0000883984-23-000009 | 10-K | XBRL Viewer

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Document and Entity Information Document - USD ($)	12 Months Ended
Document and Entity Information Document - USD ($)	Dec. 31, 2022	Jan. 31, 2023	Jun. 30, 2020
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2022
Document Transition Report	false
Entity File Number	001-34634
Entity Registrant Name	ICU MEDICAL INC/DE
Entity Central Index Key	0000883984
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Amendment Flag	false
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	33-0022692
Entity Address, Address Line One	951 Calle Amanecer
Entity Address, City or Town	San Clemente
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92673
City Area Code	949
Local Phone Number	366-2183
Title of 12(b) Security	Common stock, par value $0.10 per share
Trading Symbol	ICUI
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Entity Shell Company	false
Entity Public Float			$ 3,305,900,983
Entity Common Stock, Shares Outstanding		23,998,252
Documents Incorporated by Reference	Portions of the Proxy Statement for registrant’s 2023 Annual Meeting of Stockholders filed or to be filed pursuant to Regulation 14A within 120 days following registrant’s fiscal year ended December 31, 2022, are incorporated by reference into Part III of this Report.

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2022
Auditor [Line Items]
Auditor Name	DELOITTE & TOUCHE LLP
Auditor Location	Costa Mesa, California
Auditor Firm ID	34

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
CURRENT ASSETS:
Cash and cash equivalents	$ 208,784	$ 552,827
Short-term investment securities	4,224	14,420
TOTAL CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENT SECURITIES	213,008	567,247
Accounts receivable, net of allowance for doubtful accounts of $8,530 at December 31, 2022 and $7,038 at December 31, 2021	221,719	105,894
Inventories	696,009	290,235
Prepaid income taxes	15,528	19,586
Prepaid expenses and other current assets	88,932	46,847
Total current assets	1,235,196	1,029,809
PROPERTY, PLANT AND EQUIPMENT, net	636,113	468,365
Operating Lease, Right-of-Use Assets	74,864	39,847
Long-term Investment Securities	516	4,620
GOODWILL	1,449,258	43,439
INTANGIBLE ASSETS, net	982,766	188,311
Deferred Income Tax Assets, Net	31,466	42,604
Other Assets	105,462	63,743
TOTAL ASSETS	4,515,641	1,880,738
CURRENT LIABILITIES:
Accounts payable	215,902	81,128
Accrued liabilities	242,769	118,195
Long-Term Debt, Current Maturities	29,688	0
Accrued Income Taxes, Current	6,200	1,454
Total current liabilities	494,559	200,777
Contingent earn-out liability, Noncurrent	25,572	2,589
Long-Term Debt, Noncurrent	1,623,675	0
Other long-term Liabilities	114,104	41,830
Deferred Income Tax Liabilities, Net	126,007	1,490
Accrued Income Taxes, Noncurrent	41,796	18,021
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 23,995 and 21,280 shares at December 31, 2022 and 2021, respectively, and outstanding 23,993 and 21,280 shares at December 31, 2022 and 2021, respectively.	2,399	2,128
Additional paid-in capital	1,331,249	721,412
Treasury Stock, Value	(243)	(27)
Retained earnings	837,501	911,787
Accumulated other comprehensive loss	(80,978)	(19,269)
Total stockholders' equity	2,089,928	1,616,031
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY	$ 4,515,641	$ 1,880,738

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
REVENUES:
Revenues	$ 2,279,997	$ 1,316,308	$ 1,271,004
Cost of Goods Sold	1,582,236	824,818	809,507
Gross profit	697,761	491,490	461,497
OPERATING EXPENSES:
Selling, general and administrative	608,345	302,583	283,953
Research and development	92,984	47,498	42,948
Restructuring, strategic transaction and integration expenses	71,421	18,037	28,409
Change in fair value of contingent earn-out	(32,091)	0	9,000
Contractsettlements	0	127	(975)
Total operating expenses	740,659	368,245	363,335
Income from operations	(42,898)	123,245	98,162
Interest Income (Expense), Net	(66,375)	1,982	1,924
OTHER INCOME,NET	(5,136)	(2,041)	(2,592)
Income before income taxes	(114,409)	123,186	97,494
Provision for income taxes	40,123	(20,051)	(10,624)
Net Income	$ (74,286)	$ 103,135	$ 86,870
Basic	$ (3.11)	$ 4.86	$ 4.16
Diluted	$ (3.11)	$ 4.74	$ 4.02
WEIGHTED AVERAGE NUMBER OF SHARES
Basic (in shares)	23,868	21,206	20,907
Diluted (in shares)	23,868	21,781	21,591

Statement of Comprehensive Income (Statement) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Net Income	$ (74,286)	$ 103,135	$ 86,870
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), after Reclassification and Tax	41,016	(3,021)	904
Foreign currency translation adjustment, net of taxes of $0 for all periods	(103,928)	(14,664)	12,929
Other adjustments, net of taxes of $0 for all periods	1,203	(62)	47
Other Comprehensive Income (Loss), Net of Tax	(61,709)	(17,747)	13,880
Comprehensive (loss) income	$ (135,995)	$ 85,388	$ 100,750

- Definition

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

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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, 2019		20,742,000
Balance at Dec. 31, 2019	$ 1,377,244		$ 2,074	$ 668,947	$ (157)	$ 721,782	$ (15,402)
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
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
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of restricted stock and exercise of stock options, shares issued		263,000
Issuance of restricted stock and exercise of stock options, including excess income tax benefits	$ 8,785		21	(1,903)	10,667
Treasury Stock, Shares		(48,000)
Purchase of treasury stock,treasury stock acquired in lieu of cash payment on stock option exercises and income tax withholding obligations	(10,883)			0	(10,883)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	36,025			36,025
Adjustments to Additional Paid in Capital, Other				(10)
Other comprehensive income, net of tax	(61,719)						(61,709)
Net Income	(74,286)					(74,286)
Balance at Dec. 31, 2022	$ 2,089,928		2,399	1,331,249	$ (243)	$ 837,501	$ (80,978)
Balance, Shares at Dec. 31, 2022		23,995,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, Acquisitions	2,500,000
Stock Issued During Period, Value, Acquisitions	$ 575,975		$ 250	$ 575,725

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
CASH FLOWS FROM OPERATING ACTIVITIES:
Net Income	$ (74,286)	$ 103,135	$ 86,870
Depreciation and amortization	235,151	89,698	85,631
Amortization of Inventory Step-up	26,519	0	0
Operating Lease, Right-of-Use Asset, Amortization Expense	23,651	9,594	9,216
Provision for doubtful accounts	1,036	345	7,137
Provision for warranty and returns	4,902	831	(1,576)
Stock compensation	36,025	27,341	23,954
Gain (Loss) on Disposition of Property Plant Equipment	2,010	1,652	(1,789)
Gain (Loss) on Disposition of Business	374	0	0
Bond premium amortization	264	655	231
Debt issuance cost amortization	6,972	240	288
Change in fair value of contingent earn-out	(32,091)	0	9,000
Production Related Impairments or Charges	0	3,380	2,626
Sparepartsusage	11,924	13,046	11,191
Other	(103)	2,582	6,939
Increase (Decrease) in Accounts Receivable	(19,151)	13,755	78,049
Increase (Decrease) in Inventories	(201,095)	20,815	19,196
Increase (Decrease) in Prepaid Expense and Other Assets	22,903	(7,973)	(4,311)
Increase (Decrease) in Other Operating Assets	(21,290)	(21,038)	(16,069)
Accounts payable	37,472	2,347	(46,415)
Accrued liabilities	(55,834)	6,259	(29,379)
Income taxes, including excess tax benefits and deferred income taxes	(66,734)	874	(18,037)
Net cash provided by operating activities	(62,129)	267,538	222,752
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property and equipment	(90,311)	(68,542)	(92,005)
Proceeds from Sale of Other Property, Plant, and Equipment	989	218	6,176
Intangible asset additions	(9,018)	(12,627)	(8,385)
Business acquisitions, net of cash acquired	(1,844,164)	(14,452)	0
Payments to Acquire Equity Method Investments	0	(3,250)	0
Purchases of investment securities	(3,397)	(10,034)	(32,825)
Proceeds from sale of investment securities	36,433	18,000	28,900
Net cash (used in) provided by investing activities	(1,909,468)	(90,687)	(98,139)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of long-term debt, net of lender debt issuance costs	1,664,362	0	0
Repayments of Long-term obligations	(22,375)	0	0
Payments of Debt Issuance Costs	(2,177)	0	0
Proceeds from Long-term Lines of Credit	0	0	150,000
Repayments of Short-Term Debt	0	0	150,000
Proceeds from exercise of stock options	8,785	9,372	13,193
Finance Lease, Principal Payments	(680)	(607)	(357)
Payment for Contingent Consideration Liability, Financing Activities	0	(17,300)	0
Purchase of treasury stock	(10,883)	(8,335)	(12,876)
Net cash (used in) provided by financing activities	1,637,032	(16,870)	(40)
Effect of Exchange Rate on Cash [Abstract]
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Continuing Operations	(9,478)	(3,251)	2,854
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect, Total	(344,043)	156,730	127,427
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	208,784	552,827	396,097
SUPPLEMENTAL DISCLSOURE OF CASH FLOW INFORMATION
Cash paid during the year for income taxes	27,504	19,562	31,628
Interest Paid, Excluding Capitalized Interest, Operating Activities	63,713	858	1,753
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Accounts payable for property and equipment	4,854	9,338	2,211
Business Combination, Consideration Transferred, Equity Interests Issued and Issuable		0
Smiths Medical
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Fair value of assets acquired	1,606,300
Cash paid for acquisitions, net of cash acquired	(1,844,164)
Business Combination, Consideration Transferred, Equity Interests Issued and Issuable	(575,975)
Contingent consideration	(55,158)
Goodwill, Period Increase (Decrease)	1,462,752
Liabilities Assumed	593,755
International Distributor
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Noncash Non-compete agreement with associated contingent earn-out liability	$ 0	2,589	$ 0
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
Liabilities Assumed		$ 766

Consolidated Balance Sheets (Parenthetical) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 8,530,000	$ 7,038,000
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	23,995,000	21,280,000
Common Stock, Value, Outstanding	$ 23,993,000
Common stock, shares outstanding		21,280,000
Treasury Stock, Shares	1,633	119
Cash and cash equivalents	$ 208,784,000	$ 552,827,000

Statement of Comprehensive Income (Paranthetical) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
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	$ 12,941,000	$ (954,000)	$ 285,000

General and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

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

BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Nature of Operations

ICU Medical, Inc. ("ICU" or "we"), a Delaware corporation, develops, manufactures and sells infusion systems, infusion consumables and high-value critical care products used in hospital, alternate site and home care settings. Our wide-ranging product portfolio 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 also manufacture automated pharmacy IV compounding systems with workflow technology, closed systems transfer devices for preparing and administering hazardous IV drugs, and cardiac monitoring systems for critically ill patients. Our recent acquisition of Smiths Medical broadened our product portfolio to include, among other products, syringe and ambulatory pumps, peripheral IV catheters, fluid warming and respiratory devices, silicone and PVC tracheotomy tubes. ICU's business activities are interrelated and leverage shared manufacturing, supply chain, IT and other supporting infrastructure. All significant operating decisions are based on analysis of ICU as a single global business, accordingly we operate in one business segment.

We sell the majority of our products globally through our direct sales force and through independent distributors. Additionally, we sell our products on an original equipment manufacturer basis to other medical device manufacturers.

Basis of Presentation

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").

Certain reclassifications have been made to the prior year financial statements and footnotes to conform to the presentation used in the current year. In the statements of operations we reclassified interest income to interest (expense) income, net from other income (expense), net and in Note 4: Revenues, certain reclassifications were made to revenues disaggregated by geography. These reclassifications had no impact on net (loss) income, shareholder's equity or cash flows as previously reported.

On January 6, 2022, we acquired Smiths Medical 2020 Limited ("Smiths Medical"), see Note 2: Acquisitions. Our consolidated statement of operations includes the results of operations for Smiths Medical from January 7, 2022 through December 31, 2022.

Use of Estimates

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

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, the financial status of our customers 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,
	2022		2021
Raw materials	$	286,964	$	135,528
Work in process	73,795		36,490
Finished goods	335,250		118,217
Total	$	696,009	$	290,235

Property, Plant and Equipment

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


	As of December 31,
	2022		2021
Machinery and equipment	$	414,811	$	321,078
Land, building and building improvements	274,063		243,377
Molds	77,203		60,463
Computer equipment and software	115,214		102,979
Furniture and fixtures	29,876		7,670
Instruments placed with customers(1)	98,481		97,384
Construction in progress	152,909		72,153
Total property, plant and equipment, cost	1,162,557		905,104
Accumulated depreciation	(526,444)		(436,739)
Property, plant and equipment, net	$	636,113	$	468,365

_______________________________

(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 and 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 $95.8 million, $65.9 million and $62.4 million in 2022, 2021 and 2020, 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. In 2022, we bypassed a qualitative assessment and performed a quantitative assessment to determine whether an impairment exists. We determine the fair value of our reporting unit using the income approach and market approach to valuation, as well as other generally accepted valuation methodologies. The income approach utilizes a discounted cash flow analysis using management's assumptions. The market approach compares our reporting unit to similar companies with the assumption that companies operating in the same industry will share similar characteristics and that company values will correlate to those characteristics. If the carrying amount of the reporting unit exceeds the reporting unit’s fair value, we recognize an impairment loss equal to the difference between the carrying amount and the estimated fair value of the reporting unit. We concluded that there was no impairment of goodwill during fiscal 2022, 2021, or 2020.

The following table presents the changes in the carrying amount of our goodwill for 2022, 2021 and 2020 (in thousands):


	Total
Balance as of January 1, 2020	$	31,245

Other(1)	1,756
Balance as of December 31, 2020	$	33,001
Goodwill acquired(2)	10,626
Other	(188)
Balance as of December 31, 2021	43,439
Goodwill(3)	1,469,880
Other(4)	(7,128)
Disposition(5)	(650)
Currency translation	(56,283)
Balance as of December 31, 2022	$	1,449,258

_______________________________

(1) In 2020, "Other" primarily relates to a $1.3 million measurement period adjustment to deferred taxes related to the 2019 acquisition of Pursuit Vascular, Inc. and foreign currency translation.

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

(3) Relates to Smiths Medical acquired on January 6, 2022 (see Note 2: Acquisitions).

(4) Reflects a measurement period adjustment related to the 2021 acquisition of a small foreign infusion systems supplier.

(5) Relates to the sale of a certain line of infusion products in China.

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, 2022
		Cost		Accumulated Amortization		Net
Patents	10	$	29,998	$	18,610	$	11,388
Customer contracts	12	10,026		6,443		3,583
Non-contractual customer relationships	8	546,935		101,556		445,379
Trademarks	1	5,425		5,425		—
Trade name	15	18,251		5,959		12,292
Developed technology	10	583,176		108,708		474,468
Non-compete	3	9,100		5,250		3,850
Total amortized intangible assets		$	1,202,911	$	251,951	$	950,960

Internally developed software*		$	31,806			$	31,806

Total intangible assets		$	1,234,717	$	251,951	$	982,766

_______________________________

* 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, 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.

Amortization expense was $139.4 million, $23.8 million and $23.2 million in 2022, 2021 and 2020, respectively.

As of December 31, 2022, estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):


2023	$	130,972
2024	130,882
2025	123,223
2026	122,654
2027	114,622
Thereafter	328,607
Total	$	950,960

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 2022, 2021 or 2020.

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 2022, 2021 or 2020.

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 and long-term corporate bonds, short-term U.S. treasury securities and long-term government 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 (loss) income. We did not have any investments in available-for-sale debt securities in unrealized loss positions as of December 31, 2022 or 2021.

The amortized cost of the debt securities and U.S treasury securities is adjusted for the amortization of premiums computed under the effective interest method. Such amortization is included in interest (expense) 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 2023 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, 2022
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	2,314	$	—	$	2,314
Short-term U.S. treasury securities	1,412		—		1,412
Short-term government bonds	498		—		498
Total short-term investment securities	4,224		—		4,224
Long-term corporate bonds	516		—		516
Total investment securities	$	4,740	$	—	$	4,740

	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

Investments in Non-Marketable Equity Securities

During 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.

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 expense, 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 2022 and 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, 2022 and 2021. We did not receive any dividend distributions from this investment during 2022 and 2021.

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


	As of December 31,
	2022		2021
Equity method investment	$	3,178	$	3,238

Investments in non-marketable debt securities

During the second quarter 2022, we received $19.0 million in proceeds from a promissory note related to an acquired investment as part of the Smiths Medical acquisition.

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 expense, net, see below other expense, net table. Foreign currency transaction losses (gains), net were $5.8 million, $1.0 million and $7.2 million in 2022, 2021 and 2020, 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, Critical Care, Vascular Access and Vital 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.

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 $14.6 million, $11.0 million and $10.7 million in 2022, 2021 and 2020, 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.

Interest (expense) income, net

The following table presents interest (expense) income, net (in thousands):


	As of December 31,
	2022		2021		2020
Interest expense	$	(70,805)	$	(858)	$	(1,753)
Interest income	4,430		2,840		3,677
Interest (expense) income, net	$	(66,375)	$	1,982	$	1,924

Other expense, net

The following table presents other income (expense), net (in thousands):


	As of December 31,
	2022		2021		2020
Foreign exchange losses, net	$	(5,780)	$	(1,017)	$	(7,177)
(Loss) gain on disposition of assets	(2,554)		(1,651)		1,773
Other miscellaneous income, net	3,198		627		2,812
Other expense, net	$	(5,136)	$	(2,041)	$	(2,592)

Net (Loss) Income Per Share

Basic net (loss) earnings per share is computed by dividing net (loss) income by the weighted-average number of common shares outstanding for the period. Diluted net (loss) income per share is computed by dividing net (loss) income by the weighted-average number of common shares outstanding plus any dilutive potential securities. Dilutive potential 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. Due to the net loss for the year ended December 31, 2022 the inclusion of any potential securities is antidilutive, accordingly, basic and diluted net loss per share is the same for this period. There were 12,354 and 12,083 anti-dilutive shares in 2021 and 2020, respectively.

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


	Year ended December 31,
	2022		2021		2020
Net (loss) income	$	(74,286)	$	103,135	$	86,870
Weighted-average number of common shares outstanding (basic)	23,868		21,206		20,907
Dilutive securities	—		575		684
Weighted-average common and common equivalent shares outstanding (diluted)	23,868		21,781		21,591
EPS — basic	$	(3.11)	$	4.86	$	4.16
EPS — diluted	$	(3.11)	$	4.74	$	4.02

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 were effective for all entities as of March 12, 2020 through December 31, 2022. ASU No. 2022-06, Reference Rate Reform: Deferral of the Sunset Date of Topic 848 deferred the sunset date of Topic 848 from December 31, 2022 to December 31, 2024. In November 2021, we entered into two forward-starting swaps whereby the variable leg of the swap references LIBOR, these swaps were 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 allowed 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 allowed 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 these ASU's on our contracts has not been and is not expected to be material.

Acquisitions (Notes)

12 Months Ended

Dec. 31, 2022

Business Combinations [Abstract]

Business Combination Disclosure [Text Block]

ACQUISITIONS

2022 Acquisitions

On January 6, 2022, we acquired 100% of the equity interests in Smiths Medical, the holding company of Smiths Group plc's global medical device business, from Smiths Group International Holdings Limited (“Smiths”). The acquisition of

Smiths Medical aligns with our strategic growth plans, enabling us to broaden our product offerings to include syringe and ambulatory infusion devices, vascular access, and vital care products and to strengthen and expand our global market reach.

