0000883984-24-000042 | 10-Q | XBRL Viewer

Corporate Bond Securities

$ 501

^[1]

$ 0

Debt Securities, Available-for-sale [Line Items]

Debt Securities, Available-for-sale, Amortized Cost, Current

501

Debt Securities, Available-for-sale, Unrealized Loss

$ 501

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

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.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aa)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aaa)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-2

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481800/320-10-50-3

Prepaid Expense and Other Assets [Abstract]

Fair Value Measures and Disclosures (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)	Jun. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)	Jan. 06, 2022 USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY	$ 1,500	$ 5,447	$ 13,361	$ 25,572
Contingent Consideration, Gross ST	1,000
Contingent Consideration, Gross LT	1,500
Business Combination, Contingent Consideration, Liability	$ 3,900
Ownership requirement for Earnout Payment	0.500
SmithsMedical
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	$ 100,000
Business Combination, Contingent Consideration, Liability					$ 53,500
Foreign Infusion System Supplier
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	2,500
Business Combination, Contingent Consideration, Liability	1,500
International Distributor
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	6,000
International Distributor \| Liability
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	6,000
CONTINGENT EARN-OUT LIABILITY	$ 3,400

Prepaids and Other Current Assets (Notes)

9 Months Ended

Sep. 30, 2024

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
	September 30, 2024		December 31, 2023
Other prepaid expenses and receivables	$	21,054	$	17,833
Prepaid vendor expenses	1,657		1,309
Deferred costs	13,393		1,668
Prepaid insurance and property taxes	4,974		9,547
VAT/GST receivable	3,739		2,748
Deferred tax charge	6,652		5,822
Foreign exchange contracts	5,356		6,785
Interest rate contracts	10,940		23,065

Deposits	1,387		1,196
Other	4,583		3,667
	$	73,735	$	73,640

Other assets consist of the following (in thousands):


	As of
	September 30, 2024		December 31, 2023
Pump lease receivables	$	25,913	$	30,627
Spare parts	50,331		46,496
Equity method investment	3,080		3,120
Deferred debt issuance costs	2,355		3,439
Finance lease right-of-use assets	3,144		2,707
Interest rate contracts	—		4,876

Other	2,014		2,755
	$	86,837	$	94,020

Accrued Liabilities (Tables)

9 Months Ended

Sep. 30, 2024

Schedule of Accrued Liabilities [Table Text Block]

Accrued liabilities consist of the following (in thousands):


	As of
	September 30, 2024		December 31, 2023
Salaries and benefits	$	68,206	$	52,250
Incentive compensation	53,884		37,992

Operating lease liability-ST	17,094		20,161



Accrued sales taxes	4,931		6,748
Restructuring accrual	10,763		3,568

Deferred revenue	26,932		31,640
Accrued other taxes	6,846		3,024
Accrued professional fees	4,503		2,803
Italy medical device payback provision(1)	25,169		23,176
Legal accrual	2,715		1,874

Distribution fees	20,778		13,049
Warranties and returns	3,564		3,682
Field service corrective action(2)	38,599		30,281
Accrued freight	16,118		17,215
Foreign exchange contracts	9,878		2,590




Accrued audit fees	4,943		5,492
Defined benefit plan	2,019		2,575

Accrued interest	680		1,431
Other	8,106		8,664
	$	325,728	$	268,215

___________________________

(1) Related to potential payments associated with the IMDP (as defined below) as a result of 2015 legislation enacted requiring medical device companies to make payments to the Italian government based on regional expenditure ceilings (see Note 18: Commitments and Contingencies for further details).

(2) Primarily includes field service corrective actions associated with certain products in connection with a 2021 Warning Letter (as defined below) received by Smiths Medical from the FDA following an inspection of Smiths Medical’s Oakdale, Minnesota Facility (see Note 18: Commitments and Contingencies for further details).

