0000883984-24-000005 | 10-K | XBRL Viewer

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Revenue Disaggregation of Revenue by Geography (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Revenues	$ 2,259,126	$ 2,279,997	$ 1,316,308
UNITED STATES
Disaggregation of Revenue [Line Items]
Revenues	$ 1,440,017	$ 1,460,069	$ 941,809
Percent of total revenue	64.00%	64.00%	72.00%
EMEA [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 373,571	$ 367,411	$ 147,488
APAC [Domain]
Disaggregation of Revenue [Line Items]
Revenues	241,699	257,208	85,692
Other foreign countries [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 203,839	$ 195,309	$ 141,319
International Sales [Domain]
Disaggregation of Revenue [Line Items]
Percent of total revenue	36.00%	36.00%	28.00%

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- Definition

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

+ References

+ Details

Derivatives and Hedging Activities Derivative Instruments and Hedging Activities - Amounts Affecting Consolidated Statements of Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain Reclassified from Accumulated OCI into Income, Effective Portion	$ 40,834	$ 18,419	$ 3,444
Derivative Instrument, Gain Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]	Interest (Expense) Income, Net
Foreign Exchange Contract
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative, Net Hedge Ineffectiveness Gain (Loss)	$ 229	0	0
Foreign Exchange Contract \| Cash Flow Hedging [Member]
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Gain on Discontinuation of Cash Flow Hedge Due to Forecasted Transaction Probable of Not Occurring	13	717	0
Foreign Exchange Contract \| Cash Flow Hedging [Member] \| Trading Revenue
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	(296)	(3,829)	0
Foreign Exchange Contract \| Cash Flow Hedging [Member] \| Cost of Sales [Member]
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	(7,852)	(7,751)	(3,444)
Interest Rate Swap \| Cash Flow Hedging [Member]
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	$ (32,444)	$ (6,122)	$ 0

General and Summary of Significant Accounting Policies Intangible Assets #2 (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Amortization of Intangible Assets	$ 132.1	$ 139.4	$ 23.8

Acquisitions (Notes)

12 Months Ended

Dec. 31, 2023

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 Obligations). 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. As of December 31, 2023, the estimated fair value of the contingent earn-out was $4.0 million.

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. In 2023, we expensed $8.3 million for services provided under the TSA and we had no related open payables as of December 31, 2023. In 2022, we expensed $37.6 million for services provided under the TSA and we had $5.1 million in related open payables as of December 31, 2022.

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. As of December 31, 2023, the estimated fair value for the contingent earn-out related to certain product-related regulatory certifications was $1.5 million.

General and Summary of Significant Accounting Policies Property and Equipment #2 (Details)	Dec. 31, 2023
Building [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	15 years
Building [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	30 years
Building Improvements [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	15 years
Building Improvements [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	30 years
Machinery and Equipment [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	2 years
Machinery and Equipment [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	15 years
Furniture, fixtures and molds [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	2 years
Furniture, fixtures and molds [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	5 years
Computer Equipment and Software [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	3 years
Computer Equipment and Software [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	5 years
Instruments Placed with Customers [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	3 years
Instruments Placed with Customers [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Estimated Useful Lives	10 years

Fair Value Measurement Smiths Medical(Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	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	$ 100,000
Business Combination, Contingent Consideration, Liability	$ 4,000		$ 53,500

Share Based Award Options exercised data (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-Based Payment Arrangement [Abstract]
Intrinsic value of options exercised	$ 8,441	$ 17,340	$ 27,534
Cash received from exercise of stock options	4,022	8,785	9,372
Tax benefit from stock option exercises	$ 1,733	$ 3,637	$ 5,092

General and Summary of Significant Accounting Policies Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
GOODWILL	$ 1,449,258	$ 43,439	$ 33,001
Goodwill, Acquired During Period		1,469,880	10,626
Goodwill, Purchase Accounting Adjustments		(7,128)	(188)
Goodwill, Other Increase (Decrease)		(650)
Goodwill, Foreign Currency Translation Gain (Loss)	23,188	(56,283)
GOODWILL	$ 1,472,446	$ 1,449,258	43,439
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

Income Taxes Undistributed foreign earnings (Details) $ in Millions	Dec. 31, 2023 USD ($)
Income Tax Disclosure [Abstract]
Undistributed Earnings of Foreign Subsidiaries	$ 246.8

Share Based Award Stock Based Compensation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-Based Payment Arrangement [Abstract]
Stock compensation	$ 40,563	$ 36,025	$ 27,341
Tax benefit from stock-based compensation cost	5,379	4,636	6,391
Indirect tax benefit	0	$ 749	$ 285
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount	$ 43,100
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition	10 months 24 days

Derivatives and Hedging Activities Foreign Exchange Forward Contracts(Details)	Dec. 31, 2023 USD ($)
Derivative [Line Items]
Derivative, Notional Amount	$ 172,600,000
Foreign Currency Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months	4,200,000
other currencies
Derivative [Line Items]
Derivative, Notional Amount	9,200,000
Mexico, Pesos
Derivative [Line Items]
Derivative, Notional Amount	27,100,000
Euro Member Countries, Euro
Derivative [Line Items]
Derivative, Notional Amount	35,600,000
Japan, Yen
Derivative [Line Items]
Derivative, Notional Amount	17,400,000
China, Yuan Renminbi
Derivative [Line Items]
Derivative, Notional Amount	8,100,000
Canada, Dollars
Derivative [Line Items]
Derivative, Notional Amount	18,400,000
Australia, Dollars
Derivative [Line Items]
Derivative, Notional Amount	14,200,000
United States of America, Dollars
Derivative [Line Items]
Derivative, Notional Amount	$ 42,600,000
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

Restructuring, Strategic Transaction and Integration (Details 2) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve, Beginning Balance	$ 5,923,000	$ 664,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Restructuring Liabilities		7,536,000
Restructuring Costs	6,710,000	9,725,000
Payments for Restructuring	(7,886,000)	(11,351,000)
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	160,000	613,000
Restructuring Reserve, Accrual Adjustment	(1,019,000)	(38,000)
Restructuring Reserve, Ending Balance	3,568,000	5,923,000
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve, Beginning Balance	4,416,000	499,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Restructuring Liabilities		5,796,000
Restructuring Costs	5,521,000	9,667,000
Payments for Restructuring	(6,694,000)	(11,083,000)
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	198,000	425,000
Restructuring Reserve, Accrual Adjustment	(234,000)	(38,000)
Restructuring Reserve, Ending Balance	2,811,000	4,416,000
Facility Closing [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve, Beginning Balance	1,507,000	165,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Restructuring Liabilities		1,740,000
Restructuring Costs	1,189,000	58,000
Payments for Restructuring	(1,192,000)	(268,000)
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	(38,000)	188,000
Restructuring Reserve, Accrual Adjustment	(785,000)	0
Restructuring Reserve, Ending Balance	$ 757,000	$ 1,507,000

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2023
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. 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, 2023, the fair value of the contingent earn-out was determined to be $3.4 million and was paid out in the first quarter of 2024 (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, 2023, 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, 2023, the estimated fair value of the contingent earn-out is $4.0 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 actions identified as of the closing date of the acquisition 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 related to known field corrective actions. The actual costs to be incurred are dependent upon the scope of the work necessary to achieve regulatory clearance, including potential additional field corrective actions, and could differ from the original estimate. For the years ended December 31, 2023 and 2022, we recorded additional expense of $20.3 million and $5.3 million, respectively, primarily related to additional field corrective actions identified and initiated during those periods. As of December 31, 2023, approximately $53.6 million of the $56.3 million of accrued field service corrective action was related to Smiths Medical. Commitments We have non-cancelable operating lease agreements where we are contractually obligated to pay certain lease payment amounts (see Note 5: Leases).

Stockholders' Equity (Details) - USD ($) $ in Millions	12 Months Ended
Stockholders' Equity (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
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	59,377	47,664	40,350
Payment, Tax Withholding, Share-based Payment Arrangement	$ 9.4	$ 10.9	$ 8.3
Treasury Stock, Common, Shares	2,428	1,633	119

General and Summary of Significant Accounting Policies Other (expense) income, net (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Other (expense) income, net [Line Items]
Foreign Currency Transaction Loss, before Tax	$ (5,918)	$ (5,780)	$ (1,017)
Gain (Loss) on Disposition of Other Assets	(153)	(2,554)	(1,651)
miscellaneous income, net	166	3,198	627
Other Income Disclosure, Nonoperating	(5,905)	$ (5,136)	$ (2,041)
Gain (Loss) on Sale of Accounts Receivable	3,700
Gain on Business Interruption Insurance Recovery	$ 2,600
Gain on Business Interruption Insurance Recovery, Statement of Income or Comprehensive Income [Extensible Enumeration]	OTHER EXPENSE, NET
Total Insurance Proceeds	$ 3,100

Restructuring, Strategic Transaction and Integration (Details 1) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Restructuring and Related Activities [Abstract]
Restructuring, strategic transaction and integration expenses	$ 41,258	$ 71,421	$ 18,037
Restructuring Charges	$ 5,700	$ 9,700	(1,800)
Restructuring Adjustments - Severance and Facility			$ 2,000

Share Based Award ESPP Narrative (Details)	Dec. 31, 2023 shares
Share-Based Payment Arrangement [Abstract]
ESPP Original Issuance	750,000
ESPP Annual Issuance Increase Limit	300,000

General and Summary of Significant Accounting Policies Investments (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-Sale, Amortized Cost, Current	$ 501	$ 4,224
Investment Securities, Amortized Cost	501	4,740
Investment Securities	501	4,740
Short-term investment securities	501	4,224
Long-term Investment Securities	0	516
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	501	2,314
Short-term investment securities	501	2,314
Debt Securities, Available-for-Sale, Amortized Cost, Noncurrent	0	516
Long-term Investment Securities	0	516
Debt Securities, Available-for-Sale, Unrealized Loss	0	0
US Treasury Securities
Debt Securities, Available-for-sale [Line Items]
Short-term investment securities	0	1,412
Debt Securities, Available-for-Sale, Unrealized Loss	0	0
US Treasury Securities \| Fair Value, Inputs, Level 1 [Member]
Debt Securities, Available-for-sale [Line Items]
Short-term investment securities	0	1,412
US Government Debt Securities
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-Sale, Amortized Cost, Current	0	498
Short-term investment securities	0	498
Debt Securities, Available-for-Sale, Unrealized Loss	$ 0	0
US Government Debt Securities \| Fair Value, Inputs, Level 1 [Member]
Debt Securities, Available-for-sale [Line Items]
Short-term investment securities		$ 0

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2023
Auditor [Line Items]
Auditor Name	DELOITTE & TOUCHE LLP
Auditor Location	Costa Mesa, California
Auditor Firm ID	34

Debt Interest Expense (Details) - USD ($)	12 Months Ended
Debt Interest Expense (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Debt Disclosure [Abstract]
Interest Expense, Debt, Excluding Amortization	$ 125,550,000	$ 66,770,000	$ 0
Amortization of Debt Issuance Costs and Discounts	6,814,000	6,972,000	240,000
Line of Credit Facility, Commitment Fee Amount	1,518,000	1,290,000	221,000
Interest Expense, Debt	$ 133,882,000	$ 75,032,000	$ 461,000

General and Summary of Significant Accounting Policies New Accounting Pronouncements (Details)	12 Months Ended
	Dec. 31, 2023
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. In October 2023, the FASB issued ASU 2023-06, Disclosure Improvements - Codification Amendments in Response to the SEC's Disclosure Update and Simplification Initiative. The amendments in this update modify the disclosure or presentation requirements of a variety of Topics in the Accounting Standards Codification ("ASC") in response to the SEC’s Release No. 33-10532, Disclosure Update and Simplification Initiative, and align the ASC’s requirements with the SEC’s regulations. For entities within the scope, the guidance will be applied prospectively with the effective date for each amendment to be the date on which the SEC's removal of that related disclosure from Regulation S-X or Regulation S-K becomes effective, with early adoption prohibited. If the SEC has not removed the related disclosure from its regulations by June 30, 2027, the amendments will be removed from the Codification and will not become effective. We are currently assessing what impact this guidance will have on the Company's consolidated financial statements and related disclosures. In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280) - Improvements to Reportable Segment Disclosures. The amendments in this update expand disclosures about a public entity’s reportable segments and requires more enhanced information about a reportable segment’s significant expenses, interim segment profit or loss, and a description of how a public entity’s chief operating decision maker uses reported segment profit or loss information in assessing segment performance and allocating resources. The amendments clarify that a single reportable segment entity must apply ASC 280 in its entirety. The update will be effective for annual periods beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. This ASU is applicable to our Annual Report on Form 10-K for the fiscal year ended December 31, 2024, and subsequent interim periods, with early application permitted. We are currently assessing the effect of this update on our consolidated financial statements and related disclosures. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740) - Improvements to Income Tax Disclosures. The amendments in this update expand disclosures in an entity’s income tax rate reconciliation table and regarding cash taxes paid information. The update will be effective for annual periods beginning after December 15, 2024 and is applicable to our Annual Report on Form 10-K for the fiscal year December 31, 2025, with early application permitted. We are currently assessing the effect of this update on our consolidated financial statements and related disclosures.

- 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.

+ References

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+ Details

Accrued Liabilities an Other Long-term Liabilities (Tables)

12 Months Ended

Dec. 31, 2023

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,
	2023		2022
Salaries and benefits	$	52,250	$	44,304
Incentive compensation	37,992		30,254

Operating lease liability-ST	20,161		18,169
Accrued professional fees	2,803		5,317
Field service corrective action(1)	30,281		24,517


Italy medical device payback provision(2)	23,176		7,900
Legal accrual	1,874		3,137
Accrued sales taxes	6,748		5,844
Warranties and returns	3,682		3,097
Deferred revenue	31,640		30,838

Accrued other taxes	3,024		5,794
Distribution fees	13,049		17,063
Accrued freight	17,215		17,988
Restructuring accrual	3,568		5,923
Foreign exchange contracts	2,590		1,847
Accrued audit fees	5,492		6,279
Defined benefit plan	2,575		2,928
Accrued interest	1,431		1,033




Accrued research and development	—		3,538
Other	8,664		6,999
	$	268,215	$	242,769

_____________________________

(1) Primarily 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.

(2) As of December 31, 2022, there was an additional $12.1 million in payback provision recorded as a reduction to accounts receivable, net. Whereas we recorded the amount for the payback provision to accrued liabilities from accounts receivable in Q3 2023, the payback provision was not reclassified as of December 31, 2022 to conform to the current year presentation.

Other Liabilities

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


	As of December 31,
	2023		2022
Operating lease liability-LT	$	52,972	$	60,916
Finance lease liability-LT	1,954		1,855

Deferred revenue	10,585		16,239

Benefits	4,207		5,314
Field service corrective action(1)	26,056		25,294
Accrued rent	841		997

Other	3,882		3,489
	$	100,497	$	114,104

_______________________________

(1) Related to 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.

Leases Lease Maturity (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Lessee, Operating Lease, Liability, Payments, Remainder of Fiscal Year	$ 22,291
Lessee, Operating Lease, Liability, Payments, Due Year Two	16,409
Lessee, Operating Lease, Liability, Payments, Due Year Three	14,095
Lessee, Operating Lease, Liability, Payments, Due Year Four	10,150
Lessee, Operating Lease, Liability, Payments, Due Year Five	5,735
Lessee, Operating Lease, Liability, Payments, Due after Year Five	13,041
Lessee, Operating Lease, Liability, Payments, Due	81,721
Lessee, Operating Lease, Liability, Undiscounted Excess Amount	(8,588)
Operating Lease, Liability	$ 73,133	$ 79,085

General and Summary of Significant Accounting Policies Income Taxes - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Accounting Policies [Abstract]
Income Tax Examination, Interest Accrued	$ 2,900	$ 2,200
Income Tax Examination, Penalties Accrued	$ 2,000	$ 2,300

Share Based Award (Tables)

12 Months Ended

Dec. 31, 2023

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,
	2023		2022		2021
Stock compensation expense	$	40,563	$	36,025	$	27,341
Tax benefit from stock-based compensation cost	$	5,379	$	4,636	$	6,391
Indirect tax benefit	$	—	$	749	$	285

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 and shares in thousands, except per option amounts):


	Year ended December 31,
	2022			2021
Number of time-based options granted	7,620			7,910
Grant-date fair value of options granted	$	540		$	528
Weighted-average assumptions for stock option valuation:
Expected term (years)	5.5			5.5
Expected stock price volatility	36.0		%	35.0		%
Risk-free interest rate	3.0		%	0.9		%
Expected dividend yield	—		%	—		%
Weighted-average grant-price per option	$	185.79		$	200.07
Weighted-average grant-date fair value per option	$	70.86		$	66.78

There were no stock options granted during the year ended December 31, 2023.