Total cash consideration for the acquisition was $1.9 billion, which was financed with existing cash balances and proceeds from the credit agreement entered into on January 6, 2022 (see Note 11: Long-Term Debt). We also issued share consideration to Smiths of 2.5 million shares of our common stock. The fair value of the common shares issued to Smiths was determined based on the opening market price of our common stock on the acquisition date. Smiths may be entitled to an additional $100.0 million in cash consideration contingent on our common stock achieving certain price targets for certain periods after closing in accordance with the terms of the Share Sale and Purchase Agreement (the "Purchase Agreement"). In the event that (a) on or prior to the third anniversary of closing the 30-day volume-weighted average price for our common stock, as defined in the Purchase Agreement, equals or exceeds $300.00 per share or (b) on or prior to the fourth anniversary of closing the 45-day volume-weighted average price for our common stock, as defined in the Purchase Agreement, equals or exceeds $300.00 per share (each a "Price Target"), and provided Smiths beneficially owns at least 50.0% of the shares of common stock issued at closing at the time the Price Target is achieved, then Smiths will be entitled to receive the additional $100.0 million in cash consideration. The fair value of the contingent consideration was determined using an option pricing model, specifically the Monte Carlo Simulation. In the analysis, the determinants of payout are simulated in a risk neutral framework over a large number of simulation paths. The fair value of the contingent consideration is then calculated as the average present value across all simulated paths.

Smiths became a related party to us when we issued 2.5 million shares of our common stock as partial consideration for the acquisition of Smiths Medical. Additionally, we entered in to a transition services agreement ("TSA") with certain members of Smiths Group, plc. The TSA includes certain information technology, human resource and tax support services for an initial term of twelve months with the option to extend up to 24 months. During 2022, we expensed $37.6 million for services provided under the TSA. As of December 31, 2022, we have $5.1 million in open payables related to the services received under the TSA.

Final Price Allocation

The following table summarizes the final purchase price and the final allocation of the purchase price related to the assets acquired and liabilities assumed (in thousands):


Cash consideration for acquired assets	$	1,922,955
Fair value of contingent consideration payable to Smiths	53,520

Issuance of ICU Medical, Inc. common shares:
Number of shares issued to Smiths	2,500
Price per share (ICU's opening market price on the acquisition date)	$	230.39
Fair value of ICU shares issued to Smiths	$	575,975
Total Consideration	$	2,552,450

Purchase Price Allocation
Cash and cash equivalents	$	78,791
Accounts receivables	106,132
Inventories	228,919
Prepaid expenses and other current assets	53,554
Property, plant and equipment	206,333
Operating lease right-of-use assets	55,161
Intangible assets(1)	945,000

Other assets	379
Accounts payable	(105,291)
Accrued liabilities(2)	(173,151)
Income tax payable	(40,312)
Other long-term liabilities	(85,490)
Deferred income taxes	(187,455)
Total identifiable net assets acquired	$	1,082,570
Goodwill - not tax deductible	1,469,880
Purchase Consideration	$	2,552,450

_______________________________________________

(1) Identifiable intangible assets included $510.0 million of customer relationships, $400.0 million of developed technology, $30.0 million of internally developed software, and $5.0 million of trade mark. The estimated weighted-average amortization period for the total identifiable intangible assets is approximately nine years, and, for each identifiable intangible asset is estimated as follows: eight years for customer relationships, ten years for developed technology, five years for internally developed software, and six months for the trade mark.

(2) Accrued liabilities includes, among other things, accrued warranty reserves, accrued restructuring initiatives, accrued salaries and related benefits, deferred revenue and accrued sales and use taxes.

The identifiable intangible assets and other long-lived assets acquired have been valued utilizing Level 3 inputs as defined in Note 8: Fair Value Measurements. The fair value of identifiable intangible assets were generally developed using the income approach and are based on critical estimates, judgments and assumptions derived from: analysis of market conditions; discount rate; discounted cash flows; royalty rates; customer retention rates; and/or estimated useful lives. Certain other intangible assets were valued using a cost to replace method, estimating the labor and non-labor costs required to replace the asset under the premise that it was not part of the transaction. Property, plant and equipment was valued with the consideration of remaining economic lives. The raw materials inventory was valued at historical cost and adjusted for any obsolescence which we estimate to approximate replacement cost, the work in process inventory was valued at estimated sales proceeds less costs to complete and costs to sell, and finished goods inventory was valued at estimated sales proceeds less costs to sell. The prepaid expenses and other current assets and assumed liabilities were recorded at their carrying values as of the date of the acquisition, as their carrying values approximated their fair values due to their short-term nature.

Unaudited Pro Forma Information

Smiths Medical is included in our consolidated results beginning on January 7, 2022. Total revenues and net loss attributable to Smiths Medical for the period from January 7, 2022 to December 31, 2022 were $950.7 million and $(74.3) million, respectively. The net loss figure is an estimate as the results by company are less identifiable due to integration. The following unaudited pro forma financial information presents the combined results of operations of ICU and Smiths Medical as if the acquisition had occurred on January 1, 2021. The pro forma financial information is presented for informational purposes only and is not indicative of the results of operations that would have been achieved if the acquisition had taken place on the date indicated or of results that may occur in the future.


	Twelve months ended December 31,
(In thousands)	2022		2021
Revenues	$	2,300,371	$	2,509,830
Net (Loss) Income	$	(70,286)	$	37,454

The unaudited pro forma results presented above include the impact of the following adjustments: incremental amortization expense on intangible assets acquired of $1.9 million and $24.7 million for the twelve months ended December 31, 2022, and 2021, respectively, incremental interest expense, including amortization of debt discount and debt issuance costs, on the Credit Facilities of $1.2 million and $73.5 million for the twelve months ended December 31, 2022, and 2021, respectively and a $27.4 million expense related to the increase in fair value of inventory for the twelve months ended December 31, 2021. The unaudited pro forma results include IFRS to U.S. GAAP adjustments for Smiths Medical historical results and adjustments for accounting policy alignment, which were materially similar to the Company. Any differences in accounting policies were adjusted to reflect the accounting policies of the Company in the unaudited pro forma results presented.

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. 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. The contingent earn-out based on the achievement of certain revenue targets obtained for the annual period ending December 31, 2022 was forfeited at December 31, 2022 as the minimum threshold for earning the earn-out was not met.

Restructuring, Strategic Transaction and Integration (Notes)

12 Months Ended

Dec. 31, 2022

Restructuring and Related Activities [Abstract]

Restructuring and Related Activities Disclosure [Text Block]

RESTRUCTURING, STRATEGIC TRANSACTION AND INTEGRATION

Restructuring, strategic transaction and integration expenses were $71.4 million, $18.0 million and $28.4 million in 2022, 2021 and 2020, respectively.

Restructuring

Restructuring charges were $9.7 million, $(1.8) million and $7.9 million in 2022, 2021 and 2020, respectively, and are included in the above restructuring, strategic transaction and integration expenses in our consolidated statement of operations.

In 2022, we incurred restructuring charges primarily related to severance in connection with the January 6, 2022 acquisition of Smiths Medical, see Note 2: Acquisitions.

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.

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


	Severance Pay and Benefits		Retention and Facility Closure Costs		Total
Accrued balance, January 1, 2021	$	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
Acquired restructuring charges	5,796		1,740		7,536
Charges incurred	9,667		58		9,725
Payments	(11,083)		(268)		(11,351)
Currency translation	(425)		(188)		(613)
Other adjustments	(38)		—		(38)
Accrued balance, December 31, 2022	$	4,416	$	1,507	$	5,923

_______________________________________________

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

Strategic Transaction and Integration Expenses

We incurred $61.7 million, $19.8 million and $20.5 million in strategic transaction and integration expenses in 2022, 2021 and 2020, respectively, which are included in restructuring, strategic transaction and integration expenses in our consolidated statement of operations. The strategic transaction and integration expenses during 2022 were primarily related to transaction and integration expenses associated with our acquisition of Smiths Medical on January 6, 2022 (see Note 2: Acquisitions) which primarily included legal expenses, bank fees, employee costs and a United Kingdom stamp tax. 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. 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.

Revenue (Notes)

12 Months Ended

Dec. 31, 2022

Revenue from Contract with Customer [Abstract]

Revenue from Contract with Customer [Text Block]

REVENUE

Revenue Recognition

Following the acquisition of Smiths Medical our primary product lines are Infusion Consumables, Infusion Systems, IV Solutions, Critical Care, Infusion Systems-Smiths Medical, Vascular Access-Smiths Medical and Vital Care-Smiths Medical. 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 both our distribution and end 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,
	2022				2021				2020
Product line	Revenue		% of Revenue		Revenue		% of Revenue		Revenue		% of Revenue
Infusion Consumables	$	566,617	25	%	$	555,189	42	%	$	473,740	37	%
Infusion Systems	351,080		15	%	352,321		27	%	359,691		28	%
IV Solutions	363,472		16	%	359,477		27	%	388,971		31	%
Critical Care	47,330		2	%	49,321		4	%	48,602		4	%
Infusion Systems-Smiths Medical	340,124		15	%	—		nm		—		nm
Vascular Access-Smiths Medical	326,765		14	%	—		nm		—		nm
Vital Care-Smiths Medical	284,609		13	%	—		nm		—		nm
Total Revenues	$	2,279,997	100	%	$	1,316,308	100	%	$	1,271,004	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	2022		2021		2020
United States	$	1,460,069	$	941,809	$	910,627
Europe, the Middle East and Africa	367,411		147,488		132,763
APAC	257,208		85,692		79,610
Other Foreign	195,309		141,319		148,004
Total Revenues	$	2,279,997	$	1,316,308	$	1,271,004

Domestic sales accounted for 64%, 72% and 72% of total revenue in 2022, 2021 and 2020, respectively. International sales accounted for 36%, 28% and 28% of total revenue in 2022, 2021 and 2020, 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, 2022 and 2021, (in thousands):


	Contract Liabilities
Beginning balance, January 1, 2021	$	(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)
Fair value of acquired deferred revenue	(51,245)
Equipment revenue recognized	32,252
Equipment revenue deferred due to implementation	(20,332)
Software revenue recognized	16,277
Software revenue deferred due to implementation	(17,557)
Government grant deferred revenue	(3,729)
Government grant recognized	1,514
Other deferred revenue	(1,500)
Other deferred revenue recognized	5,915
Ending balance, December 31, 2022	$	(45,866)

During 2022, we recognized $7.5 million in revenue that was included in the opening contract balances as of December 31, 2021.

As of December 31, 2022, revenue from remaining performance obligations is as follows:


	Recognition Timing
(in thousands)	<12 Months		> 12 Months
Equipment revenue	$	(15,144)	$	(982)
Software revenue	(8,277)		(1,026)
Government grant revenue	(1,422)		(12,797)
Other deferred revenue*	(4,784)		(1,434)
Total	$	(29,627)	$	(16,239)

____________________________

*Other deferred revenue includes pump development programs, purchased training and extended warranty.

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 https://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 https://asc.fasb.org/extlink&oid=126920106&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Paragraph 13
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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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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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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 https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Paragraph 12
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-URI https://asc.fasb.org/extlink&oid=126920106&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 https://asc.fasb.org/extlink&oid=126920106&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
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-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

+ Details

Leases (Notes)

12 Months Ended

Dec. 31, 2022

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, distribution facilities, 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,
	2022		2021		2020
Operating lease cost	$	22,038	$	11,251	$	11,284
Finance lease cost — interest	112		122		91
Finance lease cost — reduction of ROU asset	712		648		383
Short-term lease cost	7		14		263
Total lease cost	$	22,869	$	12,035	$	12,021

Interest expense on our finance leases is included in interest 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,
	2022		2021		2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases(1)	$	25,225	$	11,256	$	10,185
Operating cash flows from finance leases	$	112	$	122	$	91

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	5,994	$	2,589	$	20,847
Finance leases	$	715	$	558	$	3,062

_____________________________

(1) We acquired $55.2 million of operating right-of-use assets as part of the Smiths Medical acquisition, see Note 2: Acquisitions.

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,
	2022			2021
Operating leases
Operating lease right-of-use assets	$	74,864		$	39,847

Accrued liabilities	$	18,169		$	9,009
Other long-term liabilities	60,916			33,971
Total operating lease liabilities	$	79,085		$	42,980

Weighted-Average Remaining Lease Term
Operating leases	6.1 years			5.9 years

Weighted-Average Discount Rate
Operating leases	4.34		%	4.98		%

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,
	2022			2021
Finance leases
Finance lease right-of-use assets	$	2,598		$	2,673

Accrued liabilities	$	816		$	643
Other long-term liabilities	1,855			2,067
Total finance lease liabilities	$	2,671		$	2,710

Weighted-Average Remaining Lease Term
Finance leases	4.8 years			5.6 years

Weighted-Average Discount Rate
Finance leases	4.23		%	4.28		%

As of December 31, 2022, the maturities of our operating and finance lease liabilities for each of the next five years are approximately (in thousands):


	Operating Leases		Finance Leases
2023	$	21,800	$	914
2024	17,786		657
2025	12,699		442
2026	11,297		322
2027	7,830		189
Thereafter	17,346		426
Total Lease Payments	88,758		2,950
Less imputed interest	(9,673)		(279)
Total	$	79,085	$	2,671

Share Based Award Share awards (Notes)

12 Months Ended

Dec. 31, 2022

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)	2022		2021		2020
Stock compensation expense	$	36,025	$	27,341	$	23,954
Tax benefit from stock-based compensation cost	$	4,636	$	6,391	$	5,564
Indirect tax benefit	$	749	$	285	$	1,203

As of December 31, 2022, we had $43.0 million of unamortized stock compensation cost which we will recognize as an expense over a weighted-average period of approximately 0.8 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, 2022, 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,
	2022			2021			2020
Number of time-based options granted	7,620			7,910			7,190
Grant-date fair value of options granted (in thousands)	$	540		$	528		$	425
Weighted-average assumptions for stock option valuation:
Expected term (years)	5.5			5.5			5.5
Expected stock price volatility	36.0		%	35.0		%	35.0		%
Risk-free interest rate	3.0		%	0.9		%	0.4		%
Expected dividend yield	—		%	—		%	—		%
Weighted-average grant-price per option	$	185.79		$	200.07		$	181.99
Weighted-average grant-date fair value per option	$	70.86		$	66.78		$	59.09

A summary of our stock option activity as of and for the year ended December 31, 2022 is as follows:


	Shares	Weighted-Average Exercise Price Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding at December 31, 2021	663,098	$	74.75
Granted	7,620	$	185.79
Exercised	(142,772)	$	61.53
Forfeited or expired	(485)	$	60.01
Outstanding at December 31, 2022	527,461	$	79.94	2.0	$	42,708
Exercisable at December 31, 2022	519,841	$	78.39	2.0	$	42,708
Vested and expected to vest, December 31, 2022	527,461	$	79.94	1.9	$	42,708

The intrinsic values for options exercisable, outstanding and vested or expected to vest at December 31, 2022 are based on our closing stock price of $157.48 at December 31, 2022 and are before applicable taxes.

The following table presents information regarding stock option activity:


	Year ended December 31,
(In thousands)	2022		2021		2020
Intrinsic value of options exercised	$	17,340	$	27,534	$	32,915
Cash received from exercise of stock options	$	8,785	$	9,372	$	13,193
Tax benefit from stock option exercises	$	3,637	$	5,092	$	5,179

Stock Awards

In 2022, we granted our annual PRSUs to our executive officers and certain other non-executive employees. These PRSUs will cliff-vest on March 7, 2024 subject to the achievement of net synergy savings targets related to the Smiths Medical acquisition achieved during the performance period commencing on January 1, 2022 and ending on December 31, 2023, which when reviewed against predetermined targets could result in 0% to 200% of the awarded units that could vest. We also granted certain other one-off PRSU awards to non-executive employees with various performance requirements, whereby the performance shares will be earned if the minimum requirements are met within a specified time period.

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 February 2023, the Compensation Committee made the determination that the executive officers other than the CEO, CFO and COO met their individual performance goals for 2022, therefore a third of their 2020 PRSU shares awarded vested during 2023. The performance period related to the 2020 CEO and COO PRSUs ended on December 31, 2022 and is subject to the Compensation Committee review and determination of shares earned based on the Cumulative revenue and EPS results achieved during the performance period.

In 2019, we granted PRSUs to our executive officers. For the executive officers other than the CEO and the COO, the PRSUs vested subject to a three-year time vesting and further subject to a determination by the Compensation Committee that the officers had met their individual performance goals for the applicable years. For the CEO and the COO, the performance shares were to cliff-vest on March 6, 2022, subject to the achievement of a minimum Cumulative Adjusted EBITDA and continuous service through that date. If for the three year period ending on December 31, 2021 the Cumulative Adjusted EBITDA had a growth of at least 6% to 8%, 50% of the awarded units would have vested. If on the vesting date the Cumulative Adjusted EBITDA had a growth of between 8% to 10%, 100% of the awarded units would have vested. If on the vesting date the Cumulative Adjusted EBITDA has a growth of over 10%, 200% of the awarded units would have vested. In 2019, we also granted PRSUs to one of our non-executive employees. These PRSUs vested at the end of a three-year period ending on March 31, 2022, based on meeting certain minimum performance goals. In February 2022, the Compensation Committee made the determination that the executive officers other than the CEO and COO met their individual performance goals for 2022, therefore, the final third of their 2019 PRSU shares awarded vested during 2022. The performance period related to the 2019 CEO and COO PRSUs ended on December 31, 2021 and in February 2022 the Compensation Committee determined that zero PRSUs were earned based on the actual Cumulative Adjusted EBITDA achieved during the performance period.

In 2018, we granted PRSUs to our executive officers. For the executive officers other than the CEO and the COO, the PRSUs were vested 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 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 had a growth of at least 6% to 8%, 50% of the awarded units would vest. If on the vesting date the Cumulative Adjusted EBITDA had a growth of between 8% to 10%, 100% of the awarded units would vest. If on the vesting date the Cumulative Adjusted EBITDA had a growth of over 10%, 200% of the awarded units would 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 based on the actual Cumulative Adjusted EBITDA achieved during the performance period 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 was at least $600 million but less than $650 million, 100% of the awarded units would vest. If our Cumulative Adjusted EBITDA was at least $650 million but less than $700 million, 200% of the awarded units would vest. If our Cumulative Adjusted EBITDA is at least $700 million, 300% of the awarded units would vest. On January 17, 2020, the Compensation Committee determined that based on the actual Cumulative Adjusted EBITDA achieved during the performance period that the 2017 PRSU shares were earned by our executive officers at the 300% achievement level.

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

In 2022, 2021 and 2020, 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)	2022		2021		2020
PRSU
Shares granted	60,383		53,246		38,633
Shares earned (a)	46,317		32,013		80,654
Grant-date fair value per share	$	230.31	$	198.16	$	188.34
Grant-date fair value	$	13,907	$	10,551	$	7,276
Intrinsic value vested	$	10,487	$	6,777	$	15,627

RSU
Shares granted	116,870		84,388		87,830
Grant-date fair value per share	$	221.65	$	199.13	$	188.13
Grant-date fair value	$	25,905	$	16,804	$	16,523
Intrinsic value vested	$	16,438	$	13,681	$	12,314

_______________________________

(a) 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. PRSU shares earned in 2022 were related to performance awards granted to executives in 2019, 2020 and 2021 and performance awards granted to a non-executive employee in 2019, 2020 and 2021.