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


	As of
	September 30, 2024		December 31, 2023

Operating lease liability-LT	$	45,328	$	52,972
Benefits	3,909		4,207
Accrued rent	699		841




Finance lease liability-LT	2,240		1,954
Deferred revenue	10,036		10,585
Field service corrective action(1)	12,599		26,056
Other	5,578		3,882
	$	80,389	$	100,497

Fair Value Measures and Disclosures Liabilities Recurring Basis Unobservable Input Reconciliation Roll Forward (Details) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY	$ 1,500	$ 5,447		$ 13,361				$ 25,572
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)			$ 295			$ (700)
Fair value measurement with unobservable inputs reconciliation other				(58)	$ (11)
Currency translation on earn-out				(58)	1	33
SmithsMedical
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)	$ (3,947)			$ (15,572)	4,016
Smiths Medical & Foreign Infusion Systems Supplier
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY			$ 5,786		$ 28,933	$ 24,905	$ 5,491
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)		$ (339)

Net Income Per Share:

9 Months Ended

Sep. 30, 2024

Earnings Per Share [Abstract]

Net Income Per Share [Text Block]

Net (Loss) Income Per Share

Basic (loss) earnings per share is computed by dividing net (loss) income by the weighted-average number of common shares outstanding during the period. Diluted earnings per share is computed by dividing net (loss) income by the weighted-average number of common shares outstanding during the period plus dilutive securities. Dilutive securities include outstanding common stock options and unvested restricted stock units, less the number of shares that could have been purchased with the proceeds from the exercise of the options, using the treasury stock method. Options and restricted stock units that are anti-dilutive are not included in the treasury stock method calculation. A net loss for the three and nine months ended September 30, 2024 and 2023, causes all of the potentially dilutive common shares to be antidilutive, and accordingly, they were not included in the computation of diluted earnings per share and basic and diluted net loss per share are equal for each of these periods.

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


	Three months ended September 30,				Nine months ended September 30,
	2024		2023		2024		2023
Net (loss) income	$	(32,983)	$	7,238	$	(93,860)	$	(12,508)

Weighted-average number of common shares outstanding (basic)	24,438		24,132		24,353		24,075
Dilutive securities(1)	—		236		—		—
Weighted-average common and common equivalent shares outstanding (diluted)	24,438		24,368		24,353		24,075
EPS — basic	$	(1.35)	$	0.30	$	(3.85)	$	(0.52)
EPS — diluted	$	(1.35)	$	0.30	$	(3.85)	$	(0.52)

Total anti-dilutive stock options and restricted stock awards	89		248		112		106

_______________________________

(1) Due to the net loss for the three and nine months ended September 30, 2024 and nine months ended September 30, 2023, there are no potentially dilutive common shares included in the computation of diluted earnings per share.

Leases Text (Details)	9 Months Ended
Leases Text (Details)	Sep. 30, 2024
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Option to Extend	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

Restructuring, Strategic Transaction and Integration (Tables)

9 Months Ended

Sep. 30, 2024

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 for the nine months ended September 30, 2024 (in thousands), which is included in accrued liabilities on the condensed consolidated balance sheets:


	Severance Pay and Benefits		Retention and Facility Closure Costs		Total
Accrued balance, January 1, 2024	$	2,811	$	757	$	3,568

Charges incurred	5,065		295		5,360
Payments	(2,760)		(184)		(2,944)
Other(1)	(41)		—		(41)
Currency translation	(13)		(7)		(20)
Accrued balance, March 31, 2024	$	5,062	$	861	$	5,923
Charges incurred	7,712		—		7,712
Payments	(3,678)		—		(3,678)
Currency translation	(33)		—		(33)

Accrued balance, June 30, 2024	$	9,063	$	861	$	9,924
Charges incurred	3,385		187		3,572
Payments	(2,119)		(658)		(2,777)
Other(2)	(134)		—		(134)
Currency translation	136		42		178
Accrued balance, September 30, 2024	$	10,331	$	432	$	10,763

__________________________

(1) Relates to prior year accrued restructuring charges for estimated severances costs that will not be utilized and were reversed during the three months ended March 31, 2024.

(2) Relates to prior year accrued restructuring charges for estimated severances costs that will not be utilized and were reversed during the three months ended September 30, 2024