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, 2023 is as follows:


	Shares	Weighted-Average Exercise Price Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding at December 31, 2022	527,461	$	79.94
Granted	—	$	—
Exercised	(67,633)	$	59.47
Forfeited or expired	—	$	—
Outstanding at December 31, 2023	459,828	$	82.95	1.1	$	11,856
Exercisable at December 31, 2023	459,828	$	82.95	1.1	$	11,856
Vested and expected to vest, December 31, 2023	459,828	$	82.95	1.1	$	11,856

Exercised Options Data [Table Text Block]

The following table presents information regarding stock option activity (in thousands):


	Year ended December 31,
	2023		2022		2021
Intrinsic value of options exercised	$	8,441	$	17,340	$	27,534
Cash received from exercise of stock options	$	4,022	$	8,785	$	9,372
Tax benefit from stock option exercises	$	1,733	$	3,637	$	5,092

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,
	2023		2022		2021
PRSU
Shares granted	78,213		60,383		53,246
Shares earned (1)	49,314		46,317		32,013
Grant-date fair value per share	$	190.02	$	230.31	$	198.16
Grant-date fair value	$	14,862	$	13,907	$	10,551
Intrinsic value vested	$	8,024	$	10,487	$	6,777

RSU
Shares granted	156,111		116,870		84,388
Grant-date fair value per share	$	173.10	$	221.65	$	199.13
Grant-date fair value	$	27,024	$	25,905	$	16,804
Intrinsic value vested	$	14,179	$	16,438	$	13,681

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, 2023:


	Number of Units	Grant-Date Fair Value Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Non-vested at December 31, 2022	354,004	$	213.95
Change in units due to performance expectations (1)	5,554	$	188.11
Granted	234,324	$	178.75
Vested	(140,091)	$	200.66
Forfeited	(5,190)	$	188.98
Non-vested and expected to vest at December 31, 2023	448,601	$	199.68	0.9	$	44,743

General and Summary of Significant Accounting Policies Property and Equipment #3 (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Depreciation	$ 96.7	$ 95.8	$ 65.9

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
CASH FLOWS FROM OPERATING ACTIVITIES:
Net (Loss) Income	$ (29,655)	$ (74,286)	$ 103,135
Depreciation and amortization	228,774	235,151	89,698
Amortization of Inventory Step-up	0	26,519	0
Operating Lease, Right-of-Use Asset, Amortization Expense	21,910	23,651	9,594
Provision for doubtful accounts	838	1,036	345
Provision for warranty and returns	21,582	4,902	831
Stock compensation	40,563	36,025	27,341
Loss on Disposition of Property Plant Equipment, net	2,109	2,010	1,652
Bond premium amortization	17	264	655
Debt issuance cost amortization	6,814	6,972	240
Change in fair value of contingent earn-out	(16,247)	(32,091)	0
Production Related Impairments or Charges	0	0	3,380
Sparepartsusage	17,050	11,924	13,046
Other	8,049	(477)	2,582
Increase (Decrease) in Accounts Receivable	48,635	(19,151)	13,755
Increase (Decrease) in Inventories	(6,079)	(201,095)	20,815
Increase (Decrease) in Prepaid Expense and Other Assets	11,672	22,903	(7,973)
Increase (Decrease) in Other Operating Assets	(24,695)	(21,290)	(21,038)
Accounts payable	(68,301)	37,472	2,347
Accrued liabilities	(14,479)	(55,834)	6,259
Income taxes, including excess tax benefits and deferred income taxes	(82,356)	(66,734)	874
Net cash provided by (used in)operating activities	166,201	(62,129)	267,538
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property, plant and equipment	(83,893)	(90,311)	(68,542)
Proceeds from sale of assets	1,501	989	218
Intangible asset additions	(9,777)	(9,018)	(12,627)
Business acquisitions, net of cash acquired	0	(1,844,164)	(14,452)
Payments to Acquire Equity Method Investments	0	0	(3,250)
Purchases of investment securities	0	(3,397)	(10,034)
Proceeds from sale of investment securities	4,222	36,433	18,000
Net cash used in by investing activities	(87,947)	(1,909,468)	(90,687)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of long-term debt, net of lender debt issuance costs	0	1,664,362	0
Repayments of Long-term obligations	(29,688)	(22,375)	0
Payments of Debt Issuance Costs	0	(2,177)	0
Proceeds from exercise of stock options	4,022	8,785	9,372
Payments on finance leases	(963)	(680)	(607)
Payment for Contingent Consideration Liability, Financing Activities	0	0	(17,300)
Purchase of treasury stock	(9,350)	(10,883)	(8,335)
Net cash (used in) provided by financing activities	(35,979)	1,637,032	(16,870)
Effect of Exchange Rate on Cash [Abstract]
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Continuing Operations	3,163	(9,478)	(3,251)
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect, Total	45,438	(344,043)	156,730
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	254,222	208,784	552,827
SUPPLEMENTAL DISCLSOURE OF CASH FLOW INFORMATION
Cash paid during the year for income taxes	35,809	27,504	19,562
Interest Paid, Excluding Capitalized Interest, Operating Activities	95,913	63,713	858
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES
Accounts payable for property, plant and equipment	6,570	4,854	9,338
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	$ 0	2,589
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

General and Summary of Significant Accounting Policies Inventory (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Accounting Policies [Abstract]
Raw Materials	$ 296,037	$ 286,964
Work in Process	58,906	73,795
Finished Goods	354,417	335,250
Total	$ 709,360	$ 696,009

Transfers and Servicing	12 Months Ended
Transfers and Servicing	Dec. 31, 2023
Transfers and Servicing [Abstract]
Transfers and Servicing of Financial Assets	ACCOUNTS RECEIVABLE PURCHASE PROGRAM On January 19, 2023, we entered into a revolving $150 million uncommitted receivables purchase agreement with Bank of The West ("BOW"), which was subsequently acquired by BMO in February 2023. This agreement provided 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 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 do not retain effective control over the sold receivables and BOW has the right upon purchase to pledge and/or exchange the transferred assets without restrictions. The Company acts as collection agent for BOW and collection services are undertaken by our accounts receivable personnel in their normal course of business and collected funds are remitted to BOW. We do not have any continuing involvement with the sold receivables other than the collection services which does not provide us with more than a trivial benefit. The discount rate has been negotiated net of consideration for the collection services, the cost of collection is immaterial to the Company; therefore, we did not separately record any related servicing assets or liabilities related to the sold receivables. For the year ended December 31, 2023, the carrying value of trade receivables sold to BOW in connection with the purchase program was $629.1 million. In exchange for the sale of trade receivables, we received cash of $625.3 million. For the year ended December 31, 2023, the sale of the receivables resulted in a loss of $3.7 million, recorded in other expense, net in our consolidated statement of operations. For the year ended December 31, 2023, we have collected and remitted $553.2 million in cash to BOW. As of December 31, 2023, cash remaining to be collected on behalf of BOW was $75.9 million, which has been removed from our consolidated balance sheet as of December 31, 2023 and is reflected as cash provided by operating activities in the consolidated statement of cash flows. There were no such balances at December 31, 2022. The carrying value of the sold receivables approximated the fair value at December 31, 2023.

- Definition

The entire disclosure for a transferor's continuing involvement in financial assets that it has transferred in a securitization or asset-backed financing arrangement, the nature of any restrictions on assets reported by an entity in its statement of financial position that relate to a transferred financial asset (including the carrying amounts of such assets), how servicing assets and servicing liabilities are reported, and (for securitization or asset-backed financing arrangements accounted for as sales) when a transferor has continuing involvement with the transferred financial assets and transfers of financial assets accounted for as secured borrowings, how the transfer of financial assets affects an entity's financial position, financial performance, and cash flows.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Subparagraph (b)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481420/860-30-50-1A

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 50
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Subparagraph (a)(7)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481229/860-50-50-4

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (b)(2)(i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481326/860-20-50-3

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (b)(2)(ii)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481326/860-20-50-3

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481326/860-20-50-4

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 210
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.6-04(11))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479617/946-210-S99-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 50
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481229/860-50-50-3

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 50
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (a)(4)(ii)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481229/860-50-50-3

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 50
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (a)(5)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481229/860-50-50-3

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 50
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481229/860-50-50-2

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-Name Accounting Standards Codification
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-URI https://asc.fasb.org//860/tableOfContent

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
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-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481326/860-20-50-3

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (cc)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481326/860-20-50-3

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
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-Subparagraph (a)(5)(ii)
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-URI https://asc.fasb.org//1943274/2147481326/860-20-50-4

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
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-Section 50
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-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481326/860-20-50-4

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
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-Name Accounting Standards Codification
-Section 50
-Paragraph 4D
-Subparagraph (c)(3)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481326/860-20-50-4D

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Subparagraph (c)(3)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481420/860-30-50-1A

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481420/860-30-50-7

Reference 19: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 860
-SubTopic 50
-Name Accounting Standards Codification
-Section 50
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481229/860-50-50-2

Reference 20: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 4
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481229/860-50-50-4

+ Details

SEC Schedule, Article 12-09, Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Warranty and return reserve - inventory	$ 57,796	$ 50,819	$ (1,883)	$ (1,613)
Warranty and Return Reserve costs	20,290	5,266	263
Warranty and return reserve - inventory - charged to other accounts	(13,313)	47,436	(533)
Warranty and return reserve - inventory write-offs	0	0	0
SEC Schedule, 12-09, Allowance, Credit Loss
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	8,530	7,038	21,490
Charged to Costs and Expenses	838	1,036	345
Charged to Other Accounts	1,696	456
Write-off/ Disposals	0	0	0
Balance at End of Period	11,064	8,530	7,038
SEC Schedule, 12-09, Valuation Allowances and Reserves, Deduction			(14,797)
SEC Schedule, 12-09, Reserve, Warranty
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	5,863	2,485	2,707
Charged to Costs and Expenses	1,627	(364)	568
Charged to Other Accounts	15	3,742	(790)
Write-off/ Disposals	0	0	0
Balance at End of Period	7,505	5,863	2,485
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	11,166	2,934	3,891
Charged to Costs and Expenses	0	0	0
Charged to Other Accounts	(2,714)	8,232	(957)
Write-off/ Disposals	0	0	0
Balance at End of Period	$ 8,452	$ 11,166	$ 2,934

Consolidated Balance Sheets (Parenthetical) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 11,064,000	$ 8,530,000
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	24,144,000	23,995,000
Common stock, shares outstanding	24,141,000	23,993,000
Treasury Stock, Common, Shares	2,428	1,633

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
REVENUES:
Revenues	$ 2,259,126	$ 2,279,997	$ 1,316,308
Cost of Goods Sold	1,519,253	1,582,236	824,818
Gross profit	739,873	697,761	491,490
OPERATING EXPENSES:
Selling, general and administrative	606,693	608,345	302,583
Research and development	85,344	92,984	47,498
Restructuring, strategic transaction and integration expenses	41,258	71,421	18,037
Change in fair value of contingent earn-out	(16,247)	(32,091)	0
Contractsettlements	0	0	127
Total operating expenses	717,048	740,659	368,245
Income from operations	22,825	(42,898)	123,245
Interest (Expense) Income, Net	(95,219)	(66,375)	1,982
OTHER EXPENSE, NET	(5,905)	(5,136)	(2,041)
(Loss) Income before income taxes	(78,299)	(114,409)	123,186
Benefit (Provision) for income taxes	48,644	40,123	(20,051)
Net (Loss) Income	$ (29,655)	$ (74,286)	$ 103,135
Basic	$ (1.23)	$ (3.11)	$ 4.86
Diluted	$ (1.23)	$ (3.11)	$ 4.74
WEIGHTED AVERAGE NUMBER OF SHARES
Basic (in shares)	24,091	23,868	21,206
Diluted (in shares)	24,091	23,868	21,781

Finance Leases Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Finance Lease, Right-of-Use Asset, after Accumulated Amortization	$ 2,707	$ 2,598
Finance Lease, Liability, Current	$ 860	$ 816
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Accrued liabilities	Accrued liabilities
Finance Lease, Liability, Noncurrent	$ 1,954	$ 1,855
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Other long-term Liabilities	Other long-term Liabilities
Finance Lease, Liability	$ 2,814	$ 2,671
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Other Assets	Other Assets
Finance Lease, Weighted Average Remaining Lease Term	4 years 1 month 6 days	4 years 9 months 18 days
Finance Lease, Weighted Average Discount Rate, Percent	4.93%	4.23%

Applicable Margin Based on Leverage Ratio Term Loan A(Details)	12 Months Ended
	Dec. 31, 2023
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

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net (Loss) Income	$ (29,655)	$ (74,286)	$ 103,135

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(g)(1)(ii))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 323
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-Section 50
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481687/323-10-50-3

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
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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
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/exampleRef
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-Section 55
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Statement of Comprehensive Income (Paranthetical) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income [Abstract]
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), after Reclassification, Tax	$ (5,951,000)	$ 12,941,000	$ (954,000)
Other Comprehensive Income (Loss), Foreign Currency Translation Adjustment, Tax	0	0	0
Other Comprehensive (Income) Loss, Other Adjustments, Tax	$ 0	$ 0	$ 0

Acquisitions Text (Details) - USD ($) shares in Thousands	12 Months Ended
Acquisitions Text (Details) - USD ($) shares in Thousands	Dec. 31, 2023	Dec. 31, 2022	Jan. 06, 2022
Business Acquisition [Line Items]
Contingent earn-out liability, Noncurrent	$ 3,991,000	$ 25,572,000
Related Party Transaction, Purchases from Related Party	8,300,000	37,600,000
RelatedPartyOpenPayable		$ 5,100,000
Smiths Medical 2020 Limited
Business Acquisition [Line Items]
Business Acquisition, Percentage of Voting Interests Acquired		100.00%
Business Combination, Consideration Transferred, Cash		$ 1,900,000,000
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
Smiths Medical
Business Acquisition [Line Items]
Business Combination, Contingent Consideration, Liability	$ 4,000,000		$ 53,500,000

Share Based Award Share awards (Notes)

12 Months Ended

Dec. 31, 2023

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, however, the employee stock purchase plan was suspended in 2017. 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") and performance restricted stock units ("PRSU"). 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,
	2023		2022		2021
Stock compensation expense	$	40,563	$	36,025	$	27,341
Tax benefit from stock-based compensation cost	$	5,379	$	4,636	$	6,391
Indirect tax benefit	$	—	$	749	$	285

As of December 31, 2023, we had $43.1 million of unamortized stock compensation cost which we will recognize as an expense over a weighted-average period of approximately 0.9 years.

Stock Option Plans

Our 2011 Stock Incentive Plan ("2011 Plan") replaced our 2003 Stock Option Plan ("2003 Plan"). Our 2011 Plan initially had 650,000 shares available for issuance, plus the remaining available shares for grant from the 2003 Plan and any shares that were forfeited, terminated or expired that would have otherwise returned to the 2003 Plan. In years 2012, 2014, 2017 and 2023, our stockholders approved amendments to the 2011 plan that increased the shares available for issuance by a total of 5,461,000, bringing the initial shares available for issuance to 6,111,000, plus the remaining 248,700 shares that remained available for grant from the 2003 Plan. As of December 31, 2023, the 2011 Plan has 6,374,300 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 and shares in thousands, except per option amounts):


	Year ended December 31,
	2022			2021
Number of time-based options granted	7,620			7,910
Grant-date fair value of options granted	$	540		$	528
Weighted-average assumptions for stock option valuation:
Expected term (years)	5.5			5.5
Expected stock price volatility	36.0		%	35.0		%
Risk-free interest rate	3.0		%	0.9		%
Expected dividend yield	—		%	—		%
Weighted-average grant-price per option	$	185.79		$	200.07
Weighted-average grant-date fair value per option	$	70.86		$	66.78

There were no stock options granted during the year ended December 31, 2023.

A summary of our stock option activity as of and for the year ended December 31, 2023 is as follows:


	Shares	Weighted-Average Exercise Price Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding at December 31, 2022	527,461	$	79.94
Granted	—	$	—
Exercised	(67,633)	$	59.47
Forfeited or expired	—	$	—
Outstanding at December 31, 2023	459,828	$	82.95	1.1	$	11,856
Exercisable at December 31, 2023	459,828	$	82.95	1.1	$	11,856
Vested and expected to vest, December 31, 2023	459,828	$	82.95	1.1	$	11,856

The intrinsic values for options exercisable, outstanding and vested or expected to vest at December 31, 2023 are based on our closing stock price of $99.74 at December 31, 2023 and are before applicable taxes.

The following table presents information regarding stock option activity (in thousands):


	Year ended December 31,
	2023		2022		2021
Intrinsic value of options exercised	$	8,441	$	17,340	$	27,534
Cash received from exercise of stock options	$	4,022	$	8,785	$	9,372
Tax benefit from stock option exercises	$	1,733	$	3,637	$	5,092

Stock Awards

In 2023, we granted PRSUs to our executive officers. For the executive officers other than the Chief Executive Officer ("CEO"), Chief Operations Officer ("COO"), the Chief Financial Officer ("CFO") and the Corporate Vice President, General Counsel ("CVP, GC"), the PRSUs will vest as to one-third of the total number of PRSUs underlying the award on the first, second and third anniversaries of the applicable grant date, subject to a determination by the CEO and Compensation Committee that the officers have met their individual performance goals for the applicable year and continued service through such vesting date. For the CEO, COO, the CFO, and the CVP, GC, the PRSUs will cliff-vest on March 15, 2026, subject to continued service through such vesting date and the achievement of minimum three-year adjusted revenue and Adjusted EBITDA compound annual growth rates, commencing on January 1, 2023 and ending on December 31, 2025, which when reviewed against a predetermined vesting matrix could result in the vesting of 0% to 250% of the awarded PRSUs.

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 continued service through such vesting date and 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 the vesting of 0% to 200% of the awarded PRSUs. We also granted certain other one-off PRSU awards to non-executive employees with various performance requirements, whereby the PRSUs will be earned if the minimum requirements are met within a specified time period. The performance period related to the annual 2022 PRSUs ended on December 31, 2023 and is subject to the Compensation Committee review and determination that between 0% and 200% of the PRSUs awarded were earned based on the actual net synergy savings related to the Smiths Medical acquisition achieved during the performance period.

