deferred Expense, Compensation and Benefits, Share-based Compensation Cost	7,283	7,138
Deferred Tax Assets, Unrealized Currency Losses	3,360	2,406
Noncurrent deferred tax asset - tax credits state	11,953	12,444
Deferred Tax Assets, Inventory	8,199	8,493
Deferred Tax Assets, Tax Deferred Expense, Reserves and Accruals, Allowance for Doubtful Accounts	926	4,460
Noncurrentdeferredtaxassetaccruedrestructuring	131	1,293
Noncurrentdeferredtaxassetchargebacksdiscountscustomerconcessions	27,970	22,874
Deferred Tax Assets, Valuation Allowance	2,934	3,891
Noncurrent deferred tax liability [Member]
Deferred tax assets and liabilities [Line Items]
Noncurrent deferred tax liability - state income taxes	2,724	2,398
Noncurrent deferred tax liability - foreign	0	776
Noncurrent deferred tax liability - depreciation and amortization	20,483	25,113
Deferred tax liability, change in accounting method	4,873	9,746
Deferred Tax Liabilities, Net	$ 28,080	$ 38,033

Income Taxes Operating Loss Carryforwards (Details) $ in Millions	Dec. 31, 2021 USD ($)
UNITED STATES
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	$ 2.5
State and Local Jurisdiction [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	8.2
Foreign Tax Authority [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	$ 15.0

Income Taxes Tax Carryforwards (Details) $ in Millions	Dec. 31, 2021 USD ($)
Income Tax Disclosure [Abstract]
Tax Credit Carryforward, Amount	$ 16.9

Income Taxes Tax Holiday (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Tax Holiday [Line Items]
Income Tax Holiday, Aggregate Dollar Amount	$ 9.8	$ 8.0
Income Tax Holiday, Income Tax Benefits Per Share	$ 0.45	$ 0.37

Income Taxes Undistributed foreign earnings (Details) $ in Millions	Dec. 31, 2021 USD ($)
Income Tax Disclosure [Abstract]
Undistributed Earnings of Foreign Subsidiaries	$ 98.6

Income Taxes Unrecognized tax benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Unrecognized tax benefits roll forward [Roll Forward]
Unrecognized Tax Benefits	$ 21,537	$ 18,443	$ 15,027	$ 10,824
Unrecognized Tax Benefits, Increases Resulting from Prior Period Tax Positions	231	502	138
Unrecognized Tax Benefits, Increases Resulting from Current Period Tax Positions	3,242	2,987	4,231
Unrecognized Tax Benefits, Decrease Resulting from Prior Period Tax Positions	0	(15)	(3)
Unrecognized Tax Benefits, Reductions Resulting from Lapse of Applicable Statute of Limitations	(31)	(58)	(163)
Unrecognized Tax Benefits, Decrease Resulting from Settlements with Taxing Authorities	$ 348	$ 0	$ 0

Geographic Information and Significant Customers Long Lived Assets by Geographic Location (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	$ 905,104	$ 843,096
COSTA RICA
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	115,187	104,015
Mexico Property and Equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	79,567	76,004
Other LATAM [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	36,907	37,485
CANADA
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	4,716	4,672
Italy Property and Equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	12,435	11,098
SPAIN
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	13,295	8,701
Europe [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	4,171	3,795
Asia Pacific [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	20,452	19,836
Foreign [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	286,730	265,606
United States property and equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	$ 618,374	$ 577,490

Stockholders' Equity (Details) - USD ($) $ in Millions	12 Months Ended
Stockholders' Equity (Details) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Equity, Class of Treasury Stock [Line Items]
Treasury stock purchase plan	$ 100.0
Treasury stock purchase plan remaining available	$ 100.0
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	40,350	67,041	80,186
Payment, Tax Withholding, Share-based Payment Arrangement	$ 8.3	$ 12.9	$ 18.6
Treasury Stock, Common, Shares	119	209	850