The table below provides a summary of our PRSU and RSU activity as of and for the year ended December 31, 2022:


	Number of Units	Grant-Date Fair Value Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Non-vested at December 31, 2021	275,761	$	201.05
Change in units due to performance expectations (a)	32,346	$	239.63
Granted	177,253	$	224.60
Vested	(118,321)	$	206.40
Forfeited	(13,035)	$	218.24
Non-vested and expected to vest at December 31, 2022	354,004	$	213.95	1.0	$	55,749

_______________________________

(a) Relates to net adjustments to 2019, 2020, 2021 and 2022 PRSUs granted to executives and certain non-executive employees. 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, 2022, there were no shares available for future issuance, all shares unissued under the plan expired during 2022. 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, 2022

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. 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 (loss) income and we reclassify that gain or loss into earnings in the same line item associated with the forecasted transaction and in the same period during which the hedged transaction affects earnings.

Foreign Currency Exchange Rate Risk

Forward Exchange Forward Contracts

We enter into foreign exchange forward contracts to hedge a portion of our forecasted foreign currency-denominated revenues and expenses to minimize the effect of foreign exchange rate movements on the related cash flows. These contracts are agreements to buy or sell a quantity of a currency at a predetermined future date and at a predetermined exchange rate. Our foreign exchange forward contracts hedge exposures principally denominated in Mexican Pesos ("MXN"), Euros, Czech Koruna ("CZK"), Japanese Yen ("JPY"), U.S. Dollar ("USD"), Chinese Renminbi ("CNH"), Canadian Dollar ("CAD") and Australian Dollar ("AUD") and have varying maturities with an average term of approximately twelve months. The total notional amount of these outstanding derivative contracts as of December 31, 2022 was $206.0 million, which included the notional equivalent of $61.3 million in MXN, $31.7 million in Euros, $13.9 million in CZK, $15.3 million in JPY, $11.5 million in CNH, $43.2 million in USD, $11.6 million in CAD, $11.9 million in AUD and $5.6 million in other foreign currencies, with terms currently through February 2024. Certain contracts were acquired as part of the Smiths Medical acquisition. We did not have such derivative contracts as of December 31, 2021.

Cross-currency Par Forward Contracts

We entered into cross-currency par forward contracts to hedge a portion of our Mexico forecasted expenses denominated in MXN. These contracts are agreements to exchange cash flows from one currency to another at specified intervals over the contract term with all exchanges occurring at the same predetermined rate.

In November 2018, we hedged a portion of our Mexico forecasted expenses denominated in Pesos ("MXN") by entering 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 matured 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 the new senior secured credit facilities in January 2022, which included a variable-rate term loan A and a variable-rate term loan B (see Note 11: Long-term Debt), we entered into two forward-starting interest rate swaps. In February 2022, certain terms under the agreements were amended to reflect the transition from LIBOR to the Secured Overnight Financing Rate ("SOFR"), an alternative reference rate. 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, as amended, has an initial notional amount of

$300.0 million, reducing to $150.0 million evenly on a quarterly basis through its final maturity on March 30, 2027. We will pay a fixed rate of 1.32% and will receive the greater of 3-month USD SOFR or (0.15)%. The term loan B swap, as amended, has an initial notional amount of $750.0 million, reducing to $46.9 million evenly on a quarterly basis excluding its final maturity on March 30, 2026. We will pay a fixed rate of 1.17% and will receive the greater of 3-month USD SOFR or 0.35%. 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		Interest Rate Swaps		Gross Derivatives
	(In thousands)
As of December 31, 2022
Prepaid expenses and other current assets	$	4,860	$	28,431	$	33,291
Other assets	94		26,753		26,847
Total assets	$	4,954	$	55,184	$	60,138

Accrued liabilities	$	1,847	$	—	$	1,847
Other long-term liabilities	167		—		167
Total liabilities	$	2,014	$	—	$	2,014

	Derivatives Designated as Cash Flow Hedging Instruments
As of December 31, 2021	Foreign Exchange Forward Contracts		Forward-Starting Interest Rate Swaps		Gross Derivatives
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

The following table presents the effects of our derivative instruments designated as cash flow hedges on the Consolidated Statements of Operations (in thousands):


	Gain Reclassified From Accumulated Other Comprehensive (Loss) Income into Net (Loss) Income
	Location of Gain in the Consolidated Statements of Operations	Year Ended December 31,
		2022		2021		2020
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	Total revenues	$	3,829	$	—	$	—
Foreign exchange forward contracts	Cost of goods sold	7,751		3,444		790
Foreign exchange forward contracts	Interest expense(1)	717		—		—
Interest rate swaps	Interest expense	$	6,122	$	—	$	—
Total derivatives designated as cash flow hedging instruments		$	18,419	$	3,444	$	790

_______________________________

(1) Represents location of gain reclassified from accumulated other comprehensive (loss) income to net (loss) income as a result of a forecasted transaction being no longer probable of occurring.

We recognized the following gains (losses) on our derivative instruments designated as cash flow hedges in other comprehensive (loss) income before reclassifications to net (loss) income (in thousands):


	Amount of Gain (Loss) Recognized in Other Comprehensive (Loss) Income
	Year Ended December 31,
	2022		2021		2020
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	$	9,588	$	950	$	1,980
Interest rate swaps	62,786		(1,480)		—
Total derivatives designated as cash flow hedging instruments	$	72,374	$	(530)	$	1,980

As of December 31, 2022, we expect an estimated $3.0 million in deferred gains on the outstanding foreign exchange forward contract and an estimated $29.3 million in deferred gains 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, 2022

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, 2022, 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. As of December 31, 2022, the estimated fair value for the contingent consideration related to certain product-related regulatory certifications was estimated to be $1.5 million. As of December 31, 2022, the measurement period related to the contingent earn-out based on certain revenue targets ended and based on the actual revenue achieved during the measurement period we determined the fair value of the contingent earn-out was zero as the minimum threshold for earning the earn-out was not met.

On January 6, 2022, we acquired Smiths Medical with a combination of cash consideration and share consideration issued at closing. Total consideration for the acquisition includes a potential earn-out payment of $100.0 million in cash contingent on our common stock achieving certain Price Targets from the closing date to either the third or fourth anniversary of closing (see Note 2: Acquisitions) and provided Smiths beneficially owns at least 50.0% of the shares of common stock issued at closing at the time the Price Target is achieved. The initial estimated fair value of the earn-out was determined to be $53.5 million using a Monte Carlo simulation model. The model utilized several assumptions including volatility and the risk-free interest rate. The assumed volatility is based on the average of the historical volatility of our common stock price and the implied volatility of certain at-the-money traded options. The risk-free interest rate is equal to the yield on U.S. Treasury securities at constant maturity for the period commensurate with the term of the earn-out. At each reporting date subsequent to the acquisition, we remeasure the earn-out liability and recognize any changes in its fair value in our consolidated statements of operations. If the probability of achieving the Price Targets during their respective measurement periods is significantly greater than initially anticipated, the realization of an additional liability and related expense will have a significant impact on our consolidated financial statements in the period recognized. As of December 31, 2022, the estimated fair value of the contingent earn-out is $21.0 million.

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, 2022, 2021 and 2020 (in thousands):


	Earn-out Liability
Contingent earn-out liability, January 1, 2020	$	17,300
Change in fair value of contingent earn-out (included in income from operations as a separate line item)(1)	9,000

Contingent earn-out liability, December 31, 2020	26,300
Contingent earn-out con-compete arrangement	2,589

Transfer of Pursuit earn-out liability into Level 2(2)	(26,300)
Contingent earn-out liability, December 31, 2021	2,589
Acquisition date fair value estimate of earn-out(3)	55,158

Change in fair value of contingent earn-out (included in income from operations as a separate line item)(4)	(32,091)

Currency translation	(84)
Contingent earn-out liability, December 31, 2022	$	25,572

_______________________________

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

(2) 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.

(3) $53.5 million relates to our acquisition of Smiths Medical and $1.6 million relates to our acquisition of a small foreign infusions systems supplier in the fourth quarter of 2021 (see Note 2: Acquisitions).

(4) Includes an adjustment to reduce to zero a contingent earn-out issued as part of the 2021 acquisition of a small foreign infusion systems supplier. The contingent earn-out was not earned based on our determination that the threshold target was not met.

The following tables provide quantitative information about Level 3 inputs for fair value measurement of our earn-out liabilities related to Smiths Medical and Pursuit:

Smiths Medical Earn-out


	As of December 31, 2022		At Acquisition January 6, 2022
Simulation Input
Volatility	38.00	%	37.00	%
Risk-Free Rate	4.17	%	1.31	%

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

Our investments consist of corporate and government bonds and U.S treasury securities. The fair value of our corporate and government bonds are estimated using observable market-based inputs such as quoted prices, interest rates and yield curves or Level 2 inputs. The fair value of our U.S. treasury securities are based on quoted market prices in active markets and are included in the Level 1 fair value hierarchy.

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 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 2022 or 2021.

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, 2022
	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 corporate bonds	$	2,314	$	—	$	2,314	$	—
Short-term U.S. treasury securities	1,412		1,412		—		—
Short-term government bonds	498		—		498		—
Long-term corporate bonds	516		—		516		—


Foreign exchange forwards:
Prepaid expenses and other current assets	4,860		—		—		4,860
Other assets	94		—		—		94
Interest rate contracts:
Prepaid expenses and other current assets	28,431		—		—		28,431
Other assets	26,753		—		—		26,753
Total Assets	$	64,878	$	1,412	$	3,328	$	60,138

Liabilities:

Contingent earn-out liability - LT	$	25,572	$	—	$	—	$	25,572
Foreign exchange contracts:
Accrued liabilities	1,847		—		—		1,847
Other long-term liabilities	167		—		—		167


Total Liabilities	$	27,586	$	—	$	—	$	27,586


	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

- 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, 2022

Prepaid Expense and Other Assets [Abstract]

Prepaids, other current assets and other noncurrent 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,
	2022		2021
Other prepaid expenses and receivables	$	21,635	$	14,763
Prepaid vendor expenses	3,052		—
Deferred costs	2,395		12,746
Prepaid insurance and property taxes	16,322		6,310
VAT/GST receivable	3,546		4,156
Deferred tax charge	3,830		4,241
Foreign exchange forward contract	4,860		1,061
Interest rate contracts	28,431		—
Deposits	1,329		1,343
Other	3,532		2,227
	$	88,932	$	46,847

Other assets consist of the following (in thousands):


	As of December 31,
	2022		2021
Pump lease receivables	$	27,086	$	25,941
Spare parts	38,498		28,538
Equity method investments	3,178		3,238
Interest rate contracts	26,753		—

Deferred debt issuance costs	5,156		2,827
Finance lease right-of-use assets	2,598		2,673
Other	2,193		526
	$	105,462	$	63,743

Accrued Liabilities an Other Long-term Liabilities

12 Months Ended

Dec. 31, 2022

Accrued Liabilities and Other 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,
	2022		2021
Salaries and benefits	$	44,304	$	27,304
Incentive compensation	30,254		33,107

Operating lease liability-ST	18,169		9,009
Accrued professional fees	5,317		773
Field service corrective action(1)	24,517		—


Legal accrual	3,137		3,897
Accrued sales taxes	5,844		1,980
Warranties and returns	3,097		532
Deferred revenue	30,838		12,646

Accrued other taxes	5,794		4,337
Distribution fees	17,063		5,645
Accrued freight	17,988		9,194
Restructuring accrual	5,923		664
Foreign exchange contracts	1,847		—
Accrued audit fees	6,279		1,008
Defined benefit plan	2,928		—
Accrued interest	1,033		—




Accrued research and development	3,538		—
Other	14,899		8,099
	$	242,769	$	118,195

_____________________________

(1) Includes field corrective actions associated with certain products in connection with a 2021 Warning Letter received by Smiths Medical from the FDA following an inspection of Smiths Medical's Oakdale, Minnesota Facility, see Note 15: Commitments and Contingencies for further detail.

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


	As of December 31,
	2022		2021
Operating lease liability-LT	$	60,916	$	33,971
Finance lease liability-LT	1,855		2,067

Deferred revenue	16,239		—
Forward-starting interest rate swaps	—		1,480
Benefits	5,314		1,369
Field service corrective action(1)	25,294		—
Accrued rent	997		1,262

Other	3,489		1,681
	$	114,104	$	41,830

_______________________________

Debt

12 Months Ended

Dec. 31, 2022

Debt Disclosure [Abstract]

Debt Disclosure [Text Block]

LONG-TERM OBLIGATIONS

2022 Credit Agreement

On January 6, 2022, in connection with 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”) for $2.2 billion of senior secured credit facilities. The senior secured credit facilities include (i) a five-year Tranche A term loan of $850.0 million (the "Term Loan A"), (ii) a seven-year Tranche B term loan of $850.0 million (the "Term Loan B") and (iii) a five-year revolving credit facility of $500.0 million (the "Revolving Credit Facility"), with separate sub-limits of $50.0 million for letters of credit and swingline loans (collectively, the "Senior Secured Credit Facilities"). We used the proceeds from borrowings under the Term Loan A and the Term Loan B (collectively, the "Term Loans") to fund a portion of the cash consideration for the purchase of Smiths Medical and the related fees and expenses incurred in connection with the acquisition. We did not incur borrowings under the Revolving Credit Facility on the closing date of the acquisition. The proceeds from any future borrowings under the Revolving Credit Facility may be used for working capital and other general corporate purposes.

In connection with entering into the Credit Agreement, during the period ended March 31, 2022, we incurred $37.8 million in debt discount and issuance costs, which were allocated to the Term Loan A, the Term Loan B and the Revolving Credit Facility based on lender commitment amounts relative to each type of fees paid. The lender and third-party discount and issuance costs allocated to the Term Loan A and the Term Loan B were $15.8 million and $13.4 million, respectively, and are reflected as a direct deduction from the face amount of the corresponding term loans on the consolidated balance sheet. These costs are being amortized to interest expense over the respective terms of the loans using the effective interest method. The issuance costs allocated to the Revolving Credit Facility were $8.6 million, which are capitalized and included in prepaid expenses and other current assets and other assets on our consolidated balance sheets. These costs are being amortized to interest expense over the term of the Revolving Credit Facility using the straight-line method.

The net funds received from the Term Loan A and the Term Loan B, after deducting debt issuance costs, were $834.2 million and $836.6 million, respectively.

Maturity Dates

The maturity date for the Term Loan A and the Revolving Credit Facility is January 6, 2027 and the maturity date for the Term Loan B is January 6, 2029. Pursuant to the terms and conditions of the Credit Agreement, the maturity dates of the Term Loans and the Revolving Credit Facility may be extended upon our request, subject to the consent of the Lenders.

Interest Rate Terms

In general, the Term Loans and borrowings under the Revolving Credit Facility denominated in U.S. dollars bear interest, at our option, on either: (1) the Base Rate, as defined below, plus the applicable margin, as indicated below ("Base Rate Loans") or (2) the Adjusted Term Secured Overnight Financing Rate ("Adjusted Term SOFR"), as defined below, plus the applicable margin, as indicated below ("Term SOFR Loans").

The Base Rate is defined as the highest of (a) the Prime Rate, (b) the Federal Funds Rate plus 0.50% and (c) Adjusted Term SOFR (as defined below) for a one-month period plus, in each case, 1.00%.

Adjusted Term SOFR is the rate per annum equal to (a) the Term SOFR plus (b) the Term SOFR Adjustment. Term SOFR is the forward-looking term rate based on SOFR and is calculated separately for Term SOFR Loans and Base Rate Loans, as specified in the Credit Agreement. The Term SOFR Adjustment is a percentage per annum of 0.10% for Base Rate Loans and between 0.10% to 0.25% for Term SOFR Loans based on the applicable interest period.

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. Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ended June 30, 2022, the commitment fee will be determined by reference to the leverage ratio in effect from time to time as set forth in the table below.

Applicable Interest Margins

The Term Loan A and borrowings under the Revolving Credit Facility have an initial applicable margin of 0.75% per annum for Base Rate Loans and 1.75% per annum for Term SOFR Loans.

Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ended June 30, 2022, the applicable margin for the Term Loan A and borrowings under the Revolving Credit Facility will be determined by reference to the leverage ratio in effect from time to time as set forth in the following table:


Leverage Ratio	Applicable Margin for Term SOFR Loans	Applicable Margin for Base Rate Loans	Commitment Fee Rate
Greater than 4.00 to 1.0	2.25%	1.25%	0.35%
Less than or equal to 4.00 to 1.0 but greater than 3.00 to 1.0	2.00%	1.00%	0.30%
Less than or equal to 3.00 to 1.0 but greater than 2.50 to 1.0	1.75%	0.75%	0.25%
Less than or equal to 2.50 to 1.0 but greater than 2.00 to 1.0	1.50%	0.50%	0.20%
Less than or equal to 2.00 to 1.0	1.25%	0.25%	0.15%

The Term Loan B has an initial applicable margin of 1.5% per annum for Base Rate Loans and 2.5% per annum for Term SOFR Loans.

Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ended June 30, 2022, the applicable margin for the Term Loan B will be determined by reference to the leverage ratio in effect from time to time as set forth in the following table:


Leverage Ratio	Applicable Margin for Term SOFR Loans	Applicable Margin for Base Rate Loans
Greater than 2.75 to 1.0	2.50%	1.50%
Less than 2.75 to 1.0	2.25%	1.25%

Principal Payments

Principal payments on the Term Loans are due on the last day of each calendar quarter commencing on June 30, 2022.

The Term Loan A will amortize in nineteen consecutive quarterly installments in an amount equal to 2.50% of the original principal amount in each of the first two years, 5.00% in each of the third and fourth years and 7.50% in the fifth year, with a final payment of the remaining outstanding principal balance due on the maturity date.

The Term Loan B matures in twenty-seven consecutive quarterly installments in an amount equal to 0.25% of the original principal amount, with a final payment of the remaining outstanding principal balance due on the maturity date.

We may borrow, prepay and re-borrow amounts under the Revolving Credit Facility, in accordance with the terms and conditions of the Credit Agreement, with all outstanding amounts due at maturity.

During March 2022, we prepaid $16.0 million in principal payments on the Term Loan A principal balance. For the year ended December 31, 2022, including the prepayment, we paid a total of $22.4 million in principal payments on both Term Loans.

Interest Payments

Interest payments on Base Rate Loans are payable quarterly in arrears on the last business day of each calendar quarter and the applicable maturity date. Interest periods on Term SOFR Loans will be determined, at our option, as either one, three or six months and will be payable on the last day of each interest period and the applicable maturity date. In the case of any interest periods of more than three months' duration, the interest payment will be payable on each day prior to the last day of such interest period that occurs at three-month intervals.

The commitment fee on the Revolving Credit Facility is payable quarterly in arrears on the third business day following the last day of each calendar quarter and at the maturity date. The commitment fee is included in interest expense in our consolidated statements of operations.

Guarantors and Collateral

Our obligations under the Credit Agreement are unconditionally guaranteed, on a joint and several basis, by ICU Medical, Inc. and certain of our existing subsidiaries.

Debt Covenants

The Credit Agreement contains affirmative and negative covenants, including certain financial covenants. The negative covenants include restrictions regarding the incurrence of liens and indebtedness, certain merger and acquisition transactions, asset sales and other dispositions, other investments, dividends, share purchases and payments affecting subsidiaries, changes in nature of business, fiscal year or organizational documents, prepayments and redemptions of subordinated and other junior debt, transactions with affiliates, and other matters.

The financial covenants include the Senior Secured Leverage Ratio and the Interest Coverage Ratio, both defined below, and pertain to the Term Loan A and the Revolving Credit Facility.

The Senior Secured Leverage Ratio is defined, at any measurement date, as the ratio of: (a) all Funded Debt, as defined in the Credit Agreement, that is secured by a lien on any asset or property minus the lesser of (i) all unrestricted cash and cash

equivalents and (ii) $500.0 million, to (b) Consolidated EBITDA, as defined in the Credit Agreement, for the most recently completed four fiscal quarters, calculated on a pro forma basis. The maximum Senior Secured Leverage Ratio is 4.50 to 1.00 until June 30, 2024. Thereafter, the maximum Senior Secured Leverage Ratio is 4.00 to 1.00, with limited permitted exception.