In 2021, we granted PRSUs to our executive officers. For the executive officers other than the CEO, COO and the CFO, the PRSUs will vest as to one-third of the total number of PRSUs underlying the award on the first, second and third anniversaries of the applicable grant date, subject to a determination by the CEO and Compensation Committee that the officers have met their individual performance goals for the applicable years and continued service through such vesting date. For the CEO, COO and the CFO, the PRSUs will cliff-vest on March 8, 2024, subject to continued service through such vesting date and the achievement of minimum three-year cumulative adjusted revenue dollar target frowth rate and adjusted EPS dollar target growth rate targets, commencing on January 1, 2021 and ending on December 31, 2023, which when reviewed against a predetermined vesting matrix could result in the vesting of 0% to 250% of the awarded PRSUs. In February 2022, the Compensation Committee made the determination that the executive officers other than the CEO, CFO and COO met their individual performance goals for 2021, therefore one-third of their 2021 PRSUs awarded vested during 2022. 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 one-third of their 2021 PRSUs awarded vested during 2023. The performance period related to the final third of the PRSUs awarded to the executive officers other than the CEO, CFO and COO ended on December 31, 2023 and is subject to the Compensation Committee review and determination that the PRSUs will be earned at 100% of the awarded PRSUs based on whether the officers met their individual performance goals for 2023. The performance period related to the 2021 CEO, COO and CFO PRSUs ended on December 31, 2023 and is subject to the Compensation Committee review and determination that between 0% and 250% of the awarded PRSUs will be earned based on the actual cumulative adjusted revenue dollar target growth rate and adjusted EPS dollar target growth rate achieved during the performance period.

In 2020, we granted PRSUs to our executive officers. For the executive officers other than the CEO, COO and the CFO, the PRSUs vested as to one-third of the total number of PRSUs underlying the award on the first, second and third anniversaries of the applicable grant date, subject to a determination by the CEO and Compensation Committee that the officers had met their individual performance goals for the applicable years and continued service through such vesting date. For the CEO, COO and the CFO, the PRSUs cliff-vested on March 6, 2023 and were further subjected to continued service through such vesting date and the achievement of minimum three-year cumulative adjusted revenue dollar target growth rate and

adjusted EPS dollar target growth rate targets, which when reviewed against a predetermined vesting matrix could have resulted in the vesting 0% to 250% of the awarded PRSUs. In February 2021, the Compensation Committee made the determination that the executive officers other than the CEO, COO and CFO met their individual performance goals for 2020; therefore one-third of their 2020 PRSUs 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 awarded PRSUs, to an increased potential to earn between 50% and 300% of the award granted, subject to the same minimum threshold revenue and EPS targets set forth above 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 2022, the Compensation Committee made the determination that the executive officers other than the CEO, CFO and COO met their individual performance goals for 2021, therefore one-third of their 2020 PRSUs awarded vested during 2022. 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 the final third of their 2020 PRSUs awarded vested during 2023. The performance period related to the 2020 CEO, COO and CFO PRSUs ended on December 31, 2022 and in February 2023 the Compensation Committee determined that 188% of the awarded PRSUs were earned based on the actual cumulative adjusted revenue dollar growth rate and adjusted EPS dollar target growth rate 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 as to one-third of the total number of PRSUs underlying the award on the first, second and third anniversaries of the applicable grant date, subject to a determination by the CEO and Compensation Committee that the officers had met their individual performance goals for the applicable years and continued service through such vesting date. For the CEO and the COO, the PRSUs were to cliff-vest on March 6, 2022, subject to continued service through such vesting date and the achievement of a minimum Cumulative Adjusted EBITDA growth target over the performance period. 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 PRSUs would have vested. If, on the vesting date, the Cumulative Adjusted EBITDA had a growth of between 8% to 10%, 100% of the awarded PRSUs would have vested. If, on the vesting date, the Cumulative Adjusted EBITDA had a growth of over 10%, 200% of the awarded PRSUs 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 2020, the Compensation Committee made the determination that the executive officers other than the CEO and COO met their individual performance goals for 2019, therefore, one-third of their 2019 PRSUs awarded vested during 2020. In February 2021, the Compensation Committee made the determination that the executive officers other than the CEO and COO met their individual performance goals for 2020, therefore, one-third of their 2019 PRSUs awarded vested during 2021. 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 2021, therefore, the final third of their 2019 PRSUs 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 growth 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 as to one-third of the total number of PRSUs underlying the award on the first, second and third anniversaries of the applicable grant date, subject to a determination by the CEO and Compensation Committee that the officers have met their individual performance goals for the applicable year and continued service through such vesting date. For the CEO and the COO, the PRSUs cliff-vested ending on February 15, 2021, subject to continued service through such vesting date and the achievement of a minimum Cumulative Adjusted EBITDA growth target over the performance period. 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 PRSUs would vest. If, on the vesting date, the Cumulative Adjusted EBITDA had a growth of between 8% to 10%, 100% of the awarded PRSUs would vest. If, on the vesting date, the Cumulative Adjusted EBITDA had a growth of over 10%, 200% of the awarded PRSUs would vest. In February 2019, the Compensation Committee made the determination that six of the eight executive officers other than the CEO and COO who received a 2018 PRSU award met their individual performance goals for 2018, therefore, one-third of the 2018 PRSUs awarded for those executives vested during 2019. In February 2020, the Compensation Committee made the determination that the executive officers other than the CEO and COO met their individual performance goals for 2019, therefore, one-third of their 2018 PRSUs awarded vested during 2020. The two executive officers who did not earn one-third of the PRSUs awarded during the 2018 performance period additionally earned those shares in 2019.

In February 2021, the Compensation Committee made the determination that the executive officers other than the CEO and COO met their individual performance goals for 2020, therefore, the final third of their 2018 PRSUs awarded vested during 2021. Also in February 2021, the Compensation Committee determined that based on the actual Cumulative Adjusted EBITDA growth achieved during the performance period, the CEO and COO's 2018 PRSUs were earned at 100% of the PRSUs granted.

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 2023, 2022 and 2021, 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,
	2023		2022		2021
PRSU
Shares granted	78,213		60,383		53,246
Shares earned (1)	49,314		46,317		32,013
Grant-date fair value per share	$	190.02	$	230.31	$	198.16
Grant-date fair value	$	14,862	$	13,907	$	10,551
Intrinsic value vested	$	8,024	$	10,487	$	6,777

RSU
Shares granted	156,111		116,870		84,388
Grant-date fair value per share	$	173.10	$	221.65	$	199.13
Grant-date fair value	$	27,024	$	25,905	$	16,804
Intrinsic value vested	$	14,179	$	16,438	$	13,681

_______________________________

(1) PRSU shares earned in 2023 were related to performance awards granted to executives in 2020 and 2021 and performance awards granted to a non-executive employees in 2022. PRSU shares earned in 2022 were related to performance awards granted to executives in 2019, 2020 and 2021 and performance award granted to a non-executive employee in 2019, 2020, and 2021. PRSU shares earned in 2021 were related to performance awards granted to executives in 2018, 2019 and 2020.

The table below provides a summary of our PRSU and RSU activity as of and for the year ended December 31, 2023:


	Number of Units	Grant-Date Fair Value Per Share		Weighted-Average Contractual Life (Years)	Aggregate Intrinsic Value (in thousands)
Non-vested at December 31, 2022	354,004	$	213.95
Change in units due to performance expectations (1)	5,554	$	188.11
Granted	234,324	$	178.75
Vested	(140,091)	$	200.66
Forfeited	(5,190)	$	188.98
Non-vested and expected to vest at December 31, 2023	448,601	$	199.68	0.9	$	44,743

_______________________________

(1) Relates to adjustments to 2020 PRSUs granted to executives that vested during 2023.

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. 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. All shares unissued under the plan expired during 2022.

Derivatives and Hedging Activities Derivative Balance Sheet Location (Details) - Designated as Hedging Instrument [Member] - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Foreign Exchange Forward [Member] \| Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	$ 6,785	$ 4,860
Foreign Exchange Forward [Member] \| Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	673	94
Foreign Exchange Forward [Member] \| Assets, Total
Derivatives, Fair Value [Line Items]
Derivative Asset	7,458	4,954
Foreign Exchange Forward [Member] \| Accrued Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	2,590	1,847
Foreign Exchange Forward [Member] \| Other Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	240	167
Foreign Exchange Forward [Member] \| Liabilities, Total [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	2,830	2,014
Interest Rate Swap \| Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	23,065	28,431
Interest Rate Swap \| Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	4,876	26,753
Interest Rate Swap \| Assets, Total
Derivatives, Fair Value [Line Items]
Derivative Asset	27,941	55,184
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	0
Interest Rate Swap \| Liabilities, Total [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	0	0
Derivative Financial Instruments, Assets \| Prepaid Expenses and Other Current Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	29,850	33,291
Derivative Financial Instruments, Assets \| Other Assets [Member]
Derivatives, Fair Value [Line Items]
Derivative Asset	5,549	26,847
Derivative Financial Instruments, Assets \| Assets, Total
Derivatives, Fair Value [Line Items]
Derivative Asset	35,399	60,138
Derivative Financial Instruments, Liabilities [Member] \| Accrued Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	2,590	1,847
Derivative Financial Instruments, Liabilities [Member] \| Other Liabilities
Derivatives, Fair Value [Line Items]
Derivative Liability	240	167
Derivative Financial Instruments, Liabilities [Member] \| Liabilities, Total [Member]
Derivatives, Fair Value [Line Items]
Derivative Liability	$ 2,830	$ 2,014

Insider Trading Arrangements - Vivek Jain [Member]	3 Months Ended
Insider Trading Arrangements - Vivek Jain [Member]	Dec. 31, 2023 shares
Trading Arrangements, by Individual
Name	Vivek Jain, Chief Executive Officer
Title	Vivek Jain, Chief Executive Officer
Adoption Date	March 15, 2023
Rule 10b5-1 Arrangement Terminated	false
Termination Date	February 9, 2024
Aggregate Available	206,366

Revenue Remaining Performance Obligation Recognition Timing (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Short Term
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ (31,592)
Short Term \| Equipment revenue [Member]
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(17,749)
Short Term \| Software revenue [Member]
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(10,062)
Short Term \| Government Grant Revenue
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(2,064)
Short Term \| Other deferred revenue
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(1,717)
Long Term
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(10,585)
Long Term \| Equipment revenue [Member]
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(24)
Long Term \| Software revenue [Member]
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(763)
Long Term \| Government Grant Revenue
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	(9,415)
Long Term \| Other deferred revenue
Revenue Recognition Timing [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ (383)

Leases (Tables)

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Lease, Cost

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


	Year ended December 31,
	2023		2022		2021
Operating lease cost	$	24,024	$	22,038	$	11,251
Finance lease cost — interest	125		112		122
Finance lease cost — reduction of ROU asset	1,035		712		648
Short-term lease cost	29		7		14
Total lease cost	$	25,213	$	22,869	$	12,035

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 costs of goods sold and selling, general and administrative expenses in our consolidated statements of operations.

Supplemental Cash Flow Information Leases

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


	Year ended December 31,
	2023		2022		2021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases(1)	$	24,604	$	25,225	$	11,256
Operating cash flows from finance leases	$	125	$	112	$	122

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	15,873	$	5,994	$	2,589
Finance leases	$	1,028	$	715	$	558

_____________________________

(1) In January 2022, 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,
	2023			2022
Operating leases
Operating lease right-of-use assets	$	69,909		$	74,864

Accrued liabilities	$	20,161		$	18,169
Other long-term liabilities	52,972			60,916
Total operating lease liabilities	$	73,133		$	79,085

Weighted-Average Remaining Lease Term
Operating leases	5.6 years			6.1 years

Weighted-Average Discount Rate
Operating leases	4.31		%	4.34		%

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,
	2023			2022
Finance leases
Finance lease right-of-use assets	$	2,707		$	2,598

Accrued liabilities	$	860		$	816
Other long-term liabilities	1,954			1,855
Total finance lease liabilities	$	2,814		$	2,671

Weighted-Average Remaining Lease Term
Finance leases	4.1 years			4.8 years

Weighted-Average Discount Rate
Finance leases	4.93		%	4.23		%

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

As of December 31, 2023, the maturities of our operating and finance lease liabilities for each of the next five years are approximately (in thousands):


	Operating Leases		Finance Leases
2024	$	22,291	$	977
2025	16,409		763
2026	14,095		639
2027	10,150		291
2028	5,735		189
Thereafter	13,041		236
Total Lease Payments	81,721		3,095
Less imputed interest	(8,588)		(281)
Total	$	73,133	$	2,814

Leases Supplemental Cash Flow Lease Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Operating Lease, Payments	$ 24,604	$ 25,225	$ 11,256
Finance Lease, Interest Payment on Liability	125	112	122
Right-of-Use Asset Obtained in Exchange for Operating Lease Liability	15,873	5,994	2,589
Right-of-Use Asset Obtained in Exchange for Finance Lease Liability	1,028	$ 715	$ 558
business combination, recognized identifiable asset acquired and liability assumed,	$ 55,200

Income Taxes Unrecognized tax benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Unrecognized tax benefits roll forward [Roll Forward]
Unrecognized Tax Benefits	$ 78,558	$ 54,053	$ 21,537	$ 18,443
Unrecognized Tax Benefits, Increases Resulting from Prior Period Tax Positions	2,347	148	231
Unrecognized Tax Benefits, Increase Resulting from Acquisition	0	29,606	0
Unrecognized Tax Benefits, Increases Resulting from Current Period Tax Positions	34,607	4,706	3,242
Unrecognized Tax Benefits, Decrease Resulting from Prior Period Tax Positions	(2,455)	(222)	0
Unrecognized Tax Benefits, Reductions Resulting from Lapse of Applicable Statute of Limitations	(9,591)	(1,722)	(31)
Unrecognized Tax Benefits, Decrease Resulting from Settlements with Taxing Authorities	$ 403	$ 0	$ 348

Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Prepaid Assets Current [Line Items]
Other Prepaid Expense, Current	$ 17,833	$ 21,635
Prepaid vendor expenses	1,309	3,052
Deferred Costs and Other Assets	1,668	2,395
Prepaid insurance and property taxes	9,547	16,322
Prepaid other taxes	2,748	3,546
Deferred tax charge	5,822	3,830
Derivative Asset, Current	6,785	4,860
Deposit Assets	1,196	1,329
Other Assets, Current	3,667	3,532
Prepaid expenses and other current assets	73,640	88,932
Prepaid Expenses and Other Current Assets [Member]
Prepaid Assets Current [Line Items]
Interest Rate Derivative Assets, at Fair Value	$ 23,065	$ 28,431

Other Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Other liabilities [Line Items]
Operating Lease, Liability, Noncurrent	$ 52,972	$ 60,916
Finance Lease, Liability, Noncurrent	1,954	1,855
Contract with Customer, Liability, Noncurrent	10,585	16,239
Benefits	4,207	5,314
Product Liability Accrual, Component Amount	56,300
Accrued rent	841	997
Other	3,882	3,489
OTHER LONG-TERM LIABILITIES	100,497	114,104
Long Term
Other liabilities [Line Items]
Product Liability Accrual, Component Amount	$ 26,056	$ 25,294

Prepaids and Other Current Assets (Notes)

12 Months Ended

Dec. 31, 2023

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,
	2023		2022
Other prepaid expenses and receivables	$	17,833	$	21,635
Prepaid vendor expenses	1,309		3,052
Deferred costs	1,668		2,395
Prepaid insurance and property taxes	9,547		16,322
VAT/GST receivable	2,748		3,546
Deferred tax charge	5,822		3,830
Foreign exchange forward contract	6,785		4,860
Interest rate contracts	23,065		28,431
Deposits	1,196		1,329
Other	3,667		3,532
	$	73,640	$	88,932

Other assets consist of the following (in thousands):


	As of December 31,
	2023		2022
Pump lease receivables	$	30,627	$	27,086
Spare parts	46,496		38,498
Equity method investments	3,120		3,178
Interest rate contracts	4,876		26,753

Deferred debt issuance costs	3,439		5,156
Finance lease right-of-use assets	2,707		2,598
Other	2,755		2,193
	$	94,020	$	105,462

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

12 Months Ended

Dec. 31, 2023

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, 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

For the year ended December 31, 2023:
Allowance for doubtful accounts	$	8,530	$	838	$	1,696	$	—	$	11,064
Warranty and return reserve - accounts receivable	$	5,863	$	1,627	$	15	$	—	$	7,505
Warranty and return reserve - inventory/accrued(3)	$	50,819	$	20,290	$	(13,313)	$	—	$	57,796
Deferred tax asset valuation allowance	$	11,166	$	—	$	(2,714)	$	—	$	8,452

2017 Credit Facility (Details) $ in Millions	12 Months Ended
2017 Credit Facility (Details) $ in Millions	Dec. 31, 2023 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

Share Based Award Stock Option Plans (Details) - shares	12 Months Ended
Share Based Award Stock Option Plans (Details) - shares	Dec. 31, 2023	Dec. 31, 2011
2011 Plan [Member]
Stock Incentive Plans [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized	6,111,000	650,000
Share-based Compensation Arrangement by Share-based Payment Award, Number of Additional Shares Authorized	5,461,000
Shares transferred from superseded plan	263,300
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant	6,374,300
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

Income Taxes Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Current Federal Tax Expense (Benefit)	$ (8,235)	$ 4,128	$ 20,646
Current State and Local Tax Expense (Benefit)	5,035	3,799	3,444
Current Foreign Tax Expense (Benefit)	26,035	12,924	7,236
Current Income Tax Expense (Benefit)	22,835	20,851	31,326
Deferred Federal Income Tax Expense (Benefit)	(43,042)	(42,012)	(8,154)
Deferred State and Local Income Tax Expense (Benefit)	(14,657)	(11,239)	(1,815)
Deferred Foreign Income Tax Expense (Benefit)	(13,780)	(7,723)	(1,306)
Deferred Income Tax Expense (Benefit)	(71,479)	(60,974)	(11,275)
(Benefit) Provision for income taxes	$ (48,644)	$ (40,123)	$ 20,051

Acquisitions Smiths Medical Pro Forma (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition, Pro Forma Information, Nonrecurring Adjustment [Line Items]
Revenues	$ 2,259,126	$ 2,279,997	$ 1,316,308
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)
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 - Finance Costs		$ 1,200	73,500
Pro Forma Adjustment - Inventory			$ 27,400

- Definition

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

+ References

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-SubTopic 10
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-Section 50
-Paragraph 1A
-Subparagraph (c)(1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481203/810-10-50-1A

Stockholders' Equity

12 Months Ended

Dec. 31, 2023

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 2023, 2022 or 2021. 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 2023, we withheld 59,377 shares of our common stock from employee vested restricted stock units in consideration for $9.4 million in payments for the employees' share award income tax withholding obligations. We had 2,428 shares remaining in treasury at December 31, 2022.