Stockholders' Equity Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	$ (19,269)	$ (1,522)	$ (15,402)	$ (16,945)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(15,129)	14,481	2,239
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(2,618)	(601)	(696)
Other Comprehensive Income (Loss), Net of Tax	(17,747)	13,880	1,543
Accumulated Foreign Currency Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	(19,045)	(4,381)	(17,310)	(17,682)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(14,664)	12,929	372
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0	0
Other Comprehensive Income (Loss), Net of Tax	(14,664)	12,929	372
Accumulated Net Gain (Loss) from Cash Flow Hedges Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	(237)	2,784	1,880	638
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(403)	1,505	1,938
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(2,618)	(601)	(696)
Other Comprehensive Income (Loss), Net of Tax	(3,021)	904	1,242
Accumulated Defined Benefit Plans Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	13	75	28	$ 99
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(62)	47	(71)
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0	0
Other Comprehensive Income (Loss), Net of Tax	$ (62)	$ 47	$ (71)

- Definition

Accumulated change in equity from transactions and other events and circumstances from non-owner sources, net of tax effect, at period end. Excludes Net Income (Loss), and accumulated changes in equity from transactions resulting from investments by owners and distributions to owners. Includes foreign currency translation items, certain pension adjustments, unrealized gains and losses on certain investments in debt and equity securities, other than temporary impairment (OTTI) losses related to factors other than credit losses on available-for-sale and held-to-maturity debt securities that an entity does not intend to sell and it is not more likely than not that the entity will be required to sell before recovery of the amortized cost basis, as well as changes in the fair value of derivatives related to the effective portion of a designated cash flow hedge.

+ References + Details

- Definition

Amount after tax and reclassification adjustments of other comprehensive income (loss).

+ References

+ Details

Commitments and Contingencies Contingencies (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Contingent Earn-out Liability	$ 2,589	$ 26,300	$ 17,300	$ 47,400
Short-term contingent consideration-gross	1,000
Long-term contingent consideration-gross	1,500
Hospira [Member] \| Minimum [Member]
Business Acquisition [Line Items]
contingent consideration gross	191,300
Hospira [Member] \| Maximum [Member]
Business Acquisition [Line Items]
contingent consideration gross	225,000
Pursuit Vascular, Inc. [Member]
Business Acquisition [Line Items]
contingent consideration gross	50,000
Pursuit Vascular LLC
Business Acquisition [Line Items]
Contingent Earn-out Liability	26,300
Foreign Distibutor [Member]
Business Acquisition [Line Items]
contingent consideration gross	6,000
Contingent Earn-out Liability	2,600
Foreign Infusion System Supplier
Business Acquisition [Line Items]
contingent consideration gross	$ 2,500

Collaborative and Other Arrangements (Details) $ in Millions	Dec. 31, 2021 USD ($)
Collaborative and Other Arrangements [Abstract]
Purchase Commitment, Remaining Minimum Amount Committed	$ 29.6

Subsequent Events (Details) - USD ($) shares in Millions	Jan. 06, 2022	Dec. 31, 2021	Dec. 31, 2020
Subsequent Event [Line Items]
Common Stock, Value, Issued		$ 2,128,000	$ 2,106,000
Subsequent Event
Subsequent Event [Line Items]
Common Stock, Value, Issued	$ 0.10
Ownership Share % Minimum Requirement	5.00%
Subsequent Event \| Smiths Medical
Subsequent Event [Line Items]
Business Acquisition, Percentage of Voting Interests Acquired	100.00%
Payments to Acquire Businesses, Gross	$ 1,900,000,000
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares	2.5
contingent consideration gross	$ 100,000,000