The Interest Coverage ratio is defined, at any measurement date, as the ratio of Consolidated EBITDA, as defined in the Credit Agreement, to Consolidated Interest Expense, as defined in the Credit Agreement, paid or payable in cash, for the most recently completed four fiscal quarters. The minimum Interest Coverage ratio is 3.00 to 1.00.

We were in compliance with all financial covenants as of December 31, 2022.

The Credit Agreement contains customary events of default, including, among others: non-payments of principal and interest; breach of representations and warranties; covenant defaults; cross-defaults and cross-acceleration to certain other material indebtedness; the existence of bankruptcy or insolvency proceedings; 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 all amounts due and the termination of commitments under the Senior Secured Credit Facilities.

2017 Credit Facility

On November 8, 2017, we entered into a five-year senior secured revolving credit facility with various lenders for $150.0 million, with Wells Fargo Bank, National Association as the administrative agent, swingline lender and issuing lender (the "Credit Facility"). The Credit Facility, which was set to mature on November 8, 2022, was terminated in connection with entering into the Credit Agreement on January 6, 2022. There were no borrowings outstanding under the Credit Facility at that date or at December 31, 2021. The remaining unamortized deferred debt issuance costs related to the Credit Facility were not material and were expensed in connection with its termination.

The carrying values of our long-term debt consist of the following (in thousands):


	Effective Interest Rate		As of December 31, 2022

Senior Secured Credit Facilities:
Term Loan A — principal	3.99	%	$	834,000
Term Loan B — principal	4.61	%	843,625
Revolving Credit Facility — principal	—	%	—
Less unamortized debt issuance costs(1)			(24,262)
Total carrying value of long-term debt			1,653,363
Less current portion of long-term debt			29,688
Long-term debt, net			$	1,623,675

_______________________________

(1) Comprised of $12.6 million and $11.7 million relating to the Term Loan A and the Term Loan B, respectively.

As of December 31 2022, the aggregate amount of principal repayments of our long-term debt (including any current portion) for each of the next five years is approximately (in thousands):


2023	$	29,688
2024	51,000
2025	51,000
2026	72,250
2027	672,500
Thereafter	801,187
Total	$	1,677,625

The following table presents the total interest expense related to our long-term debt (in thousands):


	Year Ended December 31,
	2022		2021		2020
Contractual interest	$	66,770	$	—	$	1,251
Amortization of debt issuance costs	6,972		240		288
Commitment fee — Revolving Credit Facility	1,290		221		110
Total long-term debt-related interest expense	$	75,032	$	461	$	1,649

- 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

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-URI https://asc.fasb.org/topic&trid=2208564

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (h)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (c)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Paragraph 1I
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (d)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (g)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1E
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495348-112611

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (i)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

+ Details

Income Taxes:

12 Months Ended

Dec. 31, 2022

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,
	2022		2021		2020
United States	$	(135,646)	$	81,484	$	41,194
Foreign	21,237		41,702		56,300
	$	(114,409)	$	123,186	$	97,494

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


	Year Ended December 31,
	2022		2021		2020
Current:
Federal	$	4,128	$	20,646	$	6,032
State	3,799		3,444		2,422
Foreign	12,924		7,236		7,290
	$	20,851	$	31,326	$	15,744
Deferred:
Federal	$	(42,012)	$	(8,154)	$	(5,319)
State	(11,239)		(1,815)		(1,850)
Foreign	(7,723)		(1,306)		2,049
	(60,974)		(11,275)		(5,120)
	$	(40,123)	$	20,051	$	10,624

We have accrued for tax contingencies for potential tax assessments, and in 2022 we recognized a $2.0 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,
	2022				2021				2020
	Amount		Percent		Amount		Percent		Amount		Percent
Federal tax at the expected statutory rate	$	(24,026)	21.0	%	$	25,869	21.0	%	$	20,474	21.0	%
State income tax, net of federal effect	(5,050)		4.4	%	2,907		2.4	%	2,099		2.2	%
Tax credits	(3,636)		3.2	%	(2,443)		(2.0)	%	(3,269)		(3.4)	%

Global intangible low-taxed income	2,303		(2.0)	%	711		0.6	%	163		0.2	%
Foreign income tax differential	(2,943)		2.5	%	(2,983)		(2.4)	%	(3,888)		(4.0)	%
Stock-based compensation	(3,721)		3.2	%	(4,263)		(3.5)	%	(4,686)		(4.8)	%
Foreign-derived intangible income	(2,269)		2.0	%	(3,775)		(3.1)	%	(2,718)		(2.8)	%
Transaction cost	2,299		(2.0)	%	—		—	%	—		—	%
Contingent consideration	(6,830)		6.0	%	(29)		—	%	1,566		1.6	%
Section 162(m)	3,942		(3.4)	%	1,812		1.5	%	1,079		1.1	%
Other	(192)		0.2	%	2,245		1.8	%	(196)		(0.2)	%
	$	(40,123)	35.1	%	$	20,051	16.3	%	$	10,624	10.9	%

Tax credits in 2022, 2021 and 2020 consist principally of research and developmental tax credits.

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


	As of December 31,
	2022		2021
Deferred tax asset:


Accruals/other	$	17,351	$	7,796



Acquired future tax deductions	14,186		5,440
Stock-based compensation	6,240		7,283
Foreign currency translation adjustments	—		3,360
Tax credits	12,906		11,953

Inventory reserves	25,100		8,199
Warranty reserve	13,241		127
Section 163(j)	9,166		—


Chargebacks, discounts, customer concessions	39,508		27,970
Valuation allowance	(11,166)		(2,934)
	$	126,532	$	69,194
Deferred tax liability:
State income taxes	$	1,816	$	2,724


Depreciation and amortization	209,687		20,483
Section 481(a) adjustment - change in accounting method	—		4,873


Foreign currency translation adjustments	9,581		—
	$	221,084	$	28,080

Deferred tax (liability) asset, net	$	(94,552)	$	41,114

Tax Holidays and Carryforwards

Net operating loss ("NOL") carryforwards consist of: (a) federal NOL carryforwards of $1.9 million which will expire at various dates from 2023 to indefinite carryforward periods, (b) state NOL carryforwards of $4.3 million which will expire at various dates from 2026 to indefinite carryforward periods and (c) foreign NOL carryforwards of $46.3 million which will expire at various dates from 2023 to indefinite carryforward periods. We believe that it is more likely than not that the benefit

from certain foreign NOL carryforwards will not be realized. In recognition of this risk, we have provided a valuation allowance of $11.5 million on the $12.7 million DTAs related to these foreign NOL carryforwards. 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 $18.5 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 2029. 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 $8.1 million or $0.34 per diluted share in 2022 and by $9.8 million or $0.45 per diluted share in 2021.

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, 2022, we have estimated $209.2 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 2019 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, 2022 was $54.1 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, 2022, it is reasonably possible that the expiration of the U.S. federal statute of limitations will cause the gross amount of unrecognized tax benefits to decrease by $7.8 million. It is not possible to estimate any other 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 accrued for penalties and interest of $2.3 million and $2.2 million, respectively as of December 31, 2022.

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


	Year Ended December 31,
	2022		2021		2020
Beginning balance	$	21,537	$	18,443	$	15,027
Increases to prior year tax positions	148		231		502
Increases due to acquisitions	29,606		—		—
Increases to current year tax positions	4,706		3,242		2,987

Decreases to prior year tax positions	(222)		—		(15)

Decrease related to lapse of statute of limitations	(1,722)		(31)		(58)
Decrease related to settlements with tax authorities	—		(348)		—
Ending balance	$	54,053	$	21,537	$	18,443

- 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, 2022

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. In 2022, we had worldwide net sales to Medline of 15% of consolidated net sales.

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,
	2022		2021
Costa Rica	$	128,179	$	115,187
Mexico	99,849		79,567
Other LATAM	39,270		36,907
Canada	5,374		4,716
Italy	24,323		12,435



Spain	18,948		13,295
Czech Republic	10,732		—
Other Europe	11,375		4,171
APAC	20,930		20,452
Total Foreign	$	358,980	$	286,730
United States	803,577		618,374
Worldwide Total	$	1,162,557	$	905,104

Stockholders' Equity

12 Months Ended

Dec. 31, 2022

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 2022, 2021 or 2020. We are limited on share purchases in accordance with the terms and conditions of our Senior Secured Credit Facilities (see Note 11: Long-Term Obligations).

In 2022, we withheld 47,664 shares of our common stock from employee vested restricted stock units in consideration for $10.9 million in payments for the employees' share award income tax withholding obligations. We had 1,633 shares remaining in treasury at December 31, 2022.

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.

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, 2020	$	(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)
Other comprehensive loss before reclassifications	(103,928)		54,962		1,203		(47,763)
Amounts reclassified from AOCI	—		(13,946)		—		(13,946)
Other comprehensive loss	(103,928)		41,016		1,203		(61,709)
Balance as of December 31, 2022	$	(122,973)	$	40,779	$	1,216	$	(80,978)

- 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, 2022
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 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, 2022, 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. As of December 31, 2022, the estimated fair value for the contingent consideration related to certain product-related regulatory certifications was estimated to be $1.5 million. As of December 31, 2022, the measurement period related to the contingent earn-out based on certain revenue targets ended and based on the actual revenue achieved during the measurement period we determined the fair value of the contingent earn-out was zero as the minimum threshold for earning the earn-out was not met. On January 6, 2022, we acquired Smiths Medical. Total consideration for the acquisition includes a potential earn-out payment of $100.0 million in cash contingent on our common stock achieving a certain volume-weighted average price from the closing date to either the third or fourth anniversary of closing. As of December 31, 2022, the estimated fair value of the contingent earn-out is $21.0 million (see Note 8: Fair Value Measurements). Prior to being acquired, during 2021, Smiths Medical received a Warning Letter from the FDA following an inspection of Smiths Medical’s Oakdale, Minnesota Facility. The Warning Letter cited, among other things, failures to comply with FDA's medical device reporting requirements and failures to comply with applicable portions of the Quality System Regulation. A provision for the estimated costs related to the field service corrective action was recorded on the opening acquired balance sheet of Smiths Medical. The initial estimate recorded was based on a probability-weighted estimate of the costs required to settle the obligation. The actual costs to be incurred are dependent upon the scope of the work necessary to achieve regulatory clearance and could differ from the original estimate. The estimated field service corrective action recorded at December 31, 2022 is $49.8 million. 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, 2022
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 included a minimum purchase obligation of $29.6 million. The minimum purchase obligation under the addendum was satisfied during 2022. The Product Addendum expired on November 30, 2022.

Subsequent Events	12 Months Ended
Subsequent Events	Dec. 31, 2022
Subsequent Events [Abstract]
Subsequent Events	SUBSEQUENT EVENTSOn January 19, 2023, we entered into a revolving $150 million uncommitted receivables purchase agreement with Bank of The West ("BOW") which provides for a less expensive form of capital. The discount rate applied to the sold receivables equals, a rate per annum equal to the sum of (i) an applicable margin of 1.75%, plus (ii) Term SOFR for a period equal to the discount period which is calculated with respect to the payment terms of the specific receivable. The accounts receivable to be sold have payment terms ranging between 30 and 60 days, and are related to customer accounts with good credit history. The transfer of the purchased accounts receivable under the agreement is intended to be an absolute and irrevocable transfer constituting a true sale as the transferred receivables have been isolated beyond the reach of the Company and our creditors, even in bankruptcy or other receivership. We will not retain effective control over the sold receivables and BOW will have the right upon purchase to pledge and/or exchange the transferred assets without restrictions. The Company will act as collection agent for BOW, collection services will be undertaken by our accounts receivable personnel in their normal course of business and collected funds will be remitted to BOW. The discount rate has been negotiated net of consideration for the collection services, the cost of collection is expected to be immaterial to the Company.

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

12 Months Ended

Dec. 31, 2022

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, 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

For the year ended December 31, 2022:
Allowance for doubtful accounts	$	7,038	$	1,036	$	456	$	—	$	8,530
Warranty and return reserve - accounts receivable(1)	$	2,485	$	(364)	$	3,742	$	—	$	5,863
Warranty and return reserve - inventory/accrued(2)	$	(1,883)	$	5,266	$	47,436	$	—	$	50,819
Deferred tax asset valuation allowance	$	2,934	$	—	$	8,232	$	—	$	11,166

General and Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Business Description and Basis of Presentation [Text Block]

Nature of Operations

Basis of Presentation

Segment Reporting, Policy

ICU's business activities are interrelated and leverage shared manufacturing, supply chain, IT and other supporting infrastructure. All significant operating decisions are based on analysis of ICU as a single global business, accordingly we operate in one business segment.

Use of Estimates, Policy [Policy Text Block]

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 and 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

Equity Method Investments

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

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 (Loss) Income Per Share

General and Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Schedule of Inventory, Current [Table Text Block]

Inventories consist of the following (in thousands):


	As of December 31,
	2022		2021
Raw materials	$	286,964	$	135,528
Work in process	73,795		36,490
Finished goods	335,250		118,217
Total	$	696,009	$	290,235

Property, Plant and Equipment [Table Text Block]

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


	As of December 31,
	2022		2021
Machinery and equipment	$	414,811	$	321,078
Land, building and building improvements	274,063		243,377
Molds	77,203		60,463
Computer equipment and software	115,214		102,979
Furniture and fixtures	29,876		7,670
Instruments placed with customers(1)	98,481		97,384
Construction in progress	152,909		72,153
Total property, plant and equipment, cost	1,162,557		905,104
Accumulated depreciation	(526,444)		(436,739)
Property, plant and equipment, net	$	636,113	$	468,365

_______________________________

(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 and 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 2022, 2021 and 2020 (in thousands):


	Total
Balance as of January 1, 2020	$	31,245

Other(1)	1,756
Balance as of December 31, 2020	$	33,001
Goodwill acquired(2)	10,626
Other	(188)
Balance as of December 31, 2021	43,439
Goodwill(3)	1,469,880
Other(4)	(7,128)
Disposition(5)	(650)
Currency translation	(56,283)
Balance as of December 31, 2022	$	1,449,258

_______________________________

(1) In 2020, "Other" primarily relates to a $1.3 million measurement period adjustment to deferred taxes related to the 2019 acquisition of Pursuit Vascular, Inc. and foreign currency translation.

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

(3) Relates to Smiths Medical acquired on January 6, 2022 (see Note 2: Acquisitions).

(4) Reflects a measurement period adjustment related to the 2021 acquisition of a small foreign infusion systems supplier.

(5) Relates to the sale of a certain line of infusion products in China.

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, 2022
		Cost		Accumulated Amortization		Net
Patents	10	$	29,998	$	18,610	$	11,388
Customer contracts	12	10,026		6,443		3,583
Non-contractual customer relationships	8	546,935		101,556		445,379
Trademarks	1	5,425		5,425		—
Trade name	15	18,251		5,959		12,292
Developed technology	10	583,176		108,708		474,468
Non-compete	3	9,100		5,250		3,850
Total amortized intangible assets		$	1,202,911	$	251,951	$	950,960

Internally developed software*		$	31,806			$	31,806

Total intangible assets		$	1,234,717	$	251,951	$	982,766

_______________________________

* 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, 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.

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

As of December 31, 2022, estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):


2023	$	130,972
2024	130,882
2025	123,223
2026	122,654
2027	114,622
Thereafter	328,607
Total	$	950,960

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, 2022
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	2,314	$	—	$	2,314
Short-term U.S. treasury securities	1,412		—		1,412
Short-term government bonds	498		—		498
Total short-term investment securities	4,224		—		4,224
Long-term corporate bonds	516		—		516
Total investment securities	$	4,740	$	—	$	4,740

	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

Equity Method Investments

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


	As of December 31,
	2022		2021
Equity method investment	$	3,178	$	3,238

Interest Income and Interest Expense Disclosure

Interest (expense) income, net

The following table presents interest (expense) income, net (in thousands):


	As of December 31,
	2022		2021		2020
Interest expense	$	(70,805)	$	(858)	$	(1,753)
Interest income	4,430		2,840		3,677
Interest (expense) income, net	$	(66,375)	$	1,982	$	1,924

Schedule of Other Nonoperating Income (Expense)

Other expense, net

The following table presents other income (expense), net (in thousands):


	As of December 31,
	2022		2021		2020
Foreign exchange losses, net	$	(5,780)	$	(1,017)	$	(7,177)
(Loss) gain on disposition of assets	(2,554)		(1,651)		1,773
Other miscellaneous income, net	3,198		627		2,812
Other expense, net	$	(5,136)	$	(2,041)	$	(2,592)

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,
	2022		2021		2020
Net (loss) income	$	(74,286)	$	103,135	$	86,870
Weighted-average number of common shares outstanding (basic)	23,868		21,206		20,907
Dilutive securities	—		575		684
Weighted-average common and common equivalent shares outstanding (diluted)	23,868		21,781		21,591
EPS — basic	$	(3.11)	$	4.86	$	4.16
EPS — diluted	$	(3.11)	$	4.74	$	4.02

Business Combination and Asset Acquisition (Tables)

12 Months Ended

Dec. 31, 2022

Business Combinations [Abstract]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

Final Price Allocation

The following table summarizes the final purchase price and the final allocation of the purchase price related to the assets acquired and liabilities assumed (in thousands):


Cash consideration for acquired assets	$	1,922,955
Fair value of contingent consideration payable to Smiths	53,520

Issuance of ICU Medical, Inc. common shares:
Number of shares issued to Smiths	2,500
Price per share (ICU's opening market price on the acquisition date)	$	230.39
Fair value of ICU shares issued to Smiths	$	575,975
Total Consideration	$	2,552,450

Purchase Price Allocation
Cash and cash equivalents	$	78,791
Accounts receivables	106,132
Inventories	228,919
Prepaid expenses and other current assets	53,554
Property, plant and equipment	206,333
Operating lease right-of-use assets	55,161
Intangible assets(1)	945,000

Other assets	379
Accounts payable	(105,291)
Accrued liabilities(2)	(173,151)
Income tax payable	(40,312)
Other long-term liabilities	(85,490)
Deferred income taxes	(187,455)
Total identifiable net assets acquired	$	1,082,570
Goodwill - not tax deductible	1,469,880
Purchase Consideration	$	2,552,450

_______________________________________________

Business Acquisition, Pro Forma Information

The following unaudited pro forma financial information presents the combined results of operations of ICU and Smiths Medical as if the acquisition had occurred on January 1, 2021. The pro forma financial information is presented for informational purposes only and is not indicative of the results of operations that would have been achieved if the acquisition had taken place on the date indicated or of results that may occur in the future.