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, 2021.

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, 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, 2021	$	(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 (income) before reclassifications	(103,928)		54,962		1,203		(47,763)
Amounts reclassified from AOCI	—		(13,946)		—		(13,946)
Other comprehensive (loss) income	(103,928)		41,016		1,203		(61,709)
Balance as of December 31, 2022	$	(122,973)	$	40,779	$	1,216	$	(80,978)
Other comprehensive income before reclassifications	46,189		12,096		603		58,888
Amounts reclassified from AOCI	—		(30,991)		—		(30,991)
Other comprehensive income (loss)	46,189		(18,895)		603		27,897
Balance as of December 31, 2023	$	(76,784)	$	21,884	$	1,819	$	(53,081)

- Definition

The entire disclosure for equity.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
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-Name Accounting Standards Codification
-Section 50
-Paragraph 13
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
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-Subparagraph (i)
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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Reference 19: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Revenue Contract Liabilities Text (Details) $ in Thousands	12 Months Ended
Revenue Contract Liabilities Text (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Contract asset and liability balances [Line Items]
Deferred Revenue, Revenue Recognized	$ 29,800

Income Taxes Operating Loss Carryforwards (Details) $ in Millions	Dec. 31, 2023 USD ($)
UNITED STATES
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	$ 1.4
State and Local Jurisdiction [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	4.1
Foreign Tax Authority [Member]
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	$ 32.6

Derivatives and Hedging Activities (Notes)

12 Months Ended

Dec. 31, 2023

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 derivative instruments we utilize, including various foreign exchange contracts and 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 current foreign exchange forward contracts hedge exposures principally denominated in Mexican Pesos ("MXN"), Euros, Japanese Yen ("JPY"), Chinese Renminbi ("CNH"), Canadian Dollar ("CAD"), U.S. Dollar ("USD") 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, 2023 was $172.6 million, which included the notional equivalent of $27.1 million in MXN, $35.6 million in Euros, $17.4 million in JPY, $8.1 million in CNH, $18.4 million in CAD, $14.2 million in AUD, $42.6 million in USD and $9.2 million in other foreign currencies, with terms currently through November 2025.

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 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 was 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 Obligations), 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 pay a fixed rate of 1.32% and will receive the greater of 3-month USD SOFR or (0.15)%. The total notional amount of this outstanding derivative as of December 31, 2023 was approximately $244.7 million. 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 through its final maturity on March 30, 2026. We pay a fixed rate of 1.17% and receive the greater of 3-month USD SOFR or 0.35%. The total notional amount of this outstanding derivative as of December 31, 2023 was approximately $421.9 million. In June 2023, we entered into an additional interest rate swap that hedges both term loan A and term loan B interest payments. The total notional amount of the swap is $300.0 million. The hedge matures on June 30, 2028. We pay a fixed rate of 3.88% and receive 3-months USD SOFR. These forward-starting swaps 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

As of December 31, 2023
Prepaid expenses and other current assets	$	6,785	$	23,065	$	29,850
Other assets	673		4,876		5,549
Total assets	$	7,458	$	27,941	$	35,399

Accrued liabilities	$	2,590	$	—	$	2,590
Other long-term liabilities	240		—		240
Total liabilities	$	2,830	$	—	$	2,830

	Derivatives Designated as Cash Flow Hedging Instruments
As of December 31, 2022	Foreign Exchange Forward Contracts		Forward-Starting Interest Rate Swaps		Gross Derivatives
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

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 Income
	Location of Gain in the Consolidated Statements of Operations	Year Ended December 31,
		2023		2022		2021
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	Total revenues	$	296	$	3,829	$	—
Foreign exchange forward contracts	Cost of goods sold	7,852		7,751		3,444
Foreign exchange forward contracts	Other expense, net(1)	229		—		—
Foreign exchange forward contracts	Interest expense(2)	13		717		—
Interest rate swaps	Interest expense	32,444		6,122		—
Total derivatives designated as cash flow hedging instruments		$	40,834	$	18,419	$	3,444

_______________________________

(1) Represents location of gain reclassified from accumulated other comprehensive income (loss) into other expense, net as a result of ineffectiveness.

(2) Represents location of gain reclassified from accumulated other comprehensive income (loss) into interest expense 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 income (loss) before reclassifications to income (in thousands):


	Amount of Gain (Loss) Recognized in Other Comprehensive Income (Loss)
	Year Ended December 31,
	2023		2022		2021
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	$	10,788	$	9,588	$	950
Interest rate swaps	5,200		62,786		(1,480)
Total derivatives designated as cash flow hedging instruments	$	15,988	$	72,374	$	(530)

As of December 31, 2023, we expect an estimated $4.2 million in deferred gains on the outstanding foreign exchange forward contract and an estimated $23.9 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 (loss) income.

Share Based Award RSU and PRSU (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Modified PRSU Incremental Expense	$ 2,100
Performance Shares [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	78,213	60,383	53,246
Performance Shares Earned	49,314	46,317	32,013
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 190.02	$ 230.31	$ 198.16
Grant date fair value performance restricted stock units	$ 14,862	$ 13,907	$ 10,551
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Aggregate Intrinsic Value, Vested	$ 8,024	$ 10,487	$ 6,777
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	156,111	116,870	84,388
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 173.10	$ 221.65	$ 199.13
Grant date fair value of restricted stock units granted	$ 27,024	$ 25,905	$ 16,804
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Aggregate Intrinsic Value, Vested	$ 14,179	$ 16,438	$ 13,681

Debt (Tables)

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Interest Margin and Commitment Fee [Table Text Block]

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 is 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%

Applicable Margin on Loan Type

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 is 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%

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, 2023

Senior Secured Credit Facilities:
Term Loan A — principal	7.67	%	$	812,813
Term Loan B — principal	8.00	%	835,125
Revolving Credit Facility — principal	—	%	—
Less unamortized debt issuance costs(1)			(19,168)
Total carrying value of long-term debt			1,628,770
Less current portion of long-term debt			51,000
Long-term debt, net			$	1,577,770

_______________________________

(1) Comprised of $9.3 million and $9.9 million relating to the Term Loan A and the Term Loan B, respectively.

Schedule of Maturities of Long-Term Debt

As of December 31 2023, 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):


2024	$	51,000
2025	51,000
2026	72,250
2027	672,563
2028	8,500
Thereafter	792,625
Total	$	1,647,938

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,
	2023		2022		2021
Contractual interest	$	125,550	$	66,770	$	—
Amortization of debt issuance costs	6,814		6,972		240
Commitment fee — Revolving Credit Facility	1,518		1,290		221
Total long-term debt-related interest expense	$	133,882	$	75,032	$	461

- 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

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+ Details

Consolidated Statements of Stockholders Equity - USD ($) $ in Thousands	Total	Common Stock Shares [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Treasury Stock, Common	Retained Earnings [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Balance, Shares at Dec. 31, 2020		21,058,000
Balance at Dec. 31, 2020	$ 1,502,265		$ 2,106	$ 693,068	$ (39)	$ 808,652	$ (1,522)
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
Adjustments to Additional Paid in Capital, Other				0
Other comprehensive income, net of tax	(17,747)						(17,747)
Net (Loss) 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
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)
Stock Issued During Period, Shares, Acquisitions		2,500,000
Stock Issued During Period, Value, Acquisitions	575,975		250	575,725
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 (Loss) 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	23,993,000	23,995,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of restricted stock and exercise of stock options, shares issued		208,000
Issuance of restricted stock and exercise of stock options, including excess income tax benefits	$ 4,022		15	(5,324)	9,331
Treasury Stock, Shares		(59,000)
Purchase of treasury stock,treasury stock acquired in lieu of cash payment on stock option exercises and income tax withholding obligations	(9,350)			0	(9,350)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	40,563			40,563
Adjustments to Additional Paid in Capital, Other				5
Other comprehensive income, net of tax	27,902						27,897
Net (Loss) Income	(29,655)					(29,655)
Balance at Dec. 31, 2023	$ 2,123,410		$ 2,414	$ 1,366,493	$ (262)	$ 807,846	$ (53,081)
Balance, Shares at Dec. 31, 2023	24,141,000	24,144,000

Statement of Comprehensive Income (Statement) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Net (Loss) Income	$ (29,655)	$ (74,286)	$ 103,135
Other Comprehensive (Loss) Income, Cash Flow Hedge, Gain (Loss), after Reclassification and Tax	(18,895)	41,016	(3,021)
Foreign currency translation adjustment, net of taxes of $0 for all periods	46,189	(103,928)	(14,664)
Other adjustments, net of taxes of $0 for all periods	603	1,203	(62)
Other Comprehensive Income (Loss), Net of Tax	27,897	(61,709)	(17,747)
Comprehensive (loss) income	$ (1,758)	$ (135,995)	$ 85,388

- Definition

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

+ References

+ Details

- Definition

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

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
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+ Details

Commitments and Contingencies Contingencies (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2019	Jan. 06, 2022	Dec. 31, 2020
Business Acquisition [Line Items]
Contingent Earn-out Liability	$ 5,491	$ 25,572	$ 2,589			$ 26,300
Short-term contingent consideration-gross	1,000		1,000
Long-term contingent consideration-gross	1,500
Contingent Consideration, Gross LT	1,500
Product Liability Accrual, Period Expense	20,300	5,300
Product Liability Accrual, Component Amount	56,300
Long Term
Business Acquisition [Line Items]
Product Liability Accrual, Component Amount	26,056	25,294
Pursuit Vascular, Inc. [Member]
Business Acquisition [Line Items]
contingent consideration gross	50,000			$ 50,000
Contingent Earn-out Liability	26,300			$ 26,300
Foreign Distibutor [Member]
Business Acquisition [Line Items]
contingent consideration gross	6,000
Contingent Earn-out Liability	3,400
Foreign Infusion System Supplier
Business Acquisition [Line Items]
contingent consideration gross	2,500		2,500
Short-term contingent consideration-gross			1,000
Long-term contingent consideration-gross			1,500
Business Combination, Contingent Consideration, Liability	1,500		$ 1,500
Smiths Medical
Business Acquisition [Line Items]
contingent consideration gross	100,000	$ 100,000
Business Combination, Contingent Consideration, Liability	4,000				$ 53,500
Product Liability Accrual, Component Amount	$ 53,600

General and Summary of Significant Accounting Policies Future Estimated Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Acquired Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Amortization Expense, Next Twelve Months	$ 132,623
Finite-Lived Intangible Assets, Amortization Expense, Year Two	125,149
Finite-Lived Intangible Assets, Amortization Expense, Year Three	124,396
Finite-Lived Intangible Assets, Amortization Expense, Year Four	114,308
Finite-Lived Intangible Assets, Amortization Expense, Year Five	113,710
Finite-Lived Intangible Assets, Amortization Expense, after Year Five	222,082
Finite-Lived Intangible Assets, Net	$ 832,268	$ 950,960

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
CURRENT ASSETS:
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	$ 254,222	$ 208,784
Short-term investment securities	501	4,224
TOTAL CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENT SECURITIES	254,723	213,008
Accounts receivable, net of allowance for doubtful accounts of $11,064 at December 31, 2023 and $8,530 at December 31, 2022	161,566	221,719
Inventories	709,360	696,009
Prepaid income taxes	21,983	15,528
Prepaid expenses and other current assets	73,640	88,932
Total current assets	1,221,272	1,235,196
PROPERTY, PLANT AND EQUIPMENT, net	612,909	636,113
Operating Lease, Right-of-Use Assets	69,909	74,864
Long-term Investment Securities	0	516
GOODWILL	1,472,446	1,449,258
INTANGIBLE ASSETS, net	870,588	982,766
Deferred Income Tax Assets	37,295	31,466
Other Assets	94,020	105,462
TOTAL ASSETS	4,378,439	4,515,641
CURRENT LIABILITIES:
Accounts payable	150,030	215,902
Accrued liabilities	268,215	242,769
Current portion of long-term debt	51,000	29,688
Income tax payable	7,714	6,200
Contingent earn-out liability	4,879	0
Total current liabilities	481,838	494,559
Contingent earn-out liability, Noncurrent	3,991	25,572
Long-Term Debt	1,577,770	1,623,675
Other long-term Liabilities	100,497	114,104
Deferred Income Tax	55,873	126,007
Income Tax Liability	35,060	41,796
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 24,144 and 23,995 shares at December 31, 2023 and 2022, respectively, and outstanding 24,141 and 23,993 shares at December 31, 2023 and 2022, respectively.	2,414	2,399
Additional paid-in capital	1,366,493	1,331,249
Treasury Stock, at cost	(262)	(243)
Retained earnings	807,846	837,501
Accumulated other comprehensive loss	(53,081)	(80,978)
Total stockholders' equity	2,123,410	2,089,928
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY	$ 4,378,439	$ 4,515,641
Common stock, shares outstanding	24,141,000	23,993,000

Revenue (Notes)

12 Months Ended

Dec. 31, 2023

Revenue from Contract with Customer [Abstract]

Revenue from Contract with Customer [Text Block]

REVENUE

Revenue Recognition

As part of the integration of our acquisition of Smiths Medical, we have renamed our business units and reorganized the products thereunder and, as of January 1, 2023, our business unit structure is composed of Consumables, Infusion Systems and Vital Care. All prior periods herein have been retrospectively conformed to the current presentation. The vast majority of our sales of these products within these business units 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. 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 include variable consideration in net sales only to the extent that a significant reversal in revenue is not probable when the uncertainty is resolved. Our variable consideration includes distributor chargebacks, product returns and end customer rebates with distributor chargebacks representing the majority and subject to the greatest judgment, (see Note 1: Basis of Presentation and Significant Accounting Policies).

We also offer certain volume-based rebates to both our distribution and end customers, which is recorded 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, including current contractual requirements, our historical experience with each customer and forecasted customer purchasing patterns, to estimate the most likely rebate amount. We also warrant products against defects and have a policy permitting the return of defective products. 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. See Note 1. Basis of Presentation and Significant Accounting Policies for further discussion.

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,
	2023				2022				2021
Product line	Revenue		% of Revenue		Revenue		% of Revenue		Revenue		% of Revenue
Consumables	$	969,129	43	%	$	974,993	43	%	$	555,189	42	%
Infusion Systems	629,043		28	%	617,435		27	%	352,321		27	%
Vital Care	660,954		29	%	687,569		30	%	408,798		31	%




Total Revenues	$	2,259,126	100	%	$	2,279,997	100	%	$	1,316,308	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	2023		2022		2021
United States	$	1,440,017	$	1,460,069	$	941,809
Europe, the Middle East and Africa	373,571		367,411		147,488
Asia-Pacific	241,699		257,208		85,692
Other Foreign	203,839		195,309		141,319
Total Revenues	$	2,259,126	$	2,279,997	$	1,316,308

Domestic sales accounted for 64%, 64% and 72% of total revenue in 2023, 2022 and 2021, respectively. International sales accounted for 36%, 36% and 28% of total revenue in 2023, 2022 and 2021, 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, 2023 and 2022, (in thousands):


	Contract Liabilities
Beginning balance, January 1, 2022	$	(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)

Equipment revenue recognized	34,121
Equipment revenue deferred due to implementation	(35,868)
Software revenue recognized	18,526
Software revenue deferred due to implementation	(19,947)
Government grant deferred revenue	(944)
Government grant recognized	3,684
Other deferred revenue	(1,924)
Other deferred revenue recognized	6,041
Ending balance, December 31, 2023	$	(42,177)

During 2023, we recognized $29.8 million in revenue that was included in the opening contract balances as of December 31, 2022

As of December 31, 2023, revenue from remaining performance obligations is as follows (in thousands):


	Recognition Timing
	<12 Months		> 12 Months
Equipment revenue	$	(17,749)	$	(24)
Software revenue	(10,062)		(763)
Government grant revenue(1)	(2,064)		(9,415)
Other deferred revenue(2)	(1,717)		(383)
Total	$	(31,592)	$	(10,585)

____________________________

(1) The government grant deferred income is amortized over the life of the related depreciable asset as a reduction to depreciation expense.