Subsequent Events Credit Agreement (Details) - Subsequent Event $ in Thousands	Jan. 06, 2022 USD ($)
Subsequent Event [Line Items]
Term Loan A Payment First Years as a % of Original Debt	2.50%
Term Loan A Payment Year 3 and 4 as a % of Original Debt Amount	5.00%
Term Loan A Payment Year 5	7.50%
Term Loan B Quarterly Payments as a % of Original Debt Amount	0.25%
line of credit spread	0.25%
Term Loan A and Credit Line Spread	1.75%
Term Loan B Initial Spread	2.50%
Term Loans & Line of Credit
Subsequent Event [Line Items]
Long-term Debt	$ 2,200,000
Term Loan A
Subsequent Event [Line Items]
Long-term Debt	850,000
Term Loan B
Subsequent Event [Line Items]
Long-term Debt	850,000
Line of Credit
Subsequent Event [Line Items]
Long-term Debt	$ 500,000

Subsequent Events Term Loan A & Credit Line Applicable Margin (Details) - Subsequent Event	Jan. 06, 2022
Subsequent Event [Line Items]
Term Loan A and Credit Line Spread	1.75%
Pricing Level 5
Subsequent Event [Line Items]
spread	2.25%
Debt Instrument, Basis Spread on Variable Rate	1.25%
Line of Credit Facility, Commitment Fee Percentage	0.35%
Pricing Level IV [Member] [Member]
Subsequent Event [Line Items]
spread	2.00%
Debt Instrument, Basis Spread on Variable Rate	1.00%
Line of Credit Facility, Commitment Fee Percentage	0.30%
Pricing Level III [Member] [Member]
Subsequent Event [Line Items]
spread	1.75%
Debt Instrument, Basis Spread on Variable Rate	0.75%
Line of Credit Facility, Commitment Fee Percentage	0.25%
Pricing Level II [Member] [Member]
Subsequent Event [Line Items]
spread	1.50%
Debt Instrument, Basis Spread on Variable Rate	0.50%
Line of Credit Facility, Commitment Fee Percentage	0.20%
Pricing Level I [Member]
Subsequent Event [Line Items]
spread	1.25%
Debt Instrument, Basis Spread on Variable Rate	0.25%
Line of Credit Facility, Commitment Fee Percentage	0.15%

Subsequent Events Term Loan B Applicable Margin (Details) - Subsequent Event	Jan. 06, 2022
Subsequent Event [Line Items]
Term Loan B Initial Spread	2.50%
Pricing Level II [Member] [Member]
Subsequent Event [Line Items]
Term Loan B Euro Rate Loan Spread	2.50%
Term Loan B Base Rate Loan Spread	1.50%
Pricing Level I [Member]
Subsequent Event [Line Items]
Term Loan B Euro Rate Loan Spread	2.25%
Term Loan B Base Rate Loan Spread	1.25%

SEC Schedule, Article 12-09, Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Warranty and return reserve - inventory write-offs	$ 0	$ 0	$ 0
Warranty and return reserve - inventory - charged to other accounts	(533)	(169)	(722)
Warranty and Return Reserve costs	263	2,033	(217)
Warranty and return reserve - inventory	(1,883)	(1,613)	(3,477)	$ (2,538)
SEC Schedule, 12-09, Allowance, Credit Loss
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	21,490	20,219	5,768
Charged to Costs and Expenses	345	7,137	14,882
Charged to Other Accounts	(14,797)	(5,866)	(431)
Write-off/ Disposals	0	0	0
Balance at End of Period	7,038	21,490	20,219
SEC Schedule, 12-09, Reserve, Warranty
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	2,707	6,377	6,752
Charged to Costs and Expenses	568	(3,609)	83
Charged to Other Accounts	(790)	(61)	(458)
Write-off/ Disposals	0	0	0
Balance at End of Period	2,485	2,707	6,377
SEC Schedule, 12-09, Valuation Allowance, Deferred Tax Asset
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	3,891	3,677	5,436
Charged to Costs and Expenses	0	0	0
Charged to Other Accounts	(957)	214	(1,584)
Write-off/ Disposals	0	0	(175)
Balance at End of Period	$ 2,934	$ 3,891	$ 3,677