	Twelve months ended December 31,
(In thousands)	2022		2021
Revenues	$	2,300,371	$	2,509,830
Net (Loss) Income	$	(70,286)	$	37,454

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

12 Months Ended

Dec. 31, 2022

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		Retention and Facility Closure Costs		Total
Accrued balance, January 1, 2021	$	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
Acquired restructuring charges	5,796		1,740		7,536
Charges incurred	9,667		58		9,725
Payments	(11,083)		(268)		(11,351)
Currency translation	(425)		(188)		(613)
Other adjustments	(38)		—		(38)
Accrued balance, December 31, 2022	$	4,416	$	1,507	$	5,923

_______________________________________________

(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, 2022

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,
	2022				2021				2020
Product line	Revenue		% of Revenue		Revenue		% of Revenue		Revenue		% of Revenue
Infusion Consumables	$	566,617	25	%	$	555,189	42	%	$	473,740	37	%
Infusion Systems	351,080		15	%	352,321		27	%	359,691		28	%
IV Solutions	363,472		16	%	359,477		27	%	388,971		31	%
Critical Care	47,330		2	%	49,321		4	%	48,602		4	%
Infusion Systems-Smiths Medical	340,124		15	%	—		nm		—		nm
Vascular Access-Smiths Medical	326,765		14	%	—		nm		—		nm
Vital Care-Smiths Medical	284,609		13	%	—		nm		—		nm
Total Revenues	$	2,279,997	100	%	$	1,316,308	100	%	$	1,271,004	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	2022		2021		2020
United States	$	1,460,069	$	941,809	$	910,627
Europe, the Middle East and Africa	367,411		147,488		132,763
APAC	257,208		85,692		79,610
Other Foreign	195,309		141,319		148,004
Total Revenues	$	2,279,997	$	1,316,308	$	1,271,004

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


	Contract Liabilities
Beginning balance, January 1, 2021	$	(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)
Fair value of acquired deferred revenue	(51,245)
Equipment revenue recognized	32,252
Equipment revenue deferred due to implementation	(20,332)
Software revenue recognized	16,277
Software revenue deferred due to implementation	(17,557)
Government grant deferred revenue	(3,729)
Government grant recognized	1,514
Other deferred revenue	(1,500)
Other deferred revenue recognized	5,915
Ending balance, December 31, 2022	$	(45,866)

Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction

As of December 31, 2022, revenue from remaining performance obligations is as follows:


	Recognition Timing
(in thousands)	<12 Months		> 12 Months
Equipment revenue	$	(15,144)	$	(982)
Software revenue	(8,277)		(1,026)
Government grant revenue	(1,422)		(12,797)
Other deferred revenue*	(4,784)		(1,434)
Total	$	(29,627)	$	(16,239)

Leases (Tables)

12 Months Ended

Dec. 31, 2022

Leases [Abstract]

Lease, Cost

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


	Year ended December 31,
	2022		2021		2020
Operating lease cost	$	22,038	$	11,251	$	11,284
Finance lease cost — interest	112		122		91
Finance lease cost — reduction of ROU asset	712		648		383
Short-term lease cost	7		14		263
Total lease cost	$	22,869	$	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,
	2022		2021		2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases(1)	$	25,225	$	11,256	$	10,185
Operating cash flows from finance leases	$	112	$	122	$	91

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	5,994	$	2,589	$	20,847
Finance leases	$	715	$	558	$	3,062

_____________________________

(1) We acquired $55.2 million of operating right-of-use assets as part of the Smiths Medical acquisition, see Note 2: Acquisitions.

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,
	2022			2021
Operating leases
Operating lease right-of-use assets	$	74,864		$	39,847

Accrued liabilities	$	18,169		$	9,009
Other long-term liabilities	60,916			33,971
Total operating lease liabilities	$	79,085		$	42,980

Weighted-Average Remaining Lease Term
Operating leases	6.1 years			5.9 years

Weighted-Average Discount Rate
Operating leases	4.34		%	4.98		%

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,
	2022			2021
Finance leases
Finance lease right-of-use assets	$	2,598		$	2,673

Accrued liabilities	$	816		$	643
Other long-term liabilities	1,855			2,067
Total finance lease liabilities	$	2,671		$	2,710

Weighted-Average Remaining Lease Term
Finance leases	4.8 years			5.6 years

Weighted-Average Discount Rate
Finance leases	4.23		%	4.28		%

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

As of December 31, 2022, the maturities of our operating and finance lease liabilities for each of the next five years are approximately (in thousands):


	Operating Leases		Finance Leases
2023	$	21,800	$	914
2024	17,786		657
2025	12,699		442
2026	11,297		322
2027	7,830		189
Thereafter	17,346		426
Total Lease Payments	88,758		2,950
Less imputed interest	(9,673)		(279)
Total	$	79,085	$	2,671

Share Based Award (Tables)

12 Months Ended

Dec. 31, 2022

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)	2022		2021		2020
Stock compensation expense	$	36,025	$	27,341	$	23,954
Tax benefit from stock-based compensation cost	$	4,636	$	6,391	$	5,564
Indirect tax benefit	$	749	$	285	$	1,203

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,
	2022			2021			2020
Number of time-based options granted	7,620			7,910			7,190
Grant-date fair value of options granted (in thousands)	$	540		$	528		$	425
Weighted-average assumptions for stock option valuation:
Expected term (years)	5.5			5.5			5.5
Expected stock price volatility	36.0		%	35.0		%	35.0		%
Risk-free interest rate	3.0		%	0.9		%	0.4		%
Expected dividend yield	—		%	—		%	—		%
Weighted-average grant-price per option	$	185.79		$	200.07		$	181.99
Weighted-average grant-date fair value per option	$	70.86		$	66.78		$	59.09

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, 2022 is as follows:


	Shares	Weighted-Average Exercise Price Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding at December 31, 2021	663,098	$	74.75
Granted	7,620	$	185.79
Exercised	(142,772)	$	61.53
Forfeited or expired	(485)	$	60.01
Outstanding at December 31, 2022	527,461	$	79.94	2.0	$	42,708
Exercisable at December 31, 2022	519,841	$	78.39	2.0	$	42,708
Vested and expected to vest, December 31, 2022	527,461	$	79.94	1.9	$	42,708

Exercised Options Data [Table Text Block]

The following table presents information regarding stock option activity:


	Year ended December 31,
(In thousands)	2022		2021		2020
Intrinsic value of options exercised	$	17,340	$	27,534	$	32,915
Cash received from exercise of stock options	$	8,785	$	9,372	$	13,193
Tax benefit from stock option exercises	$	3,637	$	5,092	$	5,179

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)	2022		2021		2020
PRSU
Shares granted	60,383		53,246		38,633
Shares earned (a)	46,317		32,013		80,654
Grant-date fair value per share	$	230.31	$	198.16	$	188.34
Grant-date fair value	$	13,907	$	10,551	$	7,276
Intrinsic value vested	$	10,487	$	6,777	$	15,627

RSU
Shares granted	116,870		84,388		87,830
Grant-date fair value per share	$	221.65	$	199.13	$	188.13
Grant-date fair value	$	25,905	$	16,804	$	16,523
Intrinsic value vested	$	16,438	$	13,681	$	12,314

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, 2022:


	Number of Units	Grant-Date Fair Value Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Non-vested at December 31, 2021	275,761	$	201.05
Change in units due to performance expectations (a)	32,346	$	239.63
Granted	177,253	$	224.60
Vested	(118,321)	$	206.40
Forfeited	(13,035)	$	218.24
Non-vested and expected to vest at December 31, 2022	354,004	$	213.95	1.0	$	55,749

Derivatives and Hedging Activities (Tables)

12 Months Ended

Dec. 31, 2022

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		Interest Rate Swaps		Gross Derivatives
	(In thousands)
As of December 31, 2022
Prepaid expenses and other current assets	$	4,860	$	28,431	$	33,291
Other assets	94		26,753		26,847
Total assets	$	4,954	$	55,184	$	60,138

Accrued liabilities	$	1,847	$	—	$	1,847
Other long-term liabilities	167		—		167
Total liabilities	$	2,014	$	—	$	2,014

	Derivatives Designated as Cash Flow Hedging Instruments
As of December 31, 2021	Foreign Exchange Forward Contracts		Forward-Starting Interest Rate Swaps		Gross Derivatives
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

The following table presents the effects of our derivative instruments designated as cash flow hedges on the Consolidated Statements of Operations (in thousands):


	Gain Reclassified From Accumulated Other Comprehensive (Loss) Income into Net (Loss) Income
	Location of Gain in the Consolidated Statements of Operations	Year Ended December 31,
		2022		2021		2020
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	Total revenues	$	3,829	$	—	$	—
Foreign exchange forward contracts	Cost of goods sold	7,751		3,444		790
Foreign exchange forward contracts	Interest expense(1)	717		—		—
Interest rate swaps	Interest expense	$	6,122	$	—	$	—
Total derivatives designated as cash flow hedging instruments		$	18,419	$	3,444	$	790

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


	Amount of Gain (Loss) Recognized in Other Comprehensive (Loss) Income
	Year Ended December 31,
	2022		2021		2020
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	$	9,588	$	950	$	1,980
Interest rate swaps	62,786		(1,480)		—
Total derivatives designated as cash flow hedging instruments	$	72,374	$	(530)	$	1,980

Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2022

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, 2020	$	17,300
Change in fair value of contingent earn-out (included in income from operations as a separate line item)(1)	9,000

Contingent earn-out liability, December 31, 2020	26,300
Contingent earn-out con-compete arrangement	2,589

Transfer of Pursuit earn-out liability into Level 2(2)	(26,300)
Contingent earn-out liability, December 31, 2021	2,589
Acquisition date fair value estimate of earn-out(3)	55,158

Change in fair value of contingent earn-out (included in income from operations as a separate line item)(4)	(32,091)

Currency translation	(84)
Contingent earn-out liability, December 31, 2022	$	25,572

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, 2022
	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 corporate bonds	$	2,314	$	—	$	2,314	$	—
Short-term U.S. treasury securities	1,412		1,412		—		—
Short-term government bonds	498		—		498		—
Long-term corporate bonds	516		—		516		—


Foreign exchange forwards:
Prepaid expenses and other current assets	4,860		—		—		4,860
Other assets	94		—		—		94
Interest rate contracts:
Prepaid expenses and other current assets	28,431		—		—		28,431
Other assets	26,753		—		—		26,753
Total Assets	$	64,878	$	1,412	$	3,328	$	60,138

Liabilities:

Contingent earn-out liability - LT	$	25,572	$	—	$	—	$	25,572
Foreign exchange contracts:
Accrued liabilities	1,847		—		—		1,847
Other long-term liabilities	167		—		—		167


Total Liabilities	$	27,586	$	—	$	—	$	27,586


	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

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, 2022

Prepaid Expense and Other Assets [Abstract]

Schedule of Other Current Assets

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


	As of December 31,
	2022		2021
Other prepaid expenses and receivables	$	21,635	$	14,763
Prepaid vendor expenses	3,052		—
Deferred costs	2,395		12,746
Prepaid insurance and property taxes	16,322		6,310
VAT/GST receivable	3,546		4,156
Deferred tax charge	3,830		4,241
Foreign exchange forward contract	4,860		1,061
Interest rate contracts	28,431		—
Deposits	1,329		1,343
Other	3,532		2,227
	$	88,932	$	46,847

Other assets consist of the following (in thousands):


	As of December 31,
	2022		2021
Pump lease receivables	$	27,086	$	25,941
Spare parts	38,498		28,538
Equity method investments	3,178		3,238
Interest rate contracts	26,753		—

Deferred debt issuance costs	5,156		2,827
Finance lease right-of-use assets	2,598		2,673
Other	2,193		526
	$	105,462	$	63,743

Schedule of Other Assets

Other assets consist of the following (in thousands):


	As of December 31,
	2022		2021
Pump lease receivables	$	27,086	$	25,941
Spare parts	38,498		28,538
Equity method investments	3,178		3,238
Interest rate contracts	26,753		—

Deferred debt issuance costs	5,156		2,827
Finance lease right-of-use assets	2,598		2,673
Other	2,193		526
	$	105,462	$	63,743

Accrued Liabilities an Other Long-term Liabilities (Tables)

12 Months Ended

Dec. 31, 2022

Accrued Liabilities and Other Liabilities [Abstract]

Schedule of Accrued Liabilities [Table Text Block]

Accrued liabilities consist of the following (in thousands):


	As of December 31,
	2022		2021
Salaries and benefits	$	44,304	$	27,304
Incentive compensation	30,254		33,107

Operating lease liability-ST	18,169		9,009
Accrued professional fees	5,317		773
Field service corrective action(1)	24,517		—


Legal accrual	3,137		3,897
Accrued sales taxes	5,844		1,980
Warranties and returns	3,097		532
Deferred revenue	30,838		12,646

Accrued other taxes	5,794		4,337
Distribution fees	17,063		5,645
Accrued freight	17,988		9,194
Restructuring accrual	5,923		664
Foreign exchange contracts	1,847		—
Accrued audit fees	6,279		1,008
Defined benefit plan	2,928		—
Accrued interest	1,033		—




Accrued research and development	3,538		—
Other	14,899		8,099
	$	242,769	$	118,195

_____________________________

Other Liabilities

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


	As of December 31,
	2022		2021
Operating lease liability-LT	$	60,916	$	33,971
Finance lease liability-LT	1,855		2,067

Deferred revenue	16,239		—
Forward-starting interest rate swaps	—		1,480
Benefits	5,314		1,369
Field service corrective action(1)	25,294		—
Accrued rent	997		1,262

Other	3,489		1,681
	$	114,104	$	41,830

_______________________________

Debt (Tables)

12 Months Ended

Dec. 31, 2022

Debt Disclosure [Abstract]

Interest Margin and Commitment Fee [Table Text Block]


Leverage Ratio	Applicable Margin for Term SOFR Loans	Applicable Margin for Base Rate Loans	Commitment Fee Rate
Greater than 4.00 to 1.0	2.25%	1.25%	0.35%
Less than or equal to 4.00 to 1.0 but greater than 3.00 to 1.0	2.00%	1.00%	0.30%
Less than or equal to 3.00 to 1.0 but greater than 2.50 to 1.0	1.75%	0.75%	0.25%
Less than or equal to 2.50 to 1.0 but greater than 2.00 to 1.0	1.50%	0.50%	0.20%
Less than or equal to 2.00 to 1.0	1.25%	0.25%	0.15%

Applicable Margin on Loan Type


Leverage Ratio	Applicable Margin for Term SOFR Loans	Applicable Margin for Base Rate Loans
Greater than 2.75 to 1.0	2.50%	1.50%
Less than 2.75 to 1.0	2.25%	1.25%

Schedule of Long-Term Debt Instruments

The carrying values of our long-term debt consist of the following (in thousands):


	Effective Interest Rate		As of December 31, 2022

Senior Secured Credit Facilities:
Term Loan A — principal	3.99	%	$	834,000
Term Loan B — principal	4.61	%	843,625
Revolving Credit Facility — principal	—	%	—
Less unamortized debt issuance costs(1)			(24,262)
Total carrying value of long-term debt			1,653,363
Less current portion of long-term debt			29,688
Long-term debt, net			$	1,623,675

_______________________________

(1) Comprised of $12.6 million and $11.7 million relating to the Term Loan A and the Term Loan B, respectively.

Schedule of Maturities of Long-Term Debt

As of December 31 2022, the aggregate amount of principal repayments of our long-term debt (including any current portion) for each of the next five years is approximately (in thousands):


2023	$	29,688
2024	51,000
2025	51,000
2026	72,250
2027	672,500
Thereafter	801,187
Total	$	1,677,625

Interest expense on long-term debt

The following table presents the total interest expense related to our long-term debt (in thousands):


	Year Ended December 31,
	2022		2021		2020
Contractual interest	$	66,770	$	—	$	1,251
Amortization of debt issuance costs	6,972		240		288
Commitment fee — Revolving Credit Facility	1,290		221		110
Total long-term debt-related interest expense	$	75,032	$	461	$	1,649

- Definition

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

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 210
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-Section S99
-Paragraph 1
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-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 3
-Subparagraph (SX 210.12-04(a))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e24072-122690

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Reference 7: http://www.xbrl.org/2003/role/exampleRef
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Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
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-URI https://asc.fasb.org/extlink&oid=123599511&loc=d3e64711-112823

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+ Details

Income Taxes Income tax disclosure (Tables)

12 Months Ended

Dec. 31, 2022

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,
	2022		2021		2020
United States	$	(135,646)	$	81,484	$	41,194
Foreign	21,237		41,702		56,300
	$	(114,409)	$	123,186	$	97,494

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,
	2022		2021		2020
Current:
Federal	$	4,128	$	20,646	$	6,032
State	3,799		3,444		2,422
Foreign	12,924		7,236		7,290
	$	20,851	$	31,326	$	15,744
Deferred:
Federal	$	(42,012)	$	(8,154)	$	(5,319)
State	(11,239)		(1,815)		(1,850)
Foreign	(7,723)		(1,306)		2,049
	(60,974)		(11,275)		(5,120)
	$	(40,123)	$	20,051	$	10,624

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,
	2022				2021				2020
	Amount		Percent		Amount		Percent		Amount		Percent
Federal tax at the expected statutory rate	$	(24,026)	21.0	%	$	25,869	21.0	%	$	20,474	21.0	%
State income tax, net of federal effect	(5,050)		4.4	%	2,907		2.4	%	2,099		2.2	%
Tax credits	(3,636)		3.2	%	(2,443)		(2.0)	%	(3,269)		(3.4)	%

Global intangible low-taxed income	2,303		(2.0)	%	711		0.6	%	163		0.2	%
Foreign income tax differential	(2,943)		2.5	%	(2,983)		(2.4)	%	(3,888)		(4.0)	%
Stock-based compensation	(3,721)		3.2	%	(4,263)		(3.5)	%	(4,686)		(4.8)	%
Foreign-derived intangible income	(2,269)		2.0	%	(3,775)		(3.1)	%	(2,718)		(2.8)	%
Transaction cost	2,299		(2.0)	%	—		—	%	—		—	%
Contingent consideration	(6,830)		6.0	%	(29)		—	%	1,566		1.6	%
Section 162(m)	3,942		(3.4)	%	1,812		1.5	%	1,079		1.1	%
Other	(192)		0.2	%	2,245		1.8	%	(196)		(0.2)	%
	$	(40,123)	35.1	%	$	20,051	16.3	%	$	10,624	10.9	%

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,
	2022		2021
Deferred tax asset:


Accruals/other	$	17,351	$	7,796



Acquired future tax deductions	14,186		5,440
Stock-based compensation	6,240		7,283
Foreign currency translation adjustments	—		3,360
Tax credits	12,906		11,953

Inventory reserves	25,100		8,199
Warranty reserve	13,241		127
Section 163(j)	9,166		—


Chargebacks, discounts, customer concessions	39,508		27,970
Valuation allowance	(11,166)		(2,934)
	$	126,532	$	69,194
Deferred tax liability:
State income taxes	$	1,816	$	2,724


Depreciation and amortization	209,687		20,483
Section 481(a) adjustment - change in accounting method	—		4,873


Foreign currency translation adjustments	9,581		—
	$	221,084	$	28,080

Deferred tax (liability) asset, net	$	(94,552)	$	41,114

Summary of Income Tax Contingencies [Table Text Block]

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


	Year Ended December 31,
	2022		2021		2020
Beginning balance	$	21,537	$	18,443	$	15,027
Increases to prior year tax positions	148		231		502
Increases due to acquisitions	29,606		—		—
Increases to current year tax positions	4,706		3,242		2,987

Decreases to prior year tax positions	(222)		—		(15)

Decrease related to lapse of statute of limitations	(1,722)		(31)		(58)
Decrease related to settlements with tax authorities	—		(348)		—
Ending balance	$	54,053	$	21,537	$	18,443

Geographic Information and Significant Customers Geographic Information (Tables)

12 Months Ended

Dec. 31, 2022

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,
	2022		2021
Costa Rica	$	128,179	$	115,187
Mexico	99,849		79,567
Other LATAM	39,270		36,907
Canada	5,374		4,716
Italy	24,323		12,435



Spain	18,948		13,295
Czech Republic	10,732		—
Other Europe	11,375		4,171
APAC	20,930		20,452
Total Foreign	$	358,980	$	286,730
United States	803,577		618,374
Worldwide Total	$	1,162,557	$	905,104