(2) 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
-Topic 606
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-Paragraph 9
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
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-Publisher FASB
-URI https://asc.fasb.org//606/tableOfContent

+ Details

Income Taxes:

12 Months Ended

Dec. 31, 2023

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,
	2023		2022		2021
United States	$	(136,980)	$	(135,646)	$	81,484
Foreign	58,681		21,237		41,702
	$	(78,299)	$	(114,409)	$	123,186

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


	Year Ended December 31,
	2023		2022		2021
Current:
Federal	$	(8,235)	$	4,128	$	20,646
State	5,035		3,799		3,444
Foreign	26,035		12,924		7,236
	$	22,835	$	20,851	$	31,326
Deferred:
Federal	$	(43,042)	$	(42,012)	$	(8,154)
State	(14,657)		(11,239)		(1,815)
Foreign	(13,780)		(7,723)		(1,306)
	(71,479)		(60,974)		(11,275)
	$	(48,644)	$	(40,123)	$	20,051

We have accrued for tax contingencies for potential tax assessments, and in 2023 we recognized a $24.5 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,
	2023				2022				2021
	Amount		Percent		Amount		Percent		Amount		Percent
Federal tax at the expected statutory rate	$	(16,443)	21.0	%	$	(24,026)	21.0	%	$	25,869	21.0	%
State income tax, net of federal effect	(6,057)		7.7	%	(5,050)		4.4	%	2,907		2.4	%
Tax credits	(9,824)		12.5	%	(3,636)		3.2	%	(2,443)		(2.0)	%

Global intangible low-taxed income	(2,658)		3.4	%	2,303		(2.0)	%	711		0.6	%
Foreign income tax differential	(2,506)		3.2	%	(2,943)		2.5	%	(2,983)		(2.4)	%
Stock-based compensation	(289)		0.4	%	(3,721)		3.2	%	(4,263)		(3.5)	%
Foreign-derived intangible income	(3,299)		4.2	%	(2,269)		2.0	%	(3,775)		(3.1)	%
Transaction cost	—		—	%	2,299		(2.0)	%	—		—	%
Contingent consideration	(3,407)		4.4	%	(6,830)		6.0	%	(29)		—	%
Section 162(m)	3,268		(4.2)	%	3,942		(3.4)	%	1,812		1.5	%
Tax reserve releases	(6,884)		8.8	%	(1,834)		1.6	%	—		—	%
Other	(545)		0.7	%	1,642		(1.4)	%	2,245		1.8	%
	$	(48,644)	62.1	%	$	(40,123)	35.1	%	$	20,051	16.3	%

Tax credits in 2023, 2022 and 2021 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,
	2023		2022
Deferred tax asset:


Accruals/other	$	30,190	$	17,351



Acquired future tax deductions	10,877		14,186
Stock-based compensation	6,987		6,240
Foreign currency translation adjustments	—		—
Tax credits	15,095		12,906

Inventory reserves	25,592		25,100
Warranty reserve	13,788		13,241
Section 163(j) - interest expense limitation	25,467		9,166


Chargebacks, discounts, customer concessions	39,077		39,508
Capitalized research and development	43,313		16,587
Valuation allowance	(8,452)		(11,166)
	$	201,934	$	143,119
Deferred tax liability:
State income taxes	$	4,465	$	1,816


Depreciation and amortization	212,429		226,274
Section 481(a) adjustment - change in accounting method	—		—


Foreign currency translation and derivative instrument adjustments	3,630		9,581
	$	220,524	$	237,671

Deferred tax (liability) asset, net	$	(18,590)	$	(94,552)

Tax Holidays and Carryforwards

Net operating loss ("NOL") carryforwards consist of: (a) federal NOL carryforwards of $1.4 million which will expire at various dates from 2031 to indefinite carryforward periods, (b) state NOL carryforwards of $4.1 million which will expire at

various dates from 2026 to indefinite carryforward periods and (c) foreign NOL carryforwards of $32.6 million which will expire at various dates from 2024 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 $9.0 million on the $9.5 million deferred tax assets 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 $20.4 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 $8.0 million or $0.33 per diluted share in 2023 and by $8.1 million or $0.34 per diluted share in 2022.

Foreign currency translation and derivative instrument 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, 2023, we have estimated $246.8 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 2020 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, 2023 was $78.6 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, 2023, 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 $6.7 million within the next twelve months. 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 recognized $1.4 million of interest expense and $0.2 million of penalties in income tax benefit during 2023 and released $0.7 million of interest expense and $0.6 million of penalties in 2023. In total, we have accrued for interest and penalties of $2.9 million and $2.0 million, respectively as of December 31, 2023, and $2.2 million and $2.3 million, respectively, as of December 31, 2022.

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


	Year Ended December 31,
	2023		2022		2021
Beginning balance	$	54,053	$	21,537	$	18,443
Increases to prior year tax positions	2,347		148		231
Increases due to acquisitions	—		29,606		—
Increases to current year tax positions	34,607		4,706		3,242

Decreases to prior year tax positions	(2,455)		(222)		—

Decrease related to lapse of statute of limitations	(9,591)		(1,722)		(31)
Decrease related to settlements with tax authorities	(403)		—		(348)
Ending balance	$	78,558	$	54,053	$	21,537

In December 2022, the European Union agreed to implement Pillar Two, the OECD’s global minimum tax rate of 15% for multinationals that meet a global revenue threshold. A number of countries have enacted or have announced plans to enact legislation to adopt Pillar Two. The Pillar Two legislation is effective for our fiscal year beginning January 1, 2024 and for fiscal year 2024 we do not anticipate that it will have a material impact to our tax provision or effective tax rate. However, the Pillar Two rules continue to evolve and their application may alter our tax obligations in certain countries in which we operate for fiscal periods beyond 2024 as we continue to assess the impact of tax legislation in these jurisdictions.

- 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 13
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+ Details

Acquisitions Smiths Medical 2020 Limited Intangible (Details) - Smiths Medical 2020 Limited $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
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

Income Taxes Income (Loss) from Continuing Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Income (Loss) from Continuing Operations before Income Taxes, Domestic	$ (136,980)	$ (135,646)	$ 81,484
Income (Loss) from Continuing Operations before Income Taxes, Foreign	58,681	21,237	41,702
(Loss) Income before income taxes	$ (78,299)	$ (114,409)	$ 123,186

Accrued Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Schedule of Accrued Liabilities [Line Items]
Salaries and benefits	$ 52,250	$ 44,304
Incentive compensation	37,992	30,254
Operating Lease, Liability, Current	20,161	18,169
Accrued Professional Fees	2,803	5,317
Accrued Product Field Action.	30,281	24,517
Accrued liability Italy payment scheme	23,176	7,900
Legal accrual	1,874	3,137
Accrued sales taxes	6,748	5,844
Warranties and returns	3,682	3,097
Contract with Customer, Liability, Current	31,640	30,838
Accrued other taxes	3,024	5,794
Outside commissions	13,049	17,063
Accrued freight	17,215	17,988
Restructuring accrual	3,568	5,923
Accrued audit fees	5,492	6,279
Liability, Defined Benefit Plan, Current	2,575	2,928
Interest Payable	1,431	1,033
Accrued research and development liability	0	3,538
Other	8,664	6,999
Accrued liabilities	268,215	242,769
ContraARItaly Payment Scheme		12,100
Foreign Exchange
Schedule of Accrued Liabilities [Line Items]
Derivative Liability, Current	$ 2,590	$ 1,847

Document and Entity Information Document - USD ($)	12 Months Ended
Document and Entity Information Document - USD ($)	Dec. 31, 2023	Jan. 31, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
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	2023
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			$ 3,601,073,250
Entity Common Stock, Shares Outstanding		24,142,564
Documents Incorporated by Reference	Portions of the Proxy Statement for registrant’s 2024 Annual Meeting of Stockholders filed or to be filed pursuant to Regulation 14A within 120 days following registrant’s fiscal year ended December 31, 2023, are incorporated by reference into Part III of this Report.
Document Financial Statement Error Correction [Flag]	false

Fair Value Measurement Text Pursuit (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2021	Dec. 31, 2019	Dec. 31, 2022	Dec. 31, 2020
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent Earn-out Liability	$ 5,491	$ 2,589		$ 25,572	$ 26,300
Short-term contingent consideration-gross	1,000	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		$ 50,000
Contingent Earn-out Liability	26,300		$ 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	3,400
Foreign Infusion System Supplier
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	$ 2,500	2,500
Short-term contingent consideration-gross		1,000
Long-term contingent consideration-gross		$ 1,500

Transfers and Servicing (Details) $ in Millions	12 Months Ended
Transfers and Servicing (Details) $ in Millions	Dec. 31, 2023 USD ($)
Transfers and Servicing [Abstract]
accounts receivable purchase program	$ 150.0
Accounts Receivable, Sale	629.1
Proceeds from Sale and Collection of Receivables	625.3
Gain (Loss) on Sale of Accounts Receivable	3.7
Cash Remitted to Purchaser	553.2
Transfer of Financial Assets Accounted for as Sales, Cash Proceeds Received for Assets Derecognized, Amount	$ 75.9

General and Summary of Significant Accounting Policies Net Income Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount			12,354
Net (Loss) Income	$ (29,655)	$ (74,286)	$ 103,135
Weighted average number of common shares outstanding (basic)	24,091,000	23,868,000	21,206,000
Weighted Average Number Diluted Shares Outstanding Adjustment	0	0	575,000
Weighted Average common and common equivalent shares outstandding (diluted)	24,091,000	23,868,000	21,781,000
Basic	$ (1.23)	$ (3.11)	$ 4.86
Diluted	$ (1.23)	$ (3.11)	$ 4.74

- Definition

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

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- Definition

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

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+ Details

- Definition

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

+ References

+ Details

Acquisitions Foreign Infusion Systems Supplier (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2021
Business Acquisition [Line Items]
Short-term contingent consideration-gross	$ 1,000	$ 1,000
Long-term contingent consideration-gross	1,500
Foreign Infusion System Supplier
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross		15,400
business combination consideration - cash holdback		500
contingent consideration gross	2,500	2,500
Short-term contingent consideration-gross		1,000
Long-term contingent consideration-gross		1,500
Business Combination, Contingent Consideration, Liability	$ 1,500	$ 1,500

Geographic Information and Significant Customers Geographic Information (Tables)

12 Months Ended

Dec. 31, 2023

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,
	2023		2022
Costa Rica	$	143,380	$	128,179
Mexico	110,124		99,849
Other LATAM	47,564		39,270
Canada	5,694		5,374
Italy	28,201		24,323



Spain	21,921		18,948
Czech Republic	12,256		10,732
Other Europe	11,440		11,375
APAC	22,966		20,930
Total Foreign	$	403,546	$	358,980
United States	833,251		803,577
Worldwide Total	$	1,236,797	$	1,162,557

Leases Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
Leases Lease Cost (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Operating Lease, Cost	$ 24,024	$ 22,038	$ 11,251
Finance Lease, Interest Expense	125	112	122
Finance Lease, Right-of-Use Asset, Amortization	1,035	712	648
Short-term Lease, Cost	29	7	14
Lease, Cost	$ 25,213	$ 22,869	$ 12,035

Share Based Award Stock Option Activity (Details) - Share-based Payment Arrangement, Option [Member] $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, Outstanding, Number \| shares	527,461
Granted \| shares	0
Exercised \| shares	(67,633)
Forfeited or expired \| shares	0
Options, Outstanding, Number \| shares	459,828
Exercisable \| shares	459,828
Vested and Expected to Vest \| shares	459,828
Options, Outstanding, Weighted Average Exercise Price \| $ / shares	$ 79.94
Weighted Average Exercise Price \| $ / shares	0
Options, Exercises in Period, Weighted Average Exercise Price \| $ / shares	59.47
Options, Nonvested Options Forfeited, Weighted Average Grant Date Fair Value \| $ / shares	0
Options, Outstanding, Weighted Average Exercise Price \| $ / shares	82.95
Exercise Price Range, Exercisable Options, Weighted Average Exercise Price \| $ / shares	82.95
Options, Vested and Expected to Vest, Outstanding, Weighted Average Exercise Price \| $ / shares	$ 82.95
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Expected Term	1 year 1 month 6 days
Options, Exercisable, Weighted Average Remaining Contractual Term	1 year 1 month 6 days
Options, Vested and Expected to Vest, Outstanding, Weighted Average Remaining Contractual Term	1 year 1 month 6 days
Options, Outstanding, Intrinsic Value \| $	$ 11,856
Options, Exercisable, Intrinsic Value \| $	11,856
Options, Vested and Expected to Vest, Outstanding, Aggregate Intrinsic Value \| $	$ 11,856

General and Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2023

Accounting Policies [Abstract]

Business Description and Basis of Presentation [Text Block]

Nature of Operations

ICU Medical, Inc. ("ICU" or "we"), a Delaware corporation, develops, manufactures and sells innovative medical products used in infusion therapy, vascular access, and vital care applications. ICU's product portfolio includes ambulatory, syringe, and large volume IV pumps and safety software; dedicated and non-dedicated IV sets, needlefree IV connectors, peripheral IV catheters, and sterile IV solutions; closed system transfer devices and pharmacy compounding systems; as well as a range of respiratory, anesthesia, patient monitoring, and temperature management products. 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 throughout the U.S. and internationally. We also sell certain 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 footnotes to conform to the presentation used in the current year. In the statements of operations, we reclassified interest income to interest expense, net from other expense, net and in Note 4: Revenues, certain reclassifications were made to revenues disaggregated by product line and by geography. These reclassifications had no impact on total revenues, net loss, shareholder's equity or cash flows as previously reported.

Segment Reporting, Policy

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]

Preparing financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amount of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

Cash and Cash Equivalents, Policy [Policy Text Block]

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

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

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.

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

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 $96.7 million, $95.8 million and $65.9 million in 2023, 2022 and 2021, respectively.

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

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 2023, 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 2023, 2022, or 2021.

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

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 2023, 2022 or 2021.

Investment, Policy [Policy Text Block]

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 consist of corporate bonds, U.S. treasury securities, and 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, 2023 or 2022.

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 our current debt securities are in 2024. All short-term investment securities are callable within one year.

Equity Method Investments

We apply the equity method of accounting for investments when we determine we have a significant influence, but not a controlling interest in the investee. We determine whether we have significant influence by considering key factors such as ownership interest, representation on the board of directors, participation in policy making decisions, business relationship and material intra-entity transactions, among other factors. Our equity method investment is reported at cost and adjusted each period for our share of the investee's income or (loss) and dividend paid, if any. We eliminate any intra-entity profits to the extent of our beneficial interest. We 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.

Income Tax, Policy [Policy Text Block]

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 accrued for interest and penalties of $2.9 million and $2.0 million, respectively, as of December 31, 2023 and $2.2 million and $2.3 million, respectively, as of December 31, 2022.

Foreign Currency Transactions and Translations Policy [Policy Text Block]

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 Other expense, net table below). Foreign currency transaction losses (gains), net were $5.9 million, $5.8 million and $1.0 million in 2023, 2022 and 2021, respectively.

Revenue [Policy Text Block]

Revenue Recognition

We recognize revenues when we transfer control of promised goods to our customers, which for the majority of our sales of products sold on a standalone basis to our distributors and end customers for direct sales, is deemed to be at point of 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.

Our variable consideration includes distributor chargebacks, product returns and end customer rebates, with distributor chargebacks representing the majority and subject to the greatest judgment.

Chargebacks are the difference between the prices we charge our distribution customers at the time they purchase our products and the contracted prices we have with the end customer, most often in the U.S. and Canada. When a distributor sells our products to one of our contracted end customers, the distributor typically will claim a refund from us for the chargeback amount which we process as a credit to the distributor.

In estimating the transaction price to present as net revenue for sales to distributors, we must estimate the expected chargeback amount that we will refund to the distributor after they sell our product to a contracted end customer. Determining the appropriate chargeback reserve requires judgment around the following assumptions:

(i) The estimated chargeback amount (the difference between the price we invoice the distributor and the contractually agreed price with specified end customers); and

(ii) The estimated period of time between the sale to the distributor and the receipt of a chargeback claim.

For purposes of estimating the expected chargeback amount, we utilize actual recent historical chargebacks paid to the specific distributor for similar products as determined at either a product or product-family level. While individual chargeback rates can vary significantly depending on the product and contracted prices with distributors and end customers, our chargeback reserve estimate is not overly sensitive to those individual price changes due to the long-term nature of our distributor and end customer contracts as well as consistency in purchasing patterns. Additionally, the use of the actual chargeback history to calculate an average chargeback rate has historically resulted in a reasonable estimation of overall current contract rates.

For purposes of estimating the period of time between the sale to the distributor and the receipt of a chargeback claim, we utilize several sources of information including actual inventory quantities of our products on hand at distributors. This inventory on hand information is received from the distributors or, when specific quantities are not provided, estimated by using the targeted days of inventory on hand for distributors. Historical experience of actual chargebacks paid has indicated that use of this information has reasonable predictive value of outstanding chargebacks and accounts for the variability of purchasing

patterns and expected timing and volume of sales to end customers. The value of the chargeback reserve generally represents approximately two months of obligation due to the timing difference between the initial sale to a distributor and the processing of a chargeback claim after the product is sold to the end customer.

The chargeback reserve estimates change from period-to-period primarily based on changes in revenue from/and the inventory levels of distributors. Our judgments regarding the information used to calculate the chargeback reserve are consistent from period to period; however, on a regular basis, we evaluate the adequacy of the chargeback reserve to reassess and ensure that the variable consideration is appropriately constrained, and the likelihood of future revenue reversal is not probable. We use metrics including chargeback provision as a percentage of gross revenue, movements in inventory on hand at distributors, trends in accrued versus paid chargebacks and impacts from price changes and similar metrics.

The chargeback reserve reflects a reasonable estimate of the amount of consideration using the expected value method and is recorded as a reduction of accounts receivable, net on the consolidated balance sheets.

We also 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, including current contractual requirements, our historical experience with each customer and forecasted customer purchasing patterns, to estimate the most likely rebate amount.

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.

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, software maintenance services 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.

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

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 $19.2 million, $14.6 million and $11.0 million in 2023, 2022 and 2021, 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 Expense, Policy [Policy Text Block]

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.

Earnings Per Share, Policy [Policy Text Block]

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.

Income Taxes Effective tax rate (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Effective Income Tax Rate Reconciliation, Percent [Abstract]
Income Tax Reconciliation, Income Tax Expense (Benefit), at Federal Statutory Income Tax Rate	$ (16,443)	$ (24,026)	$ 25,869
Income Tax Reconciliation, State and Local Income Taxes	(6,057)	(5,050)	2,907
Income Tax Reconciliation, Tax Credits	(9,824)	(3,636)	(2,443)
Effective Income Tax Rate Reconciliation, GILTI, Amount	(2,658)	(2,303)	(711)
Income Tax Reconciliation, Foreign Income Tax Rate Differential	(2,506)	(2,943)	(2,983)
Effective Income Tax Rate Reconciliation, Tax Expense (Benefit), Share-based Payment Arrangement, Amount	(289)	(3,721)	(4,263)
Effective Income Tax Rate Reconciliation, FDII, Amount	(3,299)	(2,269)	(3,775)
EffectiveIncomeTaxRateReconciliationTransaction cost	0	2,299	0
Effective Income Tax Rate Reconciliation, Contingent Consideration	(3,407)	6,830	29
Effectiveincometaxreconciliation,nondeductiblecompensation	3,268	3,942	1,812
EffectiveIncomeTaxRateReconciliationTaxReserveReleases	(6,884)	(1,834)	0
Effective Income Tax Rate Reconciliation, Other Adjustments, Amount	(545)	1,642	2,245
(Benefit) Provision for income taxes	$ (48,644)	$ (40,123)	$ 20,051
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	7.70%	4.40%	2.40%
Effective Income Tax Rate Reconciliation, Tax Credits	12.50%	3.20%	(2.00%)
Effective Income Tax Rate Reconciliation, GILTI, Percent	(3.40%)	(2.00%)	(0.60%)
Effective Income Tax Rate Reconciliation, Foreign Income Tax Rate Differential	3.20%	2.50%	(2.40%)
Effective Income Tax Rate Reconciliation, Tax Expense (Benefit), Share-based Payment Arrangement, Percent	0.40%	3.20%	(3.50%)
Effective Income Tax Rate Reconciliation, FDII, Percent	(4.20%)	(2.00%)	(3.10%)
EffectiveTaxRateReconcilationTransaction cost,Percent	0	(0.020)	0
Effective Income Tax Rate Reconciliation, Contingent Consideration, Percent	4.40%	6.00%	0.00%
Effectivetaxratereconciliationnondeductiblecomppercent	(4.20%)	(3.40%)	1.50%
Effective IncomeTaxRateReconciliationTaxReserveReleasesPercent	0.088	0.016	0
Effective Income Tax Rate Reconciliation, Other Adjustments, Percent	0.70%	(1.40%)	1.80%
Effective Income Tax Rate, Continuing Operations	62.10%	35.10%	16.30%

Prepaids and Other Noncurrent Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Prepaid Noncurrent Assets [Line Items]
Lessor, Operating Lease, Payments to be Received	$ 30,627	$ 27,086
Spare parts	46,496	38,498
Equity Method Investments	3,120	3,178
Debt Issuance Costs, Noncurrent, Net	3,439	5,156
Finance Lease, Right-of-Use Asset, after Accumulated Amortization	2,707	2,598
Other Assets, Miscellaneous, Noncurrent	2,755	2,193
Other Assets	94,020	105,462
Interest Rate Swap
Prepaid Noncurrent Assets [Line Items]
Derivative Asset, Noncurrent	$ 4,876	$ 26,753

Prepaids and Other Current Assets (Tables)

12 Months Ended

Dec. 31, 2023

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,
	2023		2022
Other prepaid expenses and receivables	$	17,833	$	21,635
Prepaid vendor expenses	1,309		3,052
Deferred costs	1,668		2,395
Prepaid insurance and property taxes	9,547		16,322
VAT/GST receivable	2,748		3,546
Deferred tax charge	5,822		3,830
Foreign exchange forward contract	6,785		4,860
Interest rate contracts	23,065		28,431
Deposits	1,196		1,329
Other	3,667		3,532
	$	73,640	$	88,932

Schedule of Other Assets

Other assets consist of the following (in thousands):


	As of December 31,
	2023		2022
Pump lease receivables	$	30,627	$	27,086
Spare parts	46,496		38,498
Equity method investments	3,120		3,178
Interest rate contracts	4,876		26,753

Deferred debt issuance costs	3,439		5,156
Finance lease right-of-use assets	2,707		2,598
Other	2,755		2,193
	$	94,020	$	105,462

Geographic Information and Significant Customers Long Lived Assets by Geographic Location (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	$ 1,236,797	$ 1,162,557
COSTA RICA
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	143,380	128,179
Mexico Property and Equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	110,124	99,849
Other LATAM [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	47,564	39,270
CANADA
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	5,694	5,374
Italy Property and Equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	28,201	24,323
SPAIN
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	21,921	18,948
Czech Republic, Koruny
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	12,256	10,732
Europe [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	11,440	11,375
Asia Pacific [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	22,966	20,930
Foreign [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	403,546	358,980
United States property and equipment [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Long-Lived Assets	$ 833,251	$ 803,577
Manufactured Product, Other \| Revenue Benchmark [Member] \| Customer Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Concentration Risk, Percentage	16.00%

General and Summary of Significant Accounting Policies Basis of Presentation (Details)	12 Months Ended
	Dec. 31, 2023 segment
Accounting Policies [Abstract]
Number of Operating Segments	1

Fair Value Measurement Smiths Medical Simulation Inputs (Details) - Smiths Medical	Dec. 31, 2023	Dec. 31, 2022
Measurement Input, Price Volatility
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.4700	0.3800
Measurement Input, Risk Free Interest Rate [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.0418	0.0417

Revenue (Tables)

12 Months Ended

Dec. 31, 2023

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,
	2023				2022				2021
Product line	Revenue		% of Revenue		Revenue		% of Revenue		Revenue		% of Revenue
Consumables	$	969,129	43	%	$	974,993	43	%	$	555,189	42	%
Infusion Systems	629,043		28	%	617,435		27	%	352,321		27	%
Vital Care	660,954		29	%	687,569		30	%	408,798		31	%




Total Revenues	$	2,259,126	100	%	$	2,279,997	100	%	$	1,316,308	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	2023		2022		2021
United States	$	1,440,017	$	1,460,069	$	941,809
Europe, the Middle East and Africa	373,571		367,411		147,488
Asia-Pacific	241,699		257,208		85,692
Other Foreign	203,839		195,309		141,319
Total Revenues	$	2,259,126	$	2,279,997	$	1,316,308

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


	Contract Liabilities
Beginning balance, January 1, 2022	$	(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)

Equipment revenue recognized	34,121
Equipment revenue deferred due to implementation	(35,868)
Software revenue recognized	18,526
Software revenue deferred due to implementation	(19,947)
Government grant deferred revenue	(944)
Government grant recognized	3,684
Other deferred revenue	(1,924)
Other deferred revenue recognized	6,041
Ending balance, December 31, 2023	$	(42,177)

Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction

As of December 31, 2023, revenue from remaining performance obligations is as follows (in thousands):


	Recognition Timing
	<12 Months		> 12 Months
Equipment revenue	$	(17,749)	$	(24)
Software revenue	(10,062)		(763)
Government grant revenue(1)	(2,064)		(9,415)
Other deferred revenue(2)	(1,717)		(383)
Total	$	(31,592)	$	(10,585)

General and Summary of Significant Accounting Policies Property and Equipment #1 (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 1,236,797	$ 1,162,557
Accumulated Depreciation	623,888	526,444
Net property and equipment	612,909	636,113
Machinery and Equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	483,382	414,811
Land, Buildings and Improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	278,251	274,063
Molds [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	89,573	77,203
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	122,038	115,214
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	30,662	29,876
Instruments Placed with Customers [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	115,672	98,481
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 117,219	$ 152,909

General and Summary of Significant Accounting Policies Post-retirement and Post-employment Benefits (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Pension and Other Postretirement Benefits Cost (Reversal of Cost)	$ 19.2	$ 14.6	$ 11.0

Fair Value Measurement (Notes)

12 Months Ended

Dec. 31, 2023

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, 2023, the fair value of the contingent earn-out was determined to be $3.4 million and was paid out in the first quarter of 2024.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, 2023, 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, 2023, the estimated fair value of the contingent earn-out is $4.0 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, 2023, 2022 and 2021 (in thousands):


	Earn-out Liability
Contingent earn-out liability, January 1, 2021	$	26,300
Contingent earn-out non-compete arrangement	2,589
Transfer of Pursuit earn-out liability into Level 2(1)	(26,300)
Contingent earn-out liability, December 31, 2021	2,589

Acquisition date fair value estimate of earn-out(2)	55,158
Change in fair value of contingent earn-out (included in income from operations as a separate line item)(3)	(32,091)
Currency translation	(84)
Contingent earn-out liability, December 31, 2022	25,572


Change in fair value of contingent earn-out (included in income from operations as a separate line item)(4)	(16,247)

Other(5)	(496)
Transfer of Mediverse earn-out liability into Level 2(6)	(3,379)
Currency translation	41
Contingent earn-out liability, December 31, 2023	$	5,491

_______________________________

(1) 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.

(2) $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).

(3) Primarily relates to the change in fair value of our Smiths Medical earn-out and 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.

(4) Primarily relates to the change in fair value of our Smiths Medical earn-out and the earn-out with one of our international distributors.

(5) Primarily relates to the reclassification to accrued liabilities of a holdback liability not subject to unobservable inputs when determining the fair market value.

(6) The Mediverse earn-out was transferred out of Level 3 and into Level 2 in the fourth quarter of 2023 when the amount of the actual payment was known, and subsequently settled during first quarter of 2024.

The following table provides quantitative information about Level 3 inputs for fair value measurement of our earn-out liabilities related to Smiths Medical:

Smiths Medical Earn-out


	As of December 31, 2023		As of December 31, 2022
Simulation Input
Volatility	47.00	%	38.00	%
Risk-Free Rate	4.18	%	4.17	%

Investments, Foreign Currency Contracts and Interest Rate Contracts

Our investments historically consist of corporate, 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 Mediverse earn-out liability described above, there were no transfers between levels in 2023 or 2022.

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, 2023
	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	$	501	$	—	$	501	$	—




Foreign exchange forwards:
Prepaid expenses and other current assets	6,785		—		6,785		—
Other assets	673		—		673		—
Interest rate contracts:
Prepaid expenses and other current assets	23,065		—		23,065		—
Other assets	4,876		—		4,876		—
Total Assets	$	35,900	$	—	$	35,900	$	—

Liabilities:
Contingent earn-out liability-ST	$	4,879	$	—	$	3,379	$	1,500
Contingent earn-out liability - LT	3,991		—		—		3,991
Foreign exchange contracts:
Accrued liabilities	2,590		—		2,590		—
Other long-term liabilities	240		—		240		—


Total Liabilities	$	11,700	$	—	$	6,209	$	5,491


	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(1)	4,860		—		4,860		—
Other assets(1)	94		—		94		—
Interest rate contracts:
Prepaid expenses and other current assets(1)	28,431		—		28,431		—
Other assets(1)	26,753		—		26,753		—
Total Assets	$	64,878	$	1,412	$	63,466	$	—

Liabilities:
Contingent earn-out liability - LT	$	25,572	$	—	$	—	$	25,572
Foreign exchange contracts:
Accrued liabilities(1)	1,847		—		1,847		—
Other long-term liabilities(1)	167		—		167		—
Total Liabilities	$	27,586	$	—	$	2,014	$	25,572

- 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

General and Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2023

Accounting Policies [Abstract]

Schedule of Inventory, Current [Table Text Block]

Inventories consist of the following (in thousands):


	As of December 31,
	2023		2022
Raw materials	$	296,037	$	286,964
Work in process	58,906		73,795
Finished goods	354,417		335,250
Total	$	709,360	$	696,009

Property, Plant and Equipment [Table Text Block]

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


	As of December 31,
	2023		2022
Machinery and equipment	$	483,382	$	414,811
Land, building and building improvements	278,251		274,063
Molds	89,573		77,203
Computer equipment and software	122,038		115,214
Furniture and fixtures	30,662		29,876
Instruments placed with customers(1)	115,672		98,481
Construction in progress	117,219		152,909
Total property, plant and equipment, cost	1,236,797		1,162,557
Accumulated depreciation	(623,888)		(526,444)
Property, plant and equipment, net	$	612,909	$	636,113

_______________________________

(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 2023, 2022 and 2021 (in thousands):


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



Currency translation	23,188
Balance as of December 31, 2023	$	1,472,446

_______________________________

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

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

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

(4) 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, 2023
		Cost		Accumulated Amortization		Net
Patents	10	$	33,261	$	20,637	$	12,624
Customer contracts	12	10,018		6,755		3,263
Non-contractual customer relationships	8	554,982		171,279		383,703
Trademarks	1	5,425		5,425		—
Trade name	15	18,251		7,162		11,089
Developed technology	10	587,852		167,913		419,939
Non-compete	3	9,100		7,450		1,650
Total amortized intangible assets		$	1,218,889	$	386,621	$	832,268

Internally developed software*		$	38,320			$	38,320

Total intangible assets		$	1,257,209	$	386,621	$	870,588

_______________________________

* 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, 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.

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

As of December 31, 2023, estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):


2024	$	132,623
2025	125,149
2026	124,396
2027	114,308
2028	113,710
Thereafter	222,082
Total	$	832,268

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, 2023
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	501	$	—	$	501
Short-term U.S. treasury securities	—		—		—
Short-term government bonds	—		—		—
Total short-term investment securities	501		—		501
Long-term corporate bonds	—		—		—
Total investment securities	$	501	$	—	$	501

	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

Equity Method Investments

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


	As of December 31,
	2023		2022
Equity method investment	$	3,120	$	3,178

Interest Income and Interest Expense Disclosure

Interest (expense) income, net

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


	As of December 31,
	2023		2022		2021
Interest expense	$	(102,727)	$	(70,805)	$	(858)
Interest income	7,508		4,430		2,840
Interest (expense) income, net	$	(95,219)	$	(66,375)	$	1,982

Schedule of Other Nonoperating Income (Expense)

Other expense, net

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


	As of December 31,
	2023		2022		2021
Foreign exchange losses, net	$	(5,918)	$	(5,780)	$	(1,017)
Loss on disposition of assets	(153)		(2,554)		(1,651)
Other miscellaneous income, net	166		3,198		627
Other expense, net	$	(5,905)	$	(5,136)	$	(2,041)

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,
	2023		2022		2021
Net (loss) income	$	(29,655)	$	(74,286)	$	103,135
Weighted-average number of common shares outstanding (basic)	24,091		23,868		21,206
Dilutive securities	—		—		575
Weighted-average common and common equivalent shares outstanding (diluted)	24,091		23,868		21,781
EPS — basic	$	(1.23)	$	(3.11)	$	4.86
EPS — diluted	$	(1.23)	$	(3.11)	$	4.74

General and Summary of Significant Accounting Policies Investments-Equity Method (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Schedule of Equity Method Investments [Line Items]
Equity Method Investment, Aggregate Cost			$ 3,300
Equity Method Investments	$ 3,120	$ 3,178
nonpublic company
Schedule of Equity Method Investments [Line Items]
Equity Method Investment, Ownership Percentage			20.00%

Leases Supplemental Balance Sheet Lease information (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Operating Lease, Right-of-Use Assets	$ 69,909	$ 74,864
Operating Lease, Liability, Current	$ 20,161	$ 18,169
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Accrued liabilities	Accrued liabilities
Operating Lease, Liability, Noncurrent	$ 52,972	$ 60,916
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other long-term Liabilities	Other long-term Liabilities
Operating Lease, Liability	$ 73,133	$ 79,085
Operating Lease, Weighted Average Remaining Lease Term	5 years 7 months 6 days	6 years 1 month 6 days
Operating Lease, Weighted Average Discount Rate, Percent	4.31%	4.34%

Income Taxes Deferred income tax assets (liabilities) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Deferred tax assets and liabilities [Line Items]
Non-current deferred tax asset	$ 201,934	$ 143,119
Deferred Tax Liabilities, Net	18,590	94,552
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	30,190	17,351
Noncurrent deferred tax asset - acquired future tax deductions	10,877	14,186
Deferred Tax Assets, Tax Deferred Expense, Compensation and Benefits, Share-based Compensation Cost	6,987	6,240
Deferred Tax Assets, Unrealized Currency Losses	0	0
Noncurrent deferred tax asset - tax credits state	15,095	12,906
Deferred Tax Assets, Inventory	25,592	25,100
Deferred Tax Assets, Tax Deferred Expense, Reserves and Accruals, Warranty Reserves	13,788	13,241
Deferred Tax Asset, Section 163(j)	25,467	9,166
Noncurrentdeferredtaxassetchargebacksdiscountscustomerconcessions	39,077	39,508
Deferred Tax Assets, in Process Research and Development	43,313	16,587
Deferred Tax Assets, Valuation Allowance	8,452	11,166
Noncurrent deferred tax liability [Member]
Deferred tax assets and liabilities [Line Items]
Noncurrent deferred tax liability - state income taxes	4,465	1,816
Noncurrent deferred tax liability - depreciation and amortization	212,429	226,274
Deferred tax liability, change in accounting method	0	0
Deferred Tax Liabilities, Other Comprehensive Income	3,630	9,581
Deferred Tax Liabilities, Net	$ 220,524	$ 237,671

Income Taxes Tax Holiday (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Income Tax Holiday [Line Items]
Income Tax Holiday, Aggregate Dollar Amount	$ 8.0	$ 8.1
Income Tax Holiday, Income Tax Benefits Per Share	$ 0.33	$ 0.34

Leases (Notes)

12 Months Ended

Dec. 31, 2023

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, manufacturing and 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,
	2023		2022		2021
Operating lease cost	$	24,024	$	22,038	$	11,251
Finance lease cost — interest	125		112		122
Finance lease cost — reduction of ROU asset	1,035		712		648
Short-term lease cost	29		7		14
Total lease cost	$	25,213	$	22,869	$	12,035

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


	Year ended December 31,
	2023		2022		2021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases(1)	$	24,604	$	25,225	$	11,256
Operating cash flows from finance leases	$	125	$	112	$	122

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	15,873	$	5,994	$	2,589
Finance leases	$	1,028	$	715	$	558

_____________________________

(1) In January 2022, 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,
	2023			2022
Operating leases
Operating lease right-of-use assets	$	69,909		$	74,864

Accrued liabilities	$	20,161		$	18,169
Other long-term liabilities	52,972			60,916
Total operating lease liabilities	$	73,133		$	79,085

Weighted-Average Remaining Lease Term
Operating leases	5.6 years			6.1 years

Weighted-Average Discount Rate
Operating leases	4.31		%	4.34		%

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,
	2023			2022
Finance leases
Finance lease right-of-use assets	$	2,707		$	2,598

Accrued liabilities	$	860		$	816
Other long-term liabilities	1,954			1,855
Total finance lease liabilities	$	2,814		$	2,671

Weighted-Average Remaining Lease Term
Finance leases	4.1 years			4.8 years

Weighted-Average Discount Rate
Finance leases	4.93		%	4.23		%

As of December 31, 2023, the maturities of our operating and finance lease liabilities for each of the next five years are approximately (in thousands):


	Operating Leases		Finance Leases
2024	$	22,291	$	977
2025	16,409		763
2026	14,095		639
2027	10,150		291
2028	5,735		189
Thereafter	13,041		236
Total Lease Payments	81,721		3,095
Less imputed interest	(8,588)		(281)
Total	$	73,133	$	2,814

Revenue Disaggregation of Revenue - Product Line (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Revenues	$ 2,259,126	$ 2,279,997	$ 1,316,308
Percentage of revenue	100.00%	100.00%	100.00%
Infusion Consumables [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 969,129	$ 974,993	$ 555,189
Percentage of revenue	43.00%	43.00%	42.00%
Infusion Systems [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 629,043	$ 617,435	$ 352,321
Percentage of revenue	28.00%	27.00%	27.00%
Vital Care
Disaggregation of Revenue [Line Items]
Revenues	$ 660,954	$ 687,569	$ 408,798
Percentage of revenue	29.00%	30.00%	31.00%

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- Definition

+ References

+ Details

Collaborative and Other Arrangements (Notes)	12 Months Ended
Collaborative and Other Arrangements (Notes)	Dec. 31, 2023
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. We no longer purchase products from Pfizer under the MSA as described in (i) above. The MSA described in (ii) above provides each party with mutually beneficial interests and is 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.