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2022

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, 2020	$	(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)
Other comprehensive loss before reclassifications	(103,928)		54,962		1,203		(47,763)
Amounts reclassified from AOCI	—		(13,946)		—		(13,946)
Other comprehensive loss	(103,928)		41,016		1,203		(61,709)
Balance as of December 31, 2022	$	(122,973)	$	40,779	$	1,216	$	(80,978)

General and Summary of Significant Accounting Policies Basis of Presentation (Details)	12 Months Ended
	Dec. 31, 2022 segment
Accounting Policies [Abstract]
Number of Operating Segments	1

General and Summary of Significant Accounting Policies Inventory (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Raw Materials	$ 286,964	$ 135,528
Work in Process	73,795	36,490
Finished Goods	335,250	118,217
Total	$ 696,009	$ 290,235

General and Summary of Significant Accounting Policies Property and Equipment #1 (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 1,162,557	$ 905,104
Accumulated Depreciation	526,444	436,739
Net property and equipment	636,113	468,365
Machinery and Equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	414,811	321,078
Land, Buildings and Improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	274,063	243,377
Molds [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	77,203	60,463
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	115,214	102,979
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	29,876	7,670
Instruments Placed with Customers [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	98,481	97,384
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 152,909	$ 72,153

General and Summary of Significant Accounting Policies Property and Equipment #2 (Details)	12 Months Ended
	Dec. 31, 2022
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, 2022	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Depreciation	$ 95.8	$ 65.9	$ 62.4

General and Summary of Significant Accounting Policies Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Goodwill [Roll Forward]
GOODWILL	$ 43,439	$ 33,001	$ 31,245
Goodwill, Acquired During Period	1,469,880	10,626
Goodwill, Purchase Accounting Adjustments	(7,128)		1,756
Goodwill, Other Increase (Decrease)	(650)
Goodwill, Foreign Currency Translation Gain (Loss)	(56,283)	(188)
GOODWILL	1,449,258	43,439	$ 33,001
Pursuit Vascular LLC
Goodwill [Roll Forward]
Goodwill, Purchase Accounting Adjustments		$ 1,300
Foreign Infusion System Supplier
Goodwill [Roll Forward]
Goodwill, Acquired During Period	$ 10,600

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

General and Summary of Significant Accounting Policies Intangible Assets #1 (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,202,911	$ 275,835
Accumulated Amortization	251,951	112,882
Finite-Lived Intangible Assets, Net	950,960	162,953
Intangible Assets, Gross (Excluding Goodwill)	1,234,717	301,193
INTANGIBLE ASSETS, net	$ 982,766	$ 188,311
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	10 years	10 years
Cost	$ 29,998	$ 27,429
Accumulated Amortization	18,610	16,764
Finite-Lived Intangible Assets, Net	$ 11,388	$ 10,665
Customer Contracts [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	12 years	12 years
Cost	$ 10,026	$ 10,412
Accumulated Amortization	6,443	6,196
Finite-Lived Intangible Assets, Net	$ 3,583	$ 4,216
Customer-Related Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	8 years	9 years
Cost	$ 546,935	$ 57,316
Accumulated Amortization	101,556	33,004
Finite-Lived Intangible Assets, Net	$ 445,379	$ 24,312
Trademarks [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	1 year	4 years
Cost	$ 5,425	$ 425
Accumulated Amortization	5,425	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	$ 18,251	$ 18,260
Accumulated Amortization	5,959	4,731
Finite-Lived Intangible Assets, Net	$ 12,292	$ 13,529
Developed Technology Rights [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	10 years	13 years
Cost	$ 583,176	$ 152,893
Accumulated Amortization	108,708	49,406
Finite-Lived Intangible Assets, Net	$ 474,468	$ 103,487
Noncompete Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	3 years	3 years
Cost	$ 9,100	$ 9,100
Accumulated Amortization	5,250	2,356
Finite-Lived Intangible Assets, Net	3,850	6,744
In Process Research and Development [Member]
Finite-Lived Intangible Assets [Line Items]
Cost	$ 31,806	$ 25,358

General and Summary of Significant Accounting Policies Intangible Assets #2 (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Amortization of Intangible Assets	$ 139.4	$ 23.8	$ 23.2

General and Summary of Significant Accounting Policies Future Estimated Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Acquired Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Amortization Expense, Next Twelve Months	$ 130,972
Finite-Lived Intangible Assets, Amortization Expense, Year Two	130,882
Finite-Lived Intangible Assets, Amortization Expense, Year Three	123,223
Finite-Lived Intangible Assets, Amortization Expense, Year Four	122,654
Finite-Lived Intangible Assets, Amortization Expense, Year Five	114,622
Finite-Lived Intangible Assets, Amortization Expense, after Year Five	328,607
Finite-Lived Intangible Assets, Net	$ 950,960	$ 162,953

General and Summary of Significant Accounting Policies Other Investments(Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Accounting Policies [Abstract]
Proceeds from Sale and Maturity of Other Investments	$ 19,000

General and Summary of Significant Accounting Policies Investments (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Debt Securities, Available-for-sale [Line Items]
Investment Securities, Amortized Cost	$ 4,740	$ 19,040
Investment Securities	4,740	19,040
Debt Securities, Available-for-Sale, Amortized Cost, Current	4,224
Short-term investment securities	4,224	14,420
Long-term Investment Securities	516	4,620
Debt Securities, Available-for-Sale, Unrealized Loss	0	0
Corporate Debt Securities
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-Sale, Amortized Cost, Current	2,314	14,420
Short-term investment securities	2,314	14,420
Debt Securities, Available-for-Sale, Amortized Cost, Noncurrent	516	4,620
Long-term Investment Securities	516	4,620
Debt Securities, Available-for-Sale, Unrealized Loss	0	$ 0
US Treasury Securities
Debt Securities, Available-for-sale [Line Items]
Short-term investment securities	1,412
Debt Securities, Available-for-Sale, Unrealized Loss	0
US Government Debt Securities
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-Sale, Amortized Cost, Current	498
Short-term investment securities	498
Long-term Investment Securities	498
Debt Securities, Available-for-Sale, Unrealized Loss	$ 0

General and Summary of Significant Accounting Policies Investments-Equity Method (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Schedule of Equity Method Investments [Line Items]
Equity Method Investment, Aggregate Cost	$ 3,300
Equity Method Investments	$ 3,178	$ 3,238
nonpublic company
Schedule of Equity Method Investments [Line Items]
Equity Method Investment, Ownership Percentage	20.00%

General and Summary of Significant Accounting Policies Foreign Currency (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Foreign Currency [Abstract]
Foreign Currency Transaction Gain (Loss), Realized	$ 5.8	$ 1.0	$ 7.2

General and Summary of Significant Accounting Policies Post-retirement and Post-employment Benefits (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Pension and Other Postretirement Benefits Cost (Reversal of Cost)	$ 14.6	$ 11.0	$ 10.7

General and Summary of Significant Accounting Policies Interest (Expense) Income, net (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Interest (expense) income, net [Line Items]
Interest Expense	$ (70,805)	$ (858)	$ (1,753)
Interest Income, Other	4,430	2,840	3,677
Interest Income (Expense), Nonoperating, Net	$ (66,375)	$ 1,982	$ 1,924

General and Summary of Significant Accounting Policies Other (expense) income, net (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Other (expense) income, net [Line Items]
Foreign Currency Transaction Loss, before Tax	$ (5,780)	$ (1,017)	$ (7,177)
Gain (Loss) on Disposition of Other Assets	(2,554)	(1,651)	1,773
miscellaneous income, net	3,198	627	2,812
Other Income Disclosure, Nonoperating	$ (5,136)	$ (2,041)	$ (2,592)

General and Summary of Significant Accounting Policies Net Income Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
NET INCOME PER SHARE
Net Income	$ (74,286)	$ 103,135	$ 86,870
Weighted average number of common shares outstanding (basic)	23,868,000	21,206,000	20,907,000
Weighted Average Number Diluted Shares Outstanding Adjustment	0	575,000	684,000
Weighted Average common and common equivalent shares outstandding (diluted)	23,868,000	21,781,000	21,591,000
Basic	$ (3.11)	$ 4.86	$ 4.16
Diluted	$ (3.11)	$ 4.74	$ 4.02
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount		12,354	12,083

- 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, 2022
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 were effective for all entities as of March 12, 2020 through December 31, 2022. ASU No. 2022-06, Reference Rate Reform: Deferral of the Sunset Date of Topic 848 deferred the sunset date of Topic 848 from December 31, 2022 to December 31, 2024. In November 2021, we entered into two forward-starting swaps whereby the variable leg of the swap references LIBOR, these swaps were 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 allowed 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 allowed 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 these ASU's 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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+ Details

Acquisitions Text (Details) - USD ($) shares in Thousands	12 Months Ended
Acquisitions Text (Details) - USD ($) shares in Thousands	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Contingent earn-out liability, Noncurrent	$ 25,572,000	$ 2,589,000
Related Party Transaction, Purchases from Related Party	37,600,000
Related Party Transaction, Due from (to) Related Party	$ (5,100,000)
Smiths Medical 2020 Limited
Business Acquisition [Line Items]
Business Acquisition, Percentage of Voting Interests Acquired	100.00%
Payments to Acquire Businesses, Gross	$ 1,922,955,000
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares	2,500
Contingent earn-out liability, Noncurrent	$ 100,000,000
Minimum Stock Price Target for Earn-out Payment	$ 300.00
Required Share Holding Of Stock Issued At Acquisition	0.500
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 945,000,000
Business Combination, Consideration Transferred, Cash	$ 1,900,000,000

Acquisitions Smiths Medical 2020 Limited Table (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Contingent earn-out liability, Noncurrent	$ 55,158
business combination, recognized identifiable asset acquired and liability assumed,	55,200
GOODWILL	1,449,258	$ 43,439	$ 33,001	$ 31,245
Smiths Medical 2020 Limited
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	1,922,955
Contingent earn-out liability, Noncurrent	$ 53,520
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares	2,500
Business Acquisition, Share Price	$ 230.39
Business Acquisition, Equity Interest Issued or Issuable, Value Assigned	$ 575,975
Business Combination, Consideration Transferred	2,552,450
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Cash and Equivalents	78,791
Business Combination, Acquired Receivable, Fair Value	106,132
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Inventory	228,919
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense and Other Assets	53,554
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Property, Plant, and Equipment	206,333
business combination, recognized identifiable asset acquired and liability assumed,	55,161
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	945,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Other Noncurrent Assets	379
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accounts Payable	(105,291)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Other	(173,151)
Business Combinations, Identified Assumed Liabilities Recognized, Income tax payable	(40,312)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Noncurrent Liabilities, Other	(85,490)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Deferred Tax Liabilities Noncurrent	(187,455)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net	1,082,570
GOODWILL	$ 1,469,880

Acquisitions Smiths Medical 2020 Limited Intangible (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Smiths Medical 2020 Limited
Acquired Finite-Lived Intangible Assets [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 945,000
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	9 years
Customer Relationships [Member]
Acquired Finite-Lived Intangible Assets [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 510,000
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	8 years
Developed Technology Rights [Member]
Acquired Finite-Lived Intangible Assets [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 400,000
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	10 years
Software Development
Acquired Finite-Lived Intangible Assets [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 30,000
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	5 years
Trademarks [Member]
Acquired Finite-Lived Intangible Assets [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 5,000
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life	6 months

Acquisitions Foreign Infusion Systems Supplier (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Business Acquisition [Line Items]
Short-term contingent consideration-gross	$ 1,000
Long-term contingent consideration-gross	1,500
Foreign Infusion System Supplier
Business Acquisition [Line Items]
contingent consideration gross	2,500
Short-term contingent consideration-gross	1,000
Long-term contingent consideration-gross	1,500
Payments to Acquire Businesses, Gross	15,400
business combination consideration - cash holdback	$ 500

Acquisitions Smiths Medical Pro Forma (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition, Pro Forma Information, Nonrecurring Adjustment [Line Items]
Revenues	$ 2,279,997	$ 1,316,308	$ 1,271,004
Business Acquisition, Pro Forma Revenue	2,300,371	2,509,830
Business Acquisition, Pro Forma Net Income (Loss)	(70,286)	37,454
Pro Forma Adjustment - Amortization	1,900	24,700
Pro Forma Adjustment - Inventory	27,400
Pro Forma Adjustment - Finance Costs	1,200	$ 73,500
Smiths Medical 2020 Limited
Business Acquisition, Pro Forma Information, Nonrecurring Adjustment [Line Items]
Revenues	950,700
Net Income (Loss), Including Portion Attributable to Noncontrolling Interest	$ (74,300)

- Definition

The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

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-URI https://asc.fasb.org/extlink&oid=126975872&loc=SL124442552-122756

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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-Section 50
-Paragraph 41
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9038-108599

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
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-URI https://asc.fasb.org/extlink&oid=126975872&loc=SL124442526-122756

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-URI https://asc.fasb.org/extlink&oid=126975872&loc=SL124442526-122756

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9054-108599

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
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-Subparagraph (SX 210.4-08(g)(1)(ii))
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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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-Section S99
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 22: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
-Topic 470
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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 https://asc.fasb.org/extlink&oid=126953954&loc=SL114868664-224227

+ Details

Restructuring, Strategic Transaction and Integration (Details 1) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Restructuring and Related Activities [Abstract]
Restructuring, strategic transaction and integration expenses	$ 71,421	$ 18,037	$ 28,409
Restructuring Charges	9,700	(1,800)	7,900
Restructuring Reserve, Accrual Adjustment	38		1,957
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve, Accrual Adjustment	38		$ 1,957
Restructuring Adjustments - Severance and Facility	2,000
Facility Closing [Member]
Restructuring and Related Activities [Abstract]
Restructuring Reserve, Accrual Adjustment	0	1,429
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve, Accrual Adjustment	$ 0	$ 1,429

Restructuring, Strategic Transaction and Integration (Details 2) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	$ 5,923,000	$ 664,000	$ 3,421,000
Restructuring Costs	9,725,000	140,000
Payments for Restructuring	(11,351,000)	(969,000)
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	613,000	(29,000)
Restructuring Reserve, Accrual Adjustment	(38,000)		(1,957,000)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Restructuring Liabilities	7,536,000
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	4,416,000	499,000	1,858,000
Restructuring Costs	9,667,000	140,000
Payments for Restructuring	(11,083,000)	(969,000)
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	425,000	2,000
Restructuring Reserve, Accrual Adjustment	(38,000)	(528,000)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Restructuring Liabilities	5,796,000
Facility Closing [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	1,507,000	165,000	$ 1,563,000
Restructuring Costs	58,000	0
Payments for Restructuring	(268,000)	0
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	188,000	(31,000)
Restructuring Reserve, Accrual Adjustment	0	$ (1,429,000)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Restructuring Liabilities	$ 1,740,000

Restructuring, Strategic Transaction and Integration Strategic Transaction and Integration Expenses (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Restructuring and Related Activities [Abstract]
Strategic Transaction and Integration	$ 61.7	$ 19.8	$ 20.5

Revenue Disaggregation of Revenue - Product Line (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Disaggregation of Revenue [Line Items]
Revenues	$ 2,279,997	$ 1,316,308	$ 1,271,004
Percentage of revenue	100.00%	100.00%	100.00%
Infusion Consumables [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 566,617	$ 555,189	$ 473,740
Percentage of revenue	25.00%	42.00%	37.00%
Infusion Systems [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 351,080	$ 352,321	$ 359,691
Percentage of revenue	15.00%	27.00%	28.00%
IV Solutions [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 363,472	$ 359,477	$ 388,971
Percentage of revenue	16.00%	27.00%	31.00%
Critical Care [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 47,330	$ 49,321	$ 48,602
Percentage of revenue	2.00%	4.00%	4.00%
Infusion Consumables-Smiths Medical
Disaggregation of Revenue [Line Items]
Revenues	$ 340,124	$ 0	$ 0
Percentage of revenue	15.00%
Vascular Access
Disaggregation of Revenue [Line Items]
Revenues	$ 326,765	0	0
Percentage of revenue	14.00%
Vital Care
Disaggregation of Revenue [Line Items]
Revenues	$ 284,609	$ 0	$ 0
Percentage of revenue	13.00%

Revenue Disaggregation of Revenue by Geography (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Disaggregation of Revenue [Line Items]
Revenues	$ 2,279,997	$ 1,316,308	$ 1,271,004
UNITED STATES
Disaggregation of Revenue [Line Items]
Revenues	$ 1,460,069	$ 941,809	$ 910,627
Percent of total revenue	64.00%	72.00%	72.00%
EMEA [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 367,411	$ 147,488	$ 132,763
APAC [Domain]
Disaggregation of Revenue [Line Items]
Revenues	257,208	85,692	79,610
Other foreign countries [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 195,309	$ 141,319	$ 148,004
International Sales [Domain]
Disaggregation of Revenue [Line Items]
Percent of total revenue	36.00%	28.00%	28.00%

- Definition

+ References

+ Details

Revenue Contract Liabilities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
COntract Liability Rollforward [Roll Forward]
Contract with Customer, Liability	$ (7,461)	$ (6,430)
Contract with Customer, Liability	(45,866)	(7,461)
Smiths Medical
COntract Liability Rollforward [Roll Forward]
Contract with Customer, Liability	(51,245)
Equipment revenue [Member]
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(32,252)	(10,048)
Deferred Revenue, Additions	20,332	13,725
Software revenue [Member]
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(16,277)	(7,261)
Deferred Revenue, Additions	17,557	$ 4,615
Government Grant Revenue
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(1,514)
Deferred Revenue, Additions	3,729
Other deferred revenue
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(5,915)
Deferred Revenue, Additions	$ 1,500

Revenue Contract Liabilities Text (Details) $ in Thousands	12 Months Ended
Revenue Contract Liabilities Text (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Contract asset and liability balances [Line Items]
Deferred Revenue, Revenue Recognized	$ 7,500

Revenue Remaining Performance Obligation Recognition Timing (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Short Term
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ (29,627)
Short Term \| Equipment revenue [Member]
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(15,144)
Short Term \| Software revenue [Member]
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(8,277)
Short Term \| Government Grant Revenue
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(1,422)
Short Term \| Other deferred revenue
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(4,784)
Long Term
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(16,239)
Long Term \| Equipment revenue [Member]
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(982)
Long Term \| Software revenue [Member]
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(1,026)
Long Term \| Government Grant Revenue
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(12,797)
Long Term \| Other deferred revenue
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ (1,434)

Leases (Details)	12 Months Ended
Leases (Details)	Dec. 31, 2022
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, 2022	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating Lease, Cost	$ 22,038	$ 11,251	$ 11,284
Finance Lease, Interest Expense	112	122	91
Finance Lease, Right-of-Use Asset, Amortization	712	648	383
Short-term Lease, Cost	7	14	263
Lease, Cost	$ 22,869	$ 12,035	$ 12,021

Leases Supplemental Cash Flow Lease Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating Lease, Payments	$ 25,225	$ 11,256	$ 10,185
Finance Lease, Interest Payment on Liability	112	122	91
Right-of-Use Asset Obtained in Exchange for Operating Lease Liability	5,994	2,589	20,847
Right-of-Use Asset Obtained in Exchange for Finance Lease Liability	715	$ 558	$ 3,062
business combination, recognized identifiable asset acquired and liability assumed,	$ 55,200

Leases Supplemental Balance Sheet Lease information (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Operating Lease, Right-of-Use Assets	$ 74,864	$ 39,847
Operating Lease, Liability, Current	18,169	9,009
Operating Lease, Liability, Noncurrent	60,916	33,971
Operating Lease, Liability	$ 79,085	$ 42,980
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 long-term Liabilities	Other long-term Liabilities
Operating Lease, Weighted Average Remaining Lease Term	6 years 1 month 6 days	5 years 10 months 24 days
Operating Lease, Weighted Average Discount Rate, Percent	4.34%	4.98%

Finance Leases Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Finance Lease, Right-of-Use Asset, after Accumulated Amortization	$ 2,598	$ 2,673
Finance Lease, Liability, Current	816	643
Finance Lease, Liability, Noncurrent	1,855	2,067
Finance Lease, Liability	$ 2,671	$ 2,710
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 long-term Liabilities	Other long-term Liabilities
Finance Lease, Weighted Average Remaining Lease Term	4 years 9 months 18 days	5 years 7 months 6 days
Finance Lease, Weighted Average Discount Rate, Percent	4.23%	4.28%

Leases Lease Maturity (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Lessee, Operating Lease, Liability, Payments, Remainder of Fiscal Year	$ 21,800
Lessee, Operating Lease, Liability, Payments, Due Year Two	17,786
Lessee, Operating Lease, Liability, Payments, Due Year Three	12,699
Lessee, Operating Lease, Liability, Payments, Due Year Four	11,297
Lessee, Operating Lease, Liability, Payments, Due Year Five	7,830
Lessee, Operating Lease, Liability, Payments, Due after Year Five	17,346
Lessee, Operating Lease, Liability, Payments, Due	88,758
Lessee, Operating Lease, Liability, Undiscounted Excess Amount	(9,673)
Operating Lease, Liability	$ 79,085	$ 42,980

Leases Finance Lease Maturity (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Finance Lease, Liability, to be Paid, Year One	$ 914
Finance Lease, Liability, to be Paid, Year Two	657
Finance Lease, Liability, to be Paid, Year Three	442
Finance Lease, Liability, to be Paid, Year Four	322
Finance Lease, Liability, to be Paid, Year Five	189
Finance Lease, Liability, to be Paid, after Year Five	426
Finance Lease, Liability, Payment, Due	2,950
Finance Lease, Liability, Undiscounted Excess Amount	(279)
Finance Lease, Liability	$ 2,671	$ 2,710

Share Based Award Stock Based Compensation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-Based Payment Arrangement [Abstract]
Stock compensation	$ 36,025	$ 27,341	$ 23,954
Tax benefit from stock-based compensation cost	4,636	6,391	5,564
Indirect tax benefit	749	$ 285	$ 1,203
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount	$ 43,000
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition	9 months 18 days

Share Based Award Stock Option Plans (Details) - shares	12 Months Ended
Share Based Award Stock Option Plans (Details) - shares	Dec. 31, 2022	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, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of options granted	7,620	7,910	7,190
Time based options grant date fair value	$ 540	$ 528	$ 425
Expected term (years)	5 years 6 months	5 years 6 months	5 years 6 months
Expected stock price volatility	36.00%	35.00%	35.00%
Risk-Free Interest Rate	3.00%	0.90%	0.40%
Expected Dividend Yield	0.00%	0.00%	0.00%
Weighted Average Exercise Price	$ 185.79	$ 200.07	$ 181.99
Weighted Average Grant Date Fair Value per option	$ 70.86	$ 66.78	$ 59.09

Share Based Award Stock Option Activity (Details) - Share-based Payment Arrangement, Option [Member] $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, Outstanding, Number \| shares	663,098
Granted \| shares	7,620
Exercised \| shares	(142,772)
Forfeited or expired \| shares	(485)
Options, Outstanding, Number \| shares	527,461
Exercisable \| shares	519,841
Vested and Expected to Vest \| shares	527,461
Options, Outstanding, Weighted Average Exercise Price \| $ / shares	$ 74.75
Weighted Average Exercise Price \| $ / shares	185.79
Options, Exercises in Period, Weighted Average Exercise Price \| $ / shares	61.53
Options, Nonvested Options Forfeited, Weighted Average Grant Date Fair Value \| $ / shares	60.01
Options, Outstanding, Weighted Average Exercise Price \| $ / shares	79.94
Exercise Price Range, Exercisable Options, Weighted Average Exercise Price \| $ / shares	78.39
Options, Vested and Expected to Vest, Outstanding, Weighted Average Exercise Price \| $ / shares	$ 79.94
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Expected Term	2 years
Options, Exercisable, Weighted Average Remaining Contractual Term	2 years
Options, Vested and Expected to Vest, Outstanding, Weighted Average Remaining Contractual Term	1 year 10 months 24 days
Options, Outstanding, Intrinsic Value \| $	$ 42,708
Options, Exercisable, Intrinsic Value \| $	42,708
Options, Vested and Expected to Vest, Outstanding, Aggregate Intrinsic Value \| $	$ 42,708

Share Based Award Share Award data (Details)	Dec. 31, 2022 $ / shares
Share award data [Abstract]
Share Price	$ 157.48

Share Based Award Options exercised data (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-Based Payment Arrangement [Abstract]
Intrinsic value of options exercised	$ 17,340	$ 27,534	$ 32,915
Cash received from exercise of stock options	8,785	9,372	13,193
Tax benefit from stock option exercises	$ 3,637	$ 5,092	$ 5,179

Share Based Award RSU and PRSU (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
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	60,383	53,246	38,633
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 230.31	$ 198.16	$ 188.34
Grant date fair value performance restricted stock units	$ 13,907	$ 10,551	$ 7,276
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Aggregate Intrinsic Value, Vested	$ 10,487	$ 6,777	$ 15,627
Performance Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Performance Shares Earned	46,317	32,013	80,654
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	116,870	84,388	87,830
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 221.65	$ 199.13	$ 188.13
Grant date fair value of restricted stock units granted	$ 25,905	$ 16,804	$ 16,523
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Aggregate Intrinsic Value, Vested	$ 16,438	$ 13,681	$ 12,314

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, 2022	Dec. 31, 2021
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	354,004	275,761
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value	$ 213.95	$ 201.05
Change in units due to performance expectations	32,346
ShareBasedCompensationArrangementByShareBasedPaymentAwardEquityInstrumentsOtherThanOptionsPerformanceExpectationAdditionsIntrinsicValue	$ 239.63
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period	177,253
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 224.60
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period	(118,321)
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period, Intrinsic Value, Amount Per Share	$ 206.40
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Forfeited in Period	(13,035)
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Forfeitures, Intrinsic Value, Amount Per Share	$ 218.24
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	$ 55,749

Share Based Award ESPP Narrative (Details)	Dec. 31, 2022 shares
Share-Based Payment Arrangement [Abstract]
ESPP Original Issuance	750,000
ESPP Annual Issuance Increase Limit	300,000

Derivatives and Hedging Activities Foreign Exchange Forward Contracts(Details)	Dec. 31, 2022 USD ($)
Derivative [Line Items]
Derivative, Notional Amount	$ 206,000,000
Foreign Currency Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months	3,000,000
other currencies
Derivative [Line Items]
Derivative, Notional Amount	5,600,000
Mexico, Pesos
Derivative [Line Items]
Derivative, Notional Amount	61,300,000
Euro Member Countries, Euro
Derivative [Line Items]
Derivative, Notional Amount	31,700,000
Czech Republic, Koruny
Derivative [Line Items]
Derivative, Notional Amount	13,900,000
Japan, Yen
Derivative [Line Items]
Derivative, Notional Amount	15,300,000
China, Yuan Renminbi
Derivative [Line Items]
Derivative, Notional Amount	11,500,000
United States of America, Dollars
Derivative [Line Items]
Derivative, Notional Amount	43,200,000
Canada, Dollars
Derivative [Line Items]
Derivative, Notional Amount	11,600,000
Australia, Dollars
Derivative [Line Items]
Derivative, Notional Amount	$ 11,900,000
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	$ 436,800,000
Hedge 5
Derivative [Line Items]
Derivative, Forward Exchange Rate	21.60
Derivative Asset, Notional Amount	$ 413,100,000

Derivatives and Hedging Activities Interest Rate Contracts(Details) $ in Thousands	Dec. 31, 2022 USD ($)
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Interest Rate Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months, Net	$ 29,300
Interest Rate Swap
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative, Fixed Interest Rate	1.32%
Derivative Interest Rate Floor	(0.15%)
us-gaap_InterestRateSwap 2
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative, Fixed Interest Rate	1.17%
Derivative Interest Rate Floor	0.35%
Maximum [Member] \| Interest Rate Swap
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Liability, Notional Amount	$ 300,000
Maximum [Member] \| us-gaap_InterestRateSwap 2
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Liability, Notional Amount	750,000
Minimum [Member] \| Interest Rate Swap
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Liability, Notional Amount	150,000
Minimum [Member] \| us-gaap_InterestRateSwap 2
Derivative Instruments and Hedging Activities Disclosures [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, 2022	Dec. 31, 2021
Foreign Exchange Forward [Member] \| Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	$ 4,860	$ 1,061
Foreign Exchange Forward [Member] \| Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	94	0
Foreign Exchange Forward [Member] \| Accrued Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	1,847	0
Foreign Exchange Forward [Member] \| Other Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	167	0
Foreign Exchange Forward [Member] \| Assets, Total
Derivatives, Fair Value [Line Items]
Derivative Asset	4,954	1,061
Foreign Exchange Forward [Member] \| Liabilities, Total [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	2,014	0
Interest Rate Swap \| Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	28,431	0
Interest Rate Swap \| Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	26,753	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	0	1,480
Interest Rate Swap \| Assets, Total
Derivatives, Fair Value [Line Items]
Derivative Asset	55,184	0
Interest Rate Swap \| Liabilities, Total [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	0	1,480
Derivative Financial Instruments, Assets \| Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	33,291	1,061
Derivative Financial Instruments, Assets \| Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	26,847	0
Derivative Financial Instruments, Assets \| Assets, Total
Derivatives, Fair Value [Line Items]
Derivative Asset	60,138	1,061
Derivative Financial Instruments, Liabilities [Member] \| Accrued Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	1,847	0
Derivative Financial Instruments, Liabilities [Member] \| Other Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	167	1,480
Derivative Financial Instruments, Liabilities [Member] \| Liabilities, Total [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	$ 2,014	$ 1,480

Derivatives and Hedging Activities Derivative Instruments and Hedging Activities - Amounts Affecting Consolidated Statements of Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Instruments, Gain Reclassified from Accumulated OCI into Income, Effective Portion	$ 18,419	$ 3,444	$ 790
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain Reclassified from Accumulated OCI into Income, Effective Portion	$ 18,419	3,444	790
Derivative Instrument, Gain Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]	Interest Income (Expense), Net
Foreign Exchange Contract \| Cash Flow Hedging [Member]
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Gain on Discontinuation of Cash Flow Hedge Due to Forecasted Transaction Probable of Not Occurring	$ 717	0	0
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Gain on Discontinuation of Cash Flow Hedge Due to Forecasted Transaction Probable of Not Occurring	717	0	0
Foreign Exchange Contract \| Cash Flow Hedging [Member] \| Trading Revenue
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	3,829	0	0
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	(3,829)	0	0
Foreign Exchange Contract \| Cash Flow Hedging [Member] \| Cost of Sales [Member]
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	7,751	3,444	790
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	(7,751)	(3,444)	(790)
Interest Rate Swap \| Cash Flow Hedging [Member]
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	6,122	0	0
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	$ (6,122)	$ 0	$ 0

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, 2022	Dec. 31, 2021	Dec. 31, 2020
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	$ 72,374	$ (530)	$ 1,980
Cash Flow Hedging [Member] \| Foreign Exchange Forward [Member]
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	9,588	950	1,980
Cash Flow Hedging [Member] \| Interest Rate Swap
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	$ 62,786	$ (1,480)	$ 0

- 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 https://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 https://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 https://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 https://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 https://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 https://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 https://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 https://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 https://asc.fasb.org/extlink&oid=126953954&loc=SL114868664-224227

+ Details

Fair Value Measurement Smiths Medical(Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)	Jan. 06, 2022 USD ($)
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Ownership requirement for Earnout Payment	0.500
Smiths Medical
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	$ 100,000
Business Combination, Contingent Consideration, Liability	$ 21,000	$ 53,500

Fair Value Measurement Text Pursuit (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent Earn-out Liability	$ 25,572	$ 2,589	$ 26,300	$ 17,300
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
Short-term contingent consideration-gross	1,000
Long-term contingent consideration-gross	$ 1,500

Fair Value Measurement Roll Forward (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent Earn-out Liability	$ 25,572	$ 2,589	$ 26,300	$ 17,300
Fair Value, Measurement with Unobservable Inputs Reconciliation, Recurring Basis, Liability, Issuances		2,589	$ 9,000
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)	(32,091)
Fair Value, Measurement with Unobservable Inputs Reconciliation, Liability, Transfers out of Level 3		$ (26,300)
Contingent earn-out liability, Noncurrent	55,158
Currency translation on earn-out	$ (84)
Fair Value, Liability, Recurring Basis, Unobservable Input Reconciliation, Gain (Loss), Statement of Income or Comprehensive Income [Extensible Enumeration]	Change in fair value of contingent earn-out
Pursuit Vascular LLC
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent Earn-out Liability	$ 26,300
Smiths Medical
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent earn-out liability, Noncurrent	53,500
Foreign Infusion System Supplier
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent earn-out liability, Noncurrent	$ 1,600

Fair Value Measurement Fair Value Inputs, Liabilities, Pursuit Quantitative Information (Details) - Pursuit Vascular, Inc. [Member]	Dec. 31, 2021	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 Smiths Medical Simulation Inputs (Details) - Smiths Medical	Dec. 31, 2022	Jan. 06, 2022
Measurement Input, Price Volatility
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.3800	0.3700
Measurement Input, Risk Free Interest Rate [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.0417	0.0131

Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Prepaid Assets Current [Line Items]
Other Prepaid Expense, Current	$ 21,635	$ 14,763
Prepaid vendor expenses	3,052	0
Deferred Costs and Other Assets	2,395	12,746
Prepaid insurance and property taxes	16,322	6,310
Prepaid other taxes	3,546	4,156
Deferred tax charge	3,830	4,241
Derivative Asset, Current	4,860	1,061
Deposit Assets	1,329	1,343
Other Assets, Current	3,532	2,227
Prepaid expenses and other current assets	88,932	46,847
Prepaid Expenses and Other Current Assets [Member]
Prepaid Assets Current [Line Items]
Interest Rate Derivative Assets, at Fair Value	$ 28,431	$ 0

Prepaids and Other Noncurrent Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Prepaid Noncurrent Assets [Line Items]
Lessor, Operating Lease, Payments to be Received	$ 27,086	$ 25,941
Spare parts	38,498	28,538
Equity Method Investments	3,178	3,238
Debt Issuance Costs, Noncurrent, Net	5,156	2,827
Finance Lease, Right-of-Use Asset, after Accumulated Amortization	2,598	2,673
Other Assets, Miscellaneous, Noncurrent	2,193	526
Other Assets	105,462	63,743
Interest Rate Swap
Prepaid Noncurrent Assets [Line Items]
Derivative Asset, Noncurrent	$ 26,753	$ 0

Accrued Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Schedule of Accrued Liabilities [Line Items]
Salaries and benefits	$ 44,304	$ 27,304
Incentive compensation	30,254	33,107
Operating Lease, Liability, Current	18,169	9,009
Accrued Professional Fees	5,317	773
Accrued Product Field Action.	24,517	0
Legal accrual	3,137	3,897
Accrued sales taxes	5,844	1,980
Warranties and returns	3,097	532
Contract with Customer, Liability, Current	30,838	12,646
Accrued other taxes	5,794	4,337
Outside commissions	17,063	5,645
Accrued freight	17,988	9,194
Restructuring accrual	5,923	664
Accrued audit fees	6,279	1,008
Liability, Defined Benefit Plan, Current	2,928	0
Interest Payable	1,033	0
Accrued research and development liability	3,538	0
Other	14,899	8,099
Accrued liabilities	242,769	118,195
Foreign Exchange
Schedule of Accrued Liabilities [Line Items]
Derivative Liability, Current	$ 1,847	$ 0

Other Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Other liabilities [Line Items]
Operating Lease, Liability, Noncurrent	$ 60,916	$ 33,971
Finance Lease, Liability, Noncurrent	1,855	2,067
Contract with Customer, Liability, Noncurrent	16,239	0
Interest Rate Derivative Liabilities, at Fair Value	0	1,480
Benefits	5,314	1,369
Product Liability Accrual, Component Amount	49,800
Accrued rent	997	1,262
Other	3,489	1,681
OTHER LONG-TERM LIABILITIES	114,104	41,830
Long Term
Other liabilities [Line Items]
Product Liability Accrual, Component Amount	$ 25,294	$ 0

Applicable Margin Based on Leverage Ratio Term Loan A(Details)	12 Months Ended
	Dec. 31, 2022
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.25%
Term Loan A
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Term SOFR Loans	0.0175
Applicable Margin Base Rate Loans	0.0075
greaterthan4.00to1.00
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.35%
greaterthan4.00to1.00 \| Term Loan A
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Term SOFR Loans	0.0225
Applicable Margin Base Rate Loans	0.0125
less than or equal to 4.00 to 1.00 but greater than 3.00 to100
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.30%
less than or equal to 4.00 to 1.00 but greater than 3.00 to100 \| Term Loan A
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Term SOFR Loans	0.0200
Applicable Margin Base Rate Loans	0.0100
less than or equal 3.00 to 1.00 but greater than 2.50to1.00
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.25%
less than or equal 3.00 to 1.00 but greater than 2.50to1.00 \| Term Loan A
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Term SOFR Loans	0.0175
Applicable Margin Base Rate Loans	0.0075
less than or equal to 2.50 to1.00 but greater than 2.00 to1.00
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.20%
less than or equal to 2.50 to1.00 but greater than 2.00 to1.00 \| Term Loan A
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Term SOFR Loans	0.0150
Applicable Margin Base Rate Loans	0.0050
less than or equal to 2.00 to 1.00
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.15%
less than or equal to 2.00 to 1.00 \| Term Loan A
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Term SOFR Loans	0.0125
Applicable Margin Base Rate Loans	0.0025

Applicable Margin Based on Leverage Ratio Term Loan B (Details) - Term Loan B	Dec. 31, 2022
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Term SOFR Loans	0.025
Applicable Margin Base Rate Loans	0.015
greater than 2.75 to1.00
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Term SOFR Loans	0.0250
Applicable Margin Base Rate Loans	0.0150
less than 2.75 to1.00
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Term SOFR Loans	0.0225
Applicable Margin Base Rate Loans	0.0125

Debt (Details)	12 Months Ended
Debt (Details)	Dec. 31, 2022 USD ($)
Debt Instrument [Line Items]
Long-Term Debt, Gross	$ 1,677,625,000
Line of Credit Facility, Fair Value of Amount Outstanding	0
Debt, Long-Term and Short-Term, Combined Amount	1,653,363,000
Debt, Current	29,688,000
Long-Term Debt, Excluding Current Maturities	1,623,675,000
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	(24,262,000)
Revolving Credit Facility
Debt Instrument [Line Items]
Long-Term Debt, Gross	$ 500,000,000
Debt Instrument, Interest Rate During Period	0.00%
Term Loan A
Debt Instrument [Line Items]
Long-Term Debt, Gross	$ 834,000,000
Debt Instrument, Interest Rate During Period	3.99%
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	$ 12,600,000
Term Loan B
Debt Instrument [Line Items]
Long-Term Debt, Gross	$ 843,625,000
Debt Instrument, Interest Rate During Period	4.61%
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	$ 11,700,000

Debt Maturity (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Debt Disclosure [Abstract]
Long-Term Debt, Maturity, Year One	$ 29,688
Long-Term Debt, Maturity, Year Two	51,000
Long-Term Debt, Maturity, Year Three	51,000
Long-Term Debt, Maturity, Year Four	72,250
Long-Term Debt, Maturity, Year Five	672,500
Long-Term Debt, Maturity, after Year Five	801,187
Long-Term Debt, Gross	$ 1,677,625