General and Summary of Significant Accounting Policies Foreign Currency (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Foreign Currency [Abstract]
Foreign Currency Transaction Gain (Loss), Realized	$ 5,900,000	$ 5,800,000	$ 1,000,000

Derivatives and Hedging Activities (Tables)

12 Months Ended

Dec. 31, 2023

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

As of December 31, 2023
Prepaid expenses and other current assets	$	6,785	$	23,065	$	29,850
Other assets	673		4,876		5,549
Total assets	$	7,458	$	27,941	$	35,399

Accrued liabilities	$	2,590	$	—	$	2,590
Other long-term liabilities	240		—		240
Total liabilities	$	2,830	$	—	$	2,830

	Derivatives Designated as Cash Flow Hedging Instruments
As of December 31, 2022	Foreign Exchange Forward Contracts		Forward-Starting Interest Rate Swaps		Gross Derivatives
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

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 Income
	Location of Gain in the Consolidated Statements of Operations	Year Ended December 31,
		2023		2022		2021
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	Total revenues	$	296	$	3,829	$	—
Foreign exchange forward contracts	Cost of goods sold	7,852		7,751		3,444
Foreign exchange forward contracts	Other expense, net(1)	229		—		—
Foreign exchange forward contracts	Interest expense(2)	13		717		—
Interest rate swaps	Interest expense	32,444		6,122		—
Total derivatives designated as cash flow hedging instruments		$	40,834	$	18,419	$	3,444

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

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


	Amount of Gain (Loss) Recognized in Other Comprehensive Income (Loss)
	Year Ended December 31,
	2023		2022		2021
Derivatives designated as cash flow hedging instruments:
Foreign exchange forward contracts	$	10,788	$	9,588	$	950
Interest rate swaps	5,200		62,786		(1,480)
Total derivatives designated as cash flow hedging instruments	$	15,988	$	72,374	$	(530)

Collaborative and Other Arrangements (Details) $ in Millions	Dec. 31, 2023 USD ($)
Collaborative and Other Arrangements [Abstract]
Purchase Commitment, Remaining Minimum Amount Committed	$ 29.6

Derivatives and Hedging Activities Interest Rate Contracts(Details) $ in Thousands	Dec. 31, 2023 USD ($)
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Interest Rate Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months, Net	$ 23,900
Interest Rate Swap
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative, Fixed Interest Rate	1.32%
Derivative Interest Rate Floor	(0.15%)
Derivative Asset, Notional Amount	$ 244,700
us-gaap_InterestRateSwap 2
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative, Fixed Interest Rate	1.17%
Derivative Interest Rate Floor	0.35%
Derivative Asset, Notional Amount	$ 421,900
us-gaap_InterestRateSwap 3
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative, Fixed Interest Rate	3.88%
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
Maximum [Member] \| us-gaap_InterestRateSwap 3
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Derivative Liability, Notional Amount	300,000
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

Debt (Details)	12 Months Ended
Debt (Details)	Dec. 31, 2023 USD ($)
Debt Instrument [Line Items]
Long-Term Debt, Gross	$ 1,647,938,000
Line of Credit Facility, Fair Value of Amount Outstanding	0
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	(19,168,000)
Debt, Long-Term and Short-Term, Combined Amount	1,628,770,000
Debt, Current	51,000,000
Long-Term Debt, Excluding Current Maturities	1,577,770,000
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	$ 812,813,000
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	$ 9,300,000
Debt Instrument, Interest Rate During Period	7.67%
Term Loan B
Debt Instrument [Line Items]
Long-Term Debt, Gross	$ 835,125,000
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	$ 9,900,000
Debt Instrument, Interest Rate During Period	8.00%

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2023

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, 2021	$	(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 (income) before reclassifications	(103,928)		54,962		1,203		(47,763)
Amounts reclassified from AOCI	—		(13,946)		—		(13,946)
Other comprehensive (loss) income	(103,928)		41,016		1,203		(61,709)
Balance as of December 31, 2022	$	(122,973)	$	40,779	$	1,216	$	(80,978)
Other comprehensive income before reclassifications	46,189		12,096		603		58,888
Amounts reclassified from AOCI	—		(30,991)		—		(30,991)
Other comprehensive income (loss)	46,189		(18,895)		603		27,897
Balance as of December 31, 2023	$	(76,784)	$	21,884	$	1,819	$	(53,081)

Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2023

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, 2021	$	26,300
Contingent earn-out non-compete arrangement	2,589
Transfer of Pursuit earn-out liability into Level 2(1)	(26,300)
Contingent earn-out liability, December 31, 2021	2,589

Acquisition date fair value estimate of earn-out(2)	55,158
Change in fair value of contingent earn-out (included in income from operations as a separate line item)(3)	(32,091)
Currency translation	(84)
Contingent earn-out liability, December 31, 2022	25,572


Change in fair value of contingent earn-out (included in income from operations as a separate line item)(4)	(16,247)

Other(5)	(496)
Transfer of Mediverse earn-out liability into Level 2(6)	(3,379)
Currency translation	41
Contingent earn-out liability, December 31, 2023	$	5,491

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, 2023
	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	$	501	$	—	$	501	$	—




Foreign exchange forwards:
Prepaid expenses and other current assets	6,785		—		6,785		—
Other assets	673		—		673		—
Interest rate contracts:
Prepaid expenses and other current assets	23,065		—		23,065		—
Other assets	4,876		—		4,876		—
Total Assets	$	35,900	$	—	$	35,900	$	—

Liabilities:
Contingent earn-out liability-ST	$	4,879	$	—	$	3,379	$	1,500
Contingent earn-out liability - LT	3,991		—		—		3,991
Foreign exchange contracts:
Accrued liabilities	2,590		—		2,590		—
Other long-term liabilities	240		—		240		—


Total Liabilities	$	11,700	$	—	$	6,209	$	5,491


	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(1)	4,860		—		4,860		—
Other assets(1)	94		—		94		—
Interest rate contracts:
Prepaid expenses and other current assets(1)	28,431		—		28,431		—
Other assets(1)	26,753		—		26,753		—
Total Assets	$	64,878	$	1,412	$	63,466	$	—

Liabilities:
Contingent earn-out liability - LT	$	25,572	$	—	$	—	$	25,572
Foreign exchange contracts:
Accrued liabilities(1)	1,847		—		1,847		—
Other long-term liabilities(1)	167		—		167		—
Total Liabilities	$	27,586	$	—	$	2,014	$	25,572

2022 Credit Facility Text (Details) $ in Thousands	12 Months Ended
2022 Credit Facility Text (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Debt Disclosure [Abstract]
TotalSeniorSecuredCreditFacility	$ 2,200,000
Long-Term Debt, Gross	1,647,938
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	$ 812,813
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	$ 835,125
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

Revenue Contract Liabilities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
COntract Liability Rollforward [Roll Forward]
Contract with Customer, Liability	$ (45,866)	$ (7,461)
Contract with Customer, Liability	(42,177)	(45,866)
Smiths Medical
COntract Liability Rollforward [Roll Forward]
Contract with Customer, Liability	(51,245)
Contract with Customer, Liability		(51,245)
Equipment revenue [Member]
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(34,121)	(32,252)
Deferred Revenue, Additions	35,868	20,332
Software revenue [Member]
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(18,526)	(16,277)
Deferred Revenue, Additions	19,947	17,557
Government Grant Revenue
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(3,684)	(1,514)
Deferred Revenue, Additions	944	3,729
Other deferred revenue
COntract Liability Rollforward [Roll Forward]
Increase (Decrease) in Deferred Revenue	(6,041)	(5,915)
Deferred Revenue, Additions	$ 1,924	$ 1,500

Leases Finance Lease Maturity (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Finance Lease, Liability, to be Paid, Year One	$ 977
Finance Lease, Liability, to be Paid, Year Two	763
Finance Lease, Liability, to be Paid, Year Three	639
Finance Lease, Liability, to be Paid, Year Four	291
Finance Lease, Liability, to be Paid, Year Five	189
Finance Lease, Liability, to be Paid, after Year Five	236
Finance Lease, Liability, Payment, Due	3,095
Finance Lease, Liability, Undiscounted Excess Amount	(281)
Finance Lease, Liability	$ 2,814	$ 2,671

Income Taxes Unrecognized tax benefits Text (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Unrecognized Tax Benefits	$ 78,558	$ 54,053	$ 21,537	$ 18,443
Unrecognizedtaxbenefitspotentialdecreasefromlapseofstatuteoflimitations	6,700
Unrecognized Tax Benefits, Interest on Income Taxes Expense	1,400
Unrecognized Tax Benefits, Income Tax Penalties Expense	200
Incometaxexaminationincrease(decrease)ininterestliabilitiesfromprioryear	700
Incometaxexaminationincrease(decrease)inpenaltiesliabilityfrom prior year	600
Income Tax Examination, Interest Accrued	2,900	2,200
Income Tax Examination, Penalties Accrued	$ 2,000	$ 2,300

Applicable Margin Based on Leverage Ratio Term Loan B (Details) - Term Loan B	Dec. 31, 2023
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

Acquisitions Smiths Medical 2020 Limited Table (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2023	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
business combination, recognized identifiable asset acquired and liability assumed,		$ 55,200
GOODWILL	$ 1,449,258	$ 1,472,446	$ 43,439	$ 33,001
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

Restructuring, Strategic Transaction and Integration (Notes)

12 Months Ended

Dec. 31, 2023

Restructuring and Related Activities [Abstract]

Restructuring and Related Activities Disclosure [Text Block]

RESTRUCTURING, STRATEGIC TRANSACTION AND INTEGRATION

Restructuring, strategic transaction and integration expenses were $41.3 million, $71.4 million and $18.0 million in 2023, 2022 and 2021, respectively.

Restructuring

Restructuring charges net of any reversed accruals were $5.7 million, $9.7 million and $(1.8) million in 2023, 2022 and 2021, respectively, and are included in the above restructuring, strategic transaction and integration expenses in our consolidated statement of operations.

In 2023, we incurred restructuring charges primarily related to severance expenses. We adjusted certain facility and severance restructuring accrued balances, shown in the table below under "Other adjustments", to reverse certain accrued balances that will not be utilized.

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.

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, 2022	$	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

Charges incurred	5,521		1,189		6,710
Payments	(6,694)		(1,192)		(7,886)
Other adjustments(1)	(234)		(785)		(1,019)
Currency translation	(198)		38		(160)
Accrued balance, December 31, 2023	$	2,811	$	757	$	3,568

_______________________________________________

(1) Relates to accrued restructuring charges for estimated facility closure costs and severance costs that will not be utilized and were reversed during the year.

Strategic Transaction and Integration Expenses

We incurred $35.6 million, $61.7 million and $19.8 million in strategic transaction and integration expenses in 2023, 2022 and 2021, respectively, which are included in restructuring, strategic transaction and integration expenses in our consolidated statement of operations. The strategic transaction and integration expenses during 2023 were primarily related to consulting expenses and employee costs incurred to integrate our Smiths Medical business acquired in 2022. 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.

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, 2023	Dec. 31, 2022	Dec. 31, 2021
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	$ 15,988	$ 72,374	$ (530)
Cash Flow Hedging [Member] \| Foreign Exchange Forward [Member]
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	10,788	9,588	950
Cash Flow Hedging [Member] \| Interest Rate Swap
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	$ 5,200	$ 62,786	$ (1,480)

- Definition

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

+ References + Details

Share Based Award Share Award data (Details)	Dec. 31, 2023 $ / shares
Share-Based Payment Arrangement [Abstract]
Share Price	$ 99.74

Debt

12 Months Ended

Dec. 31, 2023

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 is 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.


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.


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 amortizes 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, total principal paid on both Term Loans for the year ended December 31, 2022 was $22.4 million. For the twelve months ended December 31, 2023, total principal payments on both Term Loans was $29.7 million.

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 are 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 are 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, 2023.

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, 2023

Senior Secured Credit Facilities:
Term Loan A — principal	7.67	%	$	812,813
Term Loan B — principal	8.00	%	835,125
Revolving Credit Facility — principal	—	%	—
Less unamortized debt issuance costs(1)			(19,168)
Total carrying value of long-term debt			1,628,770
Less current portion of long-term debt			51,000
Long-term debt, net			$	1,577,770

_______________________________

(1) Comprised of $9.3 million and $9.9 million relating to the Term Loan A and the Term Loan B, respectively.

As of December 31 2023, 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):


2024	$	51,000
2025	51,000
2026	72,250
2027	672,563
2028	8,500
Thereafter	792,625
Total	$	1,647,938

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


	Year Ended December 31,
	2023		2022		2021
Contractual interest	$	125,550	$	66,770	$	—
Amortization of debt issuance costs	6,814		6,972		240
Commitment fee — Revolving Credit Facility	1,518		1,290		221
Total long-term debt-related interest expense	$	133,882	$	75,032	$	461

- 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://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 470
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//470/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1E
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1E

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

+ Details

Income Taxes Change in taxes payable (Details) $ in Millions	12 Months Ended
	Dec. 31, 2023 USD ($)
Income Tax Disclosure [Abstract]
Increase (Decrease) in Income Taxes Payable	$ 24.5

Stockholders' Equity Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	$ (53,081)	$ (80,978)	$ (19,269)	$ (1,522)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	58,888	(47,763)	(15,129)
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(30,991)	(13,946)	(2,618)
Other Comprehensive Income (Loss), Net of Tax	27,897	(61,709)	(17,747)
Accumulated Foreign Currency Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	(76,784)	(122,973)	(19,045)	(4,381)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	46,189	(103,928)	(14,664)
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0	0
Other Comprehensive Income (Loss), Net of Tax	46,189	(103,928)	(14,664)
Accumulated Net Gain (Loss) from Cash Flow Hedges Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	21,884	40,779	(237)	2,784
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	12,096	54,962	(403)
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(30,991)	(13,946)	(2,618)
Other Comprehensive Income (Loss), Net of Tax	(18,895)	41,016	(3,021)
Accumulated Defined Benefit Plans Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	1,819	1,216	13	$ 75
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	603	1,203	(62)
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0	0
Other Comprehensive Income (Loss), Net of Tax	$ 603	$ 1,203	$ (62)

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- Definition

Amount, after tax, of accumulated increase (decrease) in equity from transaction and other event and circumstance from nonowner source.

+ References + Details

- Definition

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

+ References

+ Details

Fair Value Measurement Roll Forward (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	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	$ 5,491	$ 25,572	$ 2,589	$ 26,300
Fair Value, Measurement with Unobservable Inputs Reconciliation, Recurring Basis, Liability, Issuances		55,158	2,589
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)	(16,247)	(32,091)
Fair Value, Measurement with Unobservable Inputs Reconciliation, Liability, Transfers out of Level 3	(3,379)
Fair value measurements with unobservable inputs reconciliation, other	(496)
Currency translation on earn-out	$ 41	(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, Inc. [Member]
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent Earn-out Liability	$ 26,300				$ 26,300
Fair Value, Measurement with Unobservable Inputs Reconciliation, Liability, Transfers out of Level 3			$ (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

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

12 Months Ended

Dec. 31, 2023

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 2023, we had net sales to Medline of 16% of consolidated worldwide 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,
	2023		2022
Costa Rica	$	143,380	$	128,179
Mexico	110,124		99,849
Other LATAM	47,564		39,270
Canada	5,694		5,374
Italy	28,201		24,323



Spain	21,921		18,948
Czech Republic	12,256		10,732
Other Europe	11,440		11,375
APAC	22,966		20,930
Total Foreign	$	403,546	$	358,980
United States	833,251		803,577
Worldwide Total	$	1,236,797	$	1,162,557

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, 2023	Dec. 31, 2022
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	448,601	354,004
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value	$ 199.68	$ 213.95
Change in units due to performance expectations	5,554
ShareBasedCompensationArrangementByShareBasedPaymentAwardEquityInstrumentsOtherThanOptionsPerformanceExpectationAdditionsIntrinsicValue	$ 188.11
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period	234,324
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 178.75
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period	(140,091)
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period, Intrinsic Value, Amount Per Share	$ 200.66
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Forfeited in Period	(5,190)
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Forfeitures, Intrinsic Value, Amount Per Share	$ 188.98
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Outstanding, Weighted Average Remaining Contractual Terms	10 months 24 days
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Aggregate Intrinsic Value, Nonvested	$ 44,743

Restructuring, Strategic Transaction and Integration Strategic Transaction and Integration Expenses (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Restructuring and Related Activities [Abstract]
Strategic Transaction and Integration	$ 35.6	$ 61.7	$ 19.8

Leases (Details)	12 Months Ended
Leases (Details)	Dec. 31, 2023
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

Income Taxes Income tax disclosure (Tables)

12 Months Ended

Dec. 31, 2023

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,
	2023		2022		2021
United States	$	(136,980)	$	(135,646)	$	81,484
Foreign	58,681		21,237		41,702
	$	(78,299)	$	(114,409)	$	123,186

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,
	2023		2022		2021
Current:
Federal	$	(8,235)	$	4,128	$	20,646
State	5,035		3,799		3,444
Foreign	26,035		12,924		7,236
	$	22,835	$	20,851	$	31,326
Deferred:
Federal	$	(43,042)	$	(42,012)	$	(8,154)
State	(14,657)		(11,239)		(1,815)
Foreign	(13,780)		(7,723)		(1,306)
	(71,479)		(60,974)		(11,275)
	$	(48,644)	$	(40,123)	$	20,051

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,
	2023				2022				2021
	Amount		Percent		Amount		Percent		Amount		Percent
Federal tax at the expected statutory rate	$	(16,443)	21.0	%	$	(24,026)	21.0	%	$	25,869	21.0	%
State income tax, net of federal effect	(6,057)		7.7	%	(5,050)		4.4	%	2,907		2.4	%
Tax credits	(9,824)		12.5	%	(3,636)		3.2	%	(2,443)		(2.0)	%

Global intangible low-taxed income	(2,658)		3.4	%	2,303		(2.0)	%	711		0.6	%
Foreign income tax differential	(2,506)		3.2	%	(2,943)		2.5	%	(2,983)		(2.4)	%
Stock-based compensation	(289)		0.4	%	(3,721)		3.2	%	(4,263)		(3.5)	%
Foreign-derived intangible income	(3,299)		4.2	%	(2,269)		2.0	%	(3,775)		(3.1)	%
Transaction cost	—		—	%	2,299		(2.0)	%	—		—	%
Contingent consideration	(3,407)		4.4	%	(6,830)		6.0	%	(29)		—	%
Section 162(m)	3,268		(4.2)	%	3,942		(3.4)	%	1,812		1.5	%
Tax reserve releases	(6,884)		8.8	%	(1,834)		1.6	%	—		—	%
Other	(545)		0.7	%	1,642		(1.4)	%	2,245		1.8	%
	$	(48,644)	62.1	%	$	(40,123)	35.1	%	$	20,051	16.3	%

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,
	2023		2022
Deferred tax asset:


Accruals/other	$	30,190	$	17,351



Acquired future tax deductions	10,877		14,186
Stock-based compensation	6,987		6,240
Foreign currency translation adjustments	—		—
Tax credits	15,095		12,906

Inventory reserves	25,592		25,100
Warranty reserve	13,788		13,241
Section 163(j) - interest expense limitation	25,467		9,166


Chargebacks, discounts, customer concessions	39,077		39,508
Capitalized research and development	43,313		16,587
Valuation allowance	(8,452)		(11,166)
	$	201,934	$	143,119
Deferred tax liability:
State income taxes	$	4,465	$	1,816


Depreciation and amortization	212,429		226,274
Section 481(a) adjustment - change in accounting method	—		—


Foreign currency translation and derivative instrument adjustments	3,630		9,581
	$	220,524	$	237,671

Deferred tax (liability) asset, net	$	(18,590)	$	(94,552)

Summary of Income Tax Contingencies [Table Text Block]

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


	Year Ended December 31,
	2023		2022		2021
Beginning balance	$	54,053	$	21,537	$	18,443
Increases to prior year tax positions	2,347		148		231
Increases due to acquisitions	—		29,606		—
Increases to current year tax positions	34,607		4,706		3,242

Decreases to prior year tax positions	(2,455)		(222)		—

Decrease related to lapse of statute of limitations	(9,591)		(1,722)		(31)
Decrease related to settlements with tax authorities	(403)		—		(348)
Ending balance	$	78,558	$	54,053	$	21,537

General and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2023

Accounting Policies [Abstract]

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

BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Nature of Operations

Basis of Presentation

Use of 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

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,
	2023		2022
Raw materials	$	296,037	$	286,964
Work in process	58,906		73,795
Finished goods	354,417		335,250
Total	$	709,360	$	696,009

Property, Plant and Equipment

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


	As of December 31,
	2023		2022
Machinery and equipment	$	483,382	$	414,811
Land, building and building improvements	278,251		274,063
Molds	89,573		77,203
Computer equipment and software	122,038		115,214
Furniture and fixtures	30,662		29,876
Instruments placed with customers(1)	115,672		98,481
Construction in progress	117,219		152,909
Total property, plant and equipment, cost	1,236,797		1,162,557
Accumulated depreciation	(623,888)		(526,444)
Property, plant and equipment, net	$	612,909	$	636,113

_______________________________

(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

Goodwill

The following table presents the changes in the carrying amount of our goodwill for 2023, 2022 and 2021 (in thousands):


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



Currency translation	23,188
Balance as of December 31, 2023	$	1,472,446

_______________________________

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

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

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

(4) 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, 2023
		Cost		Accumulated Amortization		Net
Patents	10	$	33,261	$	20,637	$	12,624
Customer contracts	12	10,018		6,755		3,263
Non-contractual customer relationships	8	554,982		171,279		383,703
Trademarks	1	5,425		5,425		—
Trade name	15	18,251		7,162		11,089
Developed technology	10	587,852		167,913		419,939
Non-compete	3	9,100		7,450		1,650
Total amortized intangible assets		$	1,218,889	$	386,621	$	832,268

Internally developed software*		$	38,320			$	38,320

Total intangible assets		$	1,257,209	$	386,621	$	870,588

_______________________________

* 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, 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.

Amortization expense was $132.1 million, $139.4 million and $23.8 million in 2023, 2022 and 2021, respectively.

As of December 31, 2023, estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):


2024	$	132,623
2025	125,149
2026	124,396
2027	114,308
2028	113,710
Thereafter	222,082
Total	$	832,268

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 2023, 2022 or 2021.

Long-Lived Assets

Investment Securities

Investments in Available-for-sale Securities

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


	As of December 31, 2023
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	501	$	—	$	501
Short-term U.S. treasury securities	—		—		—
Short-term government bonds	—		—		—
Total short-term investment securities	501		—		501
Long-term corporate bonds	—		—		—
Total investment securities	$	501	$	—	$	501

	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

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.

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


	As of December 31,
	2023		2022
Equity method investment	$	3,120	$	3,178

Investments in non-marketable debt securities

In 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

Foreign Currency

Revenue Recognition

Our variable consideration includes distributor chargebacks, product returns and end customer rebates, with distributor chargebacks representing the majority and subject to the greatest judgment.

(i) The estimated chargeback amount (the difference between the price we invoice the distributor and the contractually agreed price with specified end customers); and

(ii) The estimated period of time between the sale to the distributor and the receipt of a chargeback claim.

Arrangements with Multiple Deliverables

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

Research and Development

Interest (expense) income, net

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


	As of December 31,
	2023		2022		2021
Interest expense	$	(102,727)	$	(70,805)	$	(858)
Interest income	7,508		4,430		2,840
Interest (expense) income, net	$	(95,219)	$	(66,375)	$	1,982

Other expense, net

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


	As of December 31,
	2023		2022		2021
Foreign exchange losses, net	$	(5,918)	$	(5,780)	$	(1,017)
Loss on disposition of assets	(153)		(2,554)		(1,651)
Other miscellaneous income, net	166		3,198		627
Other expense, net	$	(5,905)	$	(5,136)	$	(2,041)

The foreign exchange losses in 2023 were primarily related to the devaluation of the Argentine peso.

In 2023, other miscellaneous income, net primarily includes $3.7 million in fees related to our accounts receivable purchase program (see Note 17: Accounts Receivable Purchase Program) mostly offset by a business interruption gain. We received total insurance recoveries for property damage and business interruption of $3.1 million, $2.6 million of which was related to insurance proceeds for business interruption included within other miscellaneous income, net. In 2022, other miscellaneous income, net primarily relates to sale of certain other assets.

Net (Loss) Income Per Share

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,
	2023		2022		2021
Net (loss) income	$	(29,655)	$	(74,286)	$	103,135
Weighted-average number of common shares outstanding (basic)	24,091		23,868		21,206
Dilutive securities	—		—		575
Weighted-average common and common equivalent shares outstanding (diluted)	24,091		23,868		21,781
EPS — basic	$	(1.23)	$	(3.11)	$	4.86
EPS — diluted	$	(1.23)	$	(3.11)	$	4.74

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.

In October 2023, the FASB issued ASU 2023-06, Disclosure Improvements - Codification Amendments in Response to the SEC's Disclosure Update and Simplification Initiative. The amendments in this update modify the disclosure or presentation requirements of a variety of Topics in the Accounting Standards Codification ("ASC") in response to the SEC’s Release No. 33-10532, Disclosure Update and Simplification Initiative, and align the ASC’s requirements with the SEC’s regulations. For entities within the scope, the guidance will be applied prospectively with the effective date for each amendment to be the date on which the SEC's removal of that related disclosure from Regulation S-X or Regulation S-K becomes effective, with early adoption prohibited. If the SEC has not removed the related disclosure from its regulations by June 30, 2027, the amendments will be removed from the Codification and will not become effective. We are currently assessing what impact this guidance will have on the Company's consolidated financial statements and related disclosures.

In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280) - Improvements to Reportable Segment Disclosures. The amendments in this update expand disclosures about a public entity’s reportable segments and requires more enhanced information about a reportable segment’s significant expenses, interim segment profit or loss, and a description of how a public entity’s chief operating decision maker uses reported segment profit or loss information in assessing segment performance and allocating resources. The amendments clarify that a single reportable segment entity must apply ASC 280 in its entirety. The update will be effective for annual periods beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. This ASU is applicable to our Annual Report on Form 10-K for the fiscal year ended December 31, 2024, and subsequent interim periods, with early application permitted. We are currently assessing the effect of this update on our consolidated financial statements and related disclosures.

In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740) - Improvements to Income Tax Disclosures. The amendments in this update expand disclosures in an entity’s income tax rate reconciliation table and regarding cash taxes paid information. The update will be effective for annual periods beginning after December 15, 2024 and is applicable to our Annual Report on Form 10-K for the fiscal year December 31, 2025, with early application permitted. We are currently assessing the effect of this update on our consolidated financial statements and related disclosures.

General and Summary of Significant Accounting Policies Intangible Assets #1 (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,218,889	$ 1,202,911
Accumulated Amortization	386,621	251,951
Finite-Lived Intangible Assets, Net	832,268	950,960
Intangible Assets, Gross (Excluding Goodwill)	1,257,209	1,234,717
INTANGIBLE ASSETS, net	$ 870,588	$ 982,766
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	10 years	10 years
Cost	$ 33,261	$ 29,998
Accumulated Amortization	20,637	18,610
Finite-Lived Intangible Assets, Net	$ 12,624	$ 11,388
Customer Contracts [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	12 years	12 years
Cost	$ 10,018	$ 10,026
Accumulated Amortization	6,755	6,443
Finite-Lived Intangible Assets, Net	$ 3,263	$ 3,583
Customer-Related Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	8 years	8 years
Cost	$ 554,982	$ 546,935
Accumulated Amortization	171,279	101,556
Finite-Lived Intangible Assets, Net	$ 383,703	$ 445,379
Trademarks [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	1 year	1 year
Cost	$ 5,425	$ 5,425
Accumulated Amortization	5,425	5,425
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	$ 18,251
Accumulated Amortization	7,162	5,959
Finite-Lived Intangible Assets, Net	$ 11,089	$ 12,292
Developed Technology Rights [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Life in Years	10 years	10 years
Cost	$ 587,852	$ 583,176
Accumulated Amortization	167,913	108,708
Finite-Lived Intangible Assets, Net	$ 419,939	$ 474,468
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	7,450	5,250
Finite-Lived Intangible Assets, Net	1,650	3,850
In Process Research and Development [Member]
Finite-Lived Intangible Assets [Line Items]
Cost	$ 38,320	$ 31,806

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

12 Months Ended

Dec. 31, 2023

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, 2022	$	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

Charges incurred	5,521		1,189		6,710
Payments	(6,694)		(1,192)		(7,886)
Other adjustments(1)	(234)		(785)		(1,019)
Currency translation	(198)		38		(160)
Accrued balance, December 31, 2023	$	2,811	$	757	$	3,568

_______________________________________________

(1) Relates to accrued restructuring charges for estimated facility closure costs and severance costs that will not be utilized and were reversed during the year.

General and Summary of Significant Accounting Policies Interest (Expense) Income, net (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Interest Expense	$ (102,727)	$ (70,805)	$ (858)
Interest Income, Other	7,508	4,430	2,840
Interest Income (Expense), Nonoperating, Net	$ (95,219)	$ (66,375)	$ 1,982

- Definition

Amount of the cost of borrowed funds accounted for as interest expense.

+ References + Details

Principal Payments (Details) - USD ($)	3 Months Ended	12 Months Ended
Principal Payments (Details) - USD ($)	Mar. 31, 2022	Dec. 31, 2023	Dec. 31, 2022
Debt Disclosure [Abstract]
Debt Instrument, Periodic Payment, Principal	$ 16,000,000	$ 29,700,000	$ 22,400,000

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
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of options granted	7,620	7,910
Time based options grant date fair value	$ 540	$ 528
Expected term (years)	5 years 6 months	5 years 6 months
Expected stock price volatility	36.00%	35.00%
Risk-Free Interest Rate	3.00%	0.90%
Expected Dividend Yield	0.00%	0.00%
Weighted Average Exercise Price	$ 185.79	$ 200.07
Weighted Average Grant Date Fair Value per option	$ 70.86	$ 66.78

Accrued Liabilities an Other Long-term Liabilities

12 Months Ended

Dec. 31, 2023

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,
	2023		2022
Salaries and benefits	$	52,250	$	44,304
Incentive compensation	37,992		30,254

Operating lease liability-ST	20,161		18,169
Accrued professional fees	2,803		5,317
Field service corrective action(1)	30,281		24,517


Italy medical device payback provision(2)	23,176		7,900
Legal accrual	1,874		3,137
Accrued sales taxes	6,748		5,844
Warranties and returns	3,682		3,097
Deferred revenue	31,640		30,838

Accrued other taxes	3,024		5,794
Distribution fees	13,049		17,063
Accrued freight	17,215		17,988
Restructuring accrual	3,568		5,923
Foreign exchange contracts	2,590		1,847
Accrued audit fees	5,492		6,279
Defined benefit plan	2,575		2,928
Accrued interest	1,431		1,033




Accrued research and development	—		3,538
Other	8,664		6,999
	$	268,215	$	242,769

_____________________________

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


	As of December 31,
	2023		2022
Operating lease liability-LT	$	52,972	$	60,916
Finance lease liability-LT	1,954		1,855

Deferred revenue	10,585		16,239

Benefits	4,207		5,314
Field service corrective action(1)	26,056		25,294
Accrued rent	841		997

Other	3,882		3,489
	$	100,497	$	114,104

_______________________________

Income Taxes Tax Carryforwards (Details) $ in Millions	Dec. 31, 2023 USD ($)
Income Tax Disclosure [Abstract]
Tax Credit Carryforward, Amount	$ 20.4
Operating Loss Carryforwards, Valuation Allowance	9.0
Deferred Tax Assets, Operating Loss Carryforwards	$ 9.5

Debt Maturity (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Debt Disclosure [Abstract]
Long-Term Debt, Maturity, Year One	$ 51,000
Long-Term Debt, Maturity, Year Two	51,000
Long-Term Debt, Maturity, Year Three	72,250
Long-Term Debt, Maturity, Year Four	672,563
Long-Term Debt, Maturity, Year Five	8,500
Long-Term Debt, Maturity, after Year Five	792,625
Long-Term Debt, Gross	$ 1,647,938

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

Fair Value Measurement Fair Value Measurements, Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	$ 501	$ 4,224
Long-term Investment Securities	0	516
Assets, Fair Value Disclosure	35,900	64,878
Liabilities, Fair Value Disclosure	11,700	27,586
US Treasury Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	0	1,412
US Government Debt Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	0	498
Corporate Bond Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Short-term investment securities	501	2,314
Long-term Investment Securities		516
Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, Fair Value Disclosure	0	1,412
Liabilities, Fair Value Disclosure	0	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	0	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]
Short-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	0
Long-term Investment Securities		0
Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, Fair Value Disclosure	35,900	63,466
Liabilities, Fair Value Disclosure	6,209	2,014
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]
Short-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	501	2,314
Long-term Investment Securities		516
Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, Fair Value Disclosure	0	0
Liabilities, Fair Value Disclosure	5,491	25,572
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]
Short-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	0
Long-term Investment Securities		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	6,785	4,860
Interest Rate Derivative Assets, at Fair Value	23,065	28,431
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
Interest Rate Derivative Assets, at Fair Value	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	6,785	4,860
Interest Rate Derivative Assets, at Fair Value	23,065	28,431
Prepaid Expenses and Other Current Assets [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0	0
Interest Rate Derivative Assets, at Fair Value	0	0
Other Assets [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	673	94
Interest Rate Derivative Assets, at Fair Value	4,876	26,753
Other Assets [Member] \| Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0	0
Interest Rate Derivative Assets, at Fair Value	0	0
Other Assets [Member] \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	673	94
Interest Rate Derivative Assets, at Fair Value	4,876	26,753
Other Assets [Member] \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0	0
Interest Rate Derivative Assets, at Fair Value	0	0
Accrued Liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure	2,590	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	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	2,590	1,847
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	0	0
Other Liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign Currency Contracts, Liability, Fair Value Disclosure	240	167
Other 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	0
Other 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	240	167
Other 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	0	0
Earn-out liability ST
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	4,879
Earn-out liability ST \| 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
Earn-out liability ST \| Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	3,379
Earn-out liability ST \| Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	1,500
Earn-out liability [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	3,991	25,572
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	$ 3,991	$ 25,572