Debt Interest Expense (Details) - USD ($)	12 Months Ended
Debt Interest Expense (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Debt Disclosure [Abstract]
Interest Expense, Debt, Excluding Amortization	$ 66,770,000	$ 0	$ 1,251,000
Amortization of Debt Issuance Costs and Discounts	6,972,000	240,000	288,000
Line of Credit Facility, Commitment Fee Amount	1,290,000	221,000	110,000
Interest Expense, Debt	$ 75,032,000	$ 461,000	$ 1,649,000

2022 Credit Facility Text (Details) $ in Thousands	12 Months Ended
2022 Credit Facility Text (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Debt Disclosure [Abstract]
TotalSeniorSecuredCreditFacility	$ 2,200,000
Long-Term Debt, Gross	1,677,625
Revolver Sub limits	$ 50,000
Interest Percentage Added to Federal Funds Rate	0.0050
Interest Percentage Added to Base Rate	0.0100
Ter SOFR Interest Rate % Adjustment for Base Rate Loans	0.0010
Line of Credit Facility, Commitment Fee Percentage	0.25%
Term A principal payment % First 2 Years	0.0250
Term A Principal Payment % Year 3 and 4	0.0500
Term A Principal Payment % in Year 5	0.0750
Term Loan B Principal Payment %	0.0025
Leverage Ratio Calculation Ceiling Subtracted Amount	$ 500,000
Long-term Debt Type [Line Items]
Debt Issuance Costs, Gross	37,800
Term Loan A
Debt Disclosure [Abstract]
Long-Term Debt, Gross	$ 834,000
Debt Instrument, Maturity Date	Jan. 06, 2027
Applicable Margin Base Rate Loans	0.0075
Applicable Margin Term SOFR Loans	0.0175
Long-term Debt Type [Line Items]
Proceeds from Issuance of Debt	$ 850,000
Debt Issuance Costs, Gross	15,800
Long-term Debt	$ 834,200
Debt Instrument, Maturity Date	Jan. 06, 2027
Term Loan B
Debt Disclosure [Abstract]
Long-Term Debt, Gross	$ 843,625
Debt Instrument, Maturity Date	Jan. 06, 2029
Applicable Margin Base Rate Loans	0.015
Applicable Margin Term SOFR Loans	0.025
Long-term Debt Type [Line Items]
Proceeds from Issuance of Debt	$ 850,000
Debt Issuance Costs, Gross	13,400
Long-term Debt	$ 836,600
Debt Instrument, Maturity Date	Jan. 06, 2029
Revolving Credit Facility
Debt Disclosure [Abstract]
Long-Term Debt, Gross	$ 500,000
Long-term Debt Type [Line Items]
Debt Issuance Costs, Gross	$ 8,600
Minimum [Member]
Debt Disclosure [Abstract]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0010
Interest Rates [Line Items]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0010
Maximum [Member]
Debt Disclosure [Abstract]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0025
Interest Rates [Line Items]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0025

Principal Payments (Details) - USD ($)	3 Months Ended	12 Months Ended
Principal Payments (Details) - USD ($)	Mar. 31, 2022	Dec. 31, 2022
Debt Disclosure [Abstract]
Debt Instrument, Periodic Payment, Principal	$ 16,000,000	$ 22,400,000

2017 Credit Facility (Details) $ in Millions	12 Months Ended
2017 Credit Facility (Details) $ in Millions	Dec. 31, 2022 USD ($)
Debt Disclosure [Abstract]
Line of Credit Facility, Maximum Borrowing Capacity	$ 150.0
Line of Credit Facility, Expiration Date	Nov. 08, 2022
Line of Credit, Current	$ 0.0

- Definition

The carrying value as of the balance sheet date of the current portion of long-term obligations drawn from a line of credit, which is a bank's commitment to make loans up to a specific amount. Examples of items that might be included in the application of this element may consist of letters of credit, standby letters of credit, and revolving credit arrangements, under which borrowings can be made up to a maximum amount as of any point in time conditional on satisfaction of specified terms before, as of and after the date of drawdowns on the line. Includes short-term obligations that would normally be classified as current liabilities but for which (a) postbalance sheet date issuance of a long term obligation to refinance the short term obligation on a long term basis, or (b) the enterprise has entered into a financing agreement that clearly permits the enterprise to refinance the short-term obligation on a long term basis and the following conditions are met (1) the agreement does not expire within 1 year and is not cancelable by the lender except for violation of an objectively determinable provision, (2) no violation exists at the BS date, and (3) the lender has entered into the financing agreement is expected to be financially capable of honoring the agreement.

+ References + Details

Income Taxes Income (Loss) from Continuing Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Income (Loss) from Continuing Operations before Income Taxes, Domestic	$ (135,646)	$ 81,484	$ 41,194
Income (Loss) from Continuing Operations before Income Taxes, Foreign	21,237	41,702	56,300
Income before income taxes	$ (114,409)	$ 123,186	$ 97,494

Income Taxes Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Current Federal Tax Expense (Benefit)	$ 4,128	$ 20,646	$ 6,032
Current State and Local Tax Expense (Benefit)	3,799	3,444	2,422
Current Foreign Tax Expense (Benefit)	12,924	7,236	7,290
Current Income Tax Expense (Benefit)	20,851	31,326	15,744
Deferred Federal Income Tax Expense (Benefit)	(42,012)	(8,154)	(5,319)
Deferred State and Local Income Tax Expense (Benefit)	(11,239)	(1,815)	(1,850)
Deferred Foreign Income Tax Expense (Benefit)	(7,723)	(1,306)	2,049
Deferred Income Tax Expense (Benefit)	(60,974)	(11,275)	(5,120)
Provision for income taxes	$ (40,123)	$ 20,051	$ 10,624

Income Taxes Change in taxes payable (Details) $ in Millions	12 Months Ended
	Dec. 31, 2022 USD ($)
Income Tax Disclosure [Abstract]
Increase (Decrease) in Income Taxes Payable	$ 2.0

Income Taxes Effective tax rate (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Effective Income Tax Rate Reconciliation, Percent [Abstract]
Income Tax Reconciliation, Income Tax Expense (Benefit), at Federal Statutory Income Tax Rate	$ (24,026)	$ 25,869	$ 20,474
Income Tax Reconciliation, State and Local Income Taxes	(5,050)	2,907	2,099
Income Tax Reconciliation, Tax Credits	(3,636)	(2,443)	(3,269)
GILTItaxexpense	2,303	711	163
Income Tax Reconciliation, Foreign Income Tax Rate Differential	(2,943)	(2,983)	(3,888)
Effective Income Tax Rate Reconciliation, Tax Expense (Benefit), Share-based Payment Arrangement, Amount	(3,721)	(4,263)	(4,686)
EffectiveIncomeTaxRateReconciliationForeignDerivedIntangibleIncome	(2,269)	(3,775)	(2,718)
Effective Income Tax Rate Reconciliation, Contingent Consideration	(6,830)	(29)	1,566
Effectiveincometaxreconciliation,nondeductiblecompensation	3,942	1,812	1,079
Effective Income Tax Rate Reconciliation, Other Adjustments, Amount	(192)	2,245	(196)
Provision for income taxes	$ (40,123)	$ 20,051	$ 10,624
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	4.40%	2.40%	2.20%
Effective Income Tax Rate Reconciliation, Tax Credits	3.20%	(2.00%)	(3.40%)
GILTItaxexpensepercent	(2.00%)	0.60%	0.20%
Effective Income Tax Rate Reconciliation, Foreign Income Tax Rate Differential	2.50%	(2.40%)	(4.00%)
Effective Income Tax Rate Reconciliation, Tax Expense (Benefit), Share-based Payment Arrangement, Percent	3.20%	(3.50%)	(4.80%)
EffectiveIncomeTaxRateReconciliationForeignDerivedIntangibleIncome,Percent	2.00%	(3.10%)	(2.80%)
EffectiveTaxRateReconcilationTransaction cost,Percent	(0.020)	0	0
EffectiveIncomeTaxRateReconciliationTransaction cost	$ 2,299	$ 0	$ 0
Effective Income Tax Rate Reconciliation, Contingent Consideration, Percent	6.00%	0.00%	1.60%
Effectivetaxratereconciliationnondeductiblecomppercent	(3.40%)	1.50%	1.10%
Effective Income Tax Rate Reconciliation, Other Adjustments, Percent	0.20%	1.80%	(0.20%)
Effective Income Tax Rate, Continuing Operations	35.10%	16.30%	10.90%

Income Taxes Deferred income tax assets (liabilities) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Deferred tax assets and liabilities [Line Items]
Non-current deferred tax asset	$ 126,532	$ 69,194
Deferred Tax Liabilities, Net	94,552
Deferred Tax Assets, Net		41,114
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	17,351	7,796
Noncurrent deferred tax asset - acquired future tax deductions	14,186	5,440
Deferred Tax Assets, Tax Deferred Expense, Compensation and Benefits, Share-based Compensation Cost	6,240	7,283
Deferred Tax Assets, Unrealized Currency Losses	0	3,360
Noncurrent deferred tax asset - tax credits state	12,906	11,953
Deferred Tax Assets, Inventory	25,100	8,199
Deferred Tax Assets, Tax Deferred Expense, Reserves and Accruals, Warranty Reserves	13,241	127
Deferred Tax Asset, Section 163(j)	9,166	0
Noncurrentdeferredtaxassetchargebacksdiscountscustomerconcessions	39,508	27,970
Deferred Tax Assets, Valuation Allowance	11,166	2,934
Noncurrent deferred tax liability [Member]
Deferred tax assets and liabilities [Line Items]
Noncurrent deferred tax liability - state income taxes	1,816	2,724
Noncurrent deferred tax liability - depreciation and amortization	209,687	20,483
Deferred tax liability, change in accounting method	0	4,873
Deferred Tax Liabilities, Other Comprehensive Income	9,581	0
Deferred Tax Liabilities, Net	$ 221,084	$ 28,080

Income Taxes Operating Loss Carryforwards (Details) $ in Millions	Dec. 31, 2022 USD ($)
UNITED STATES
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	$ 1.9
State and Local Jurisdiction [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	4.3
Foreign Tax Authority [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	$ 46.3

Income Taxes Tax Carryforwards (Details) $ in Millions	Dec. 31, 2022 USD ($)
Income Tax Disclosure [Abstract]
Tax Credit Carryforward, Amount	$ 18.5
Operating Loss Carryforwards, Valuation Allowance	11.5
Deferred Tax Assets, Operating Loss Carryforwards	$ 12.7

Income Taxes Tax Holiday (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Income Tax Holiday [Line Items]
Income Tax Holiday, Aggregate Dollar Amount	$ 8.1	$ 9.8
Income Tax Holiday, Income Tax Benefits Per Share	$ 0.34	$ 0.45

Income Taxes Undistributed foreign earnings (Details) $ in Millions	Dec. 31, 2022 USD ($)
Income Tax Disclosure [Abstract]
Undistributed Earnings of Foreign Subsidiaries	$ 209.2

Income Taxes Unrecognized tax benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Unrecognized tax benefits roll forward [Roll Forward]
Unrecognized Tax Benefits	$ 54,053	$ 21,537	$ 18,443	$ 15,027
Unrecognized Tax Benefits, Increases Resulting from Prior Period Tax Positions	148	231	502
Unrecognized Tax Benefits, Increases Resulting from Current Period Tax Positions	4,706	3,242	2,987
Unrecognized Tax Benefits, Decrease Resulting from Prior Period Tax Positions	(222)	0	(15)
Unrecognized Tax Benefits, Reductions Resulting from Lapse of Applicable Statute of Limitations	(1,722)	(31)	(58)
Unrecognized Tax Benefits, Decrease Resulting from Settlements with Taxing Authorities	0	348	0
Unrecognized Tax Benefits, Increase Resulting from Acquisition	29,606	$ 0	$ 0
Unrecognized Tax Benefits, Income Tax Penalties Expense	2,300
Unrecognized Tax Benefits, Interest on Income Taxes Expense	$ 2,200

Geographic Information and Significant Customers Long Lived Assets by Geographic Location (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	$ 1,162,557	$ 905,104
COSTA RICA
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	128,179	115,187
Mexico Property and Equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	99,849	79,567
Other LATAM [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	39,270	36,907
CANADA
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	5,374	4,716
Italy Property and Equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	24,323	12,435
SPAIN
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	18,948	13,295
Czech Republic, Koruny
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	10,732	0
Europe [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	11,375	4,171
Asia Pacific [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	20,930	20,452
Foreign [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	358,980	286,730
United States property and equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	$ 803,577	$ 618,374
Manufactured Product, Other \| Revenue Benchmark [Member] \| Customer Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Concentration Risk, Percentage	15.00%

Stockholders' Equity (Details) - USD ($) $ in Millions	12 Months Ended
Stockholders' Equity (Details) - USD ($) $ in Millions	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
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	47,664	40,350	67,041
Payment, Tax Withholding, Share-based Payment Arrangement	$ 10.9	$ 8.3	$ 12.9
Treasury Stock, Common, Shares	1,633	119	209

Stockholders' Equity Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	$ (80,978)	$ (19,269)	$ (1,522)	$ (15,402)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(47,763)	(15,129)	14,481
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(13,946)	(2,618)	(601)
Other Comprehensive Income (Loss), Net of Tax	(61,709)	(17,747)	13,880
Accumulated Foreign Currency Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	(122,973)	(19,045)	(4,381)	(17,310)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(103,928)	(14,664)	12,929
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0	0
Other Comprehensive Income (Loss), Net of Tax	(103,928)	(14,664)	12,929
Accumulated Net Gain (Loss) from Cash Flow Hedges Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	40,779	(237)	2,784	1,880
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	54,962	(403)	1,505
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(13,946)	(2,618)	(601)
Other Comprehensive Income (Loss), Net of Tax	41,016	(3,021)	904
Accumulated Defined Benefit Plans Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	1,216	13	75	$ 28
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	1,203	(62)	47
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0	0
Other Comprehensive Income (Loss), Net of Tax	$ 1,203	$ (62)	$ 47

- 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, 2022	Jan. 06, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Contingent Earn-out Liability	$ 25,572		$ 2,589	$ 26,300	$ 17,300
Short-term contingent consideration-gross	1,000
Long-term contingent consideration-gross	1,500
Contingent Consideration, Gross LT	1,500
Product Liability Accrual, Component Amount	49,800
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
Short-term contingent consideration-gross	1,000
Long-term contingent consideration-gross	1,500
Smiths Medical
Business Acquisition [Line Items]
contingent consideration gross	100,000
Business Combination, Contingent Consideration, Liability	$ 21,000	$ 53,500

Collaborative and Other Arrangements (Details) $ in Millions	Dec. 31, 2022 USD ($)
Collaborative and Other Arrangements [Abstract]
Purchase Commitment, Remaining Minimum Amount Committed	$ 29.6

Subsequent Events (Details) $ in Millions	Dec. 31, 2022 USD ($)
Subsequent Event [Line Items]
accounts receivable purchase program	$ 150.0

SEC Schedule, Article 12-09, Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
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	47,436	(533)	(169)
Warranty and Return Reserve costs	5,266	263	2,033
Warranty and return reserve - inventory	50,819	(1,883)	(1,613)	$ (3,477)
SEC Schedule, 12-09, Allowance, Credit Loss
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	7,038	21,490	20,219
Charged to Costs and Expenses	1,036	345	7,137
Charged to Other Accounts	456	(14,797)	(5,866)
Write-off/ Disposals	0	0	0
Balance at End of Period	8,530	7,038	21,490
SEC Schedule, 12-09, Reserve, Warranty
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	2,485	2,707	6,377
Charged to Costs and Expenses	(364)	568	(3,609)
Charged to Other Accounts	3,742	(790)	(61)
Write-off/ Disposals	0	0	0
Balance at End of Period	5,863	2,485	2,707
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	2,934	3,891	3,677
Charged to Costs and Expenses	0	0	0
Charged to Other Accounts	8,232	(957)	214
Write-off/ Disposals	0	0	0
Balance at End of Period	$ 11,166	$ 2,934	$ 3,891

Label	Element	Value
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	us-gaap_CashCashEquivalentsRestrictedCashAndRestrictedCashEquivalents	$ 268,670,000

Fair Value Measurement Fair Value Measurements, Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	$ 4,224	$ 14,420
Long-term Investment Securities	516	4,620
Debt Securities, Noncurrent		4,620
Assets, Fair Value Disclosure	64,878	20,101
noncurrent
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	94
current
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest Rate Derivative Assets, at Fair Value	28,431
US Treasury Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	1,412
US Government Debt Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	498
Long-term Investment Securities	498
Corporate Bond Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	2,314
Debt Securities, Noncurrent	516
Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities		0
Debt Securities, Noncurrent		0
Assets, Fair Value Disclosure	1,412	0
Fair Value, Inputs, Level 1 [Member] \| noncurrent
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0
Fair Value, Inputs, Level 1 [Member] \| current
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest Rate Derivative Assets, at Fair Value	0
Fair Value, Inputs, Level 1 [Member] \| US Treasury Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	1,412
Fair Value, Inputs, Level 1 [Member] \| US Government Debt Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-term Investment Securities	0
Fair Value, Inputs, Level 1 [Member] \| Corporate Bond Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	0
Debt Securities, Noncurrent	0
Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities		14,420
Debt Securities, Noncurrent		4,620
Assets, Fair Value Disclosure	3,328	20,101
Fair Value, Inputs, Level 2 [Member] \| noncurrent
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0
Fair Value, Inputs, Level 2 [Member] \| current
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest Rate Derivative Assets, at Fair Value	0
Fair Value, Inputs, Level 2 [Member] \| US Treasury Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	0
Fair Value, Inputs, Level 2 [Member] \| US Government Debt Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-term Investment Securities	498
Fair Value, Inputs, Level 2 [Member] \| Corporate Bond Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	2,314
Debt Securities, Noncurrent	516
Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities		0
Debt Securities, Noncurrent		0
Assets, Fair Value Disclosure	60,138	0
Fair Value, Inputs, Level 3 [Member] \| noncurrent
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	94
Fair Value, Inputs, Level 3 [Member] \| current
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest Rate Derivative Assets, at Fair Value	28,431
Fair Value, Inputs, Level 3 [Member] \| US Treasury Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	0
Fair Value, Inputs, Level 3 [Member] \| US Government Debt Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-term Investment Securities	0
Fair Value, Inputs, Level 3 [Member] \| Corporate Bond Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	0
Debt Securities, Noncurrent	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	4,860	1,061
Interest Rate Derivative Assets, at Fair Value	28,431	0
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	0	1,061
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	4,860	0
Other Liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure		1,480
Foreign Currency Contracts, Liability, Fair Value Disclosure	167
Other Liabilities \| 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
Foreign Currency Contracts, Liability, Fair Value Disclosure	0
Other Liabilities \| 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		1,480
Foreign Currency Contracts, Liability, Fair Value Disclosure	0
Other Liabilities \| 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
Foreign Currency Contracts, Liability, Fair Value Disclosure	167
Other Assets [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest Rate Derivative Assets, at Fair Value	26,753
Other Assets [Member] \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest Rate Derivative Assets, at Fair Value	0
Other Assets [Member] \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest Rate Derivative Assets, at Fair Value	0
Other Assets [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest Rate Derivative Assets, at Fair Value	26,753
Accrued Liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure	1,847
Accrued Liabilities \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure	0
Accrued Liabilities \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure	0
Accrued Liabilities \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure	1,847
Earn-out liability [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	25,572	2,589
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	25,572	2,589
Liabilities, Total [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	27,586	4,069
Liabilities, Total [Member] \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	0
Liabilities, Total [Member] \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0	1,480
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	$ 27,586	$ 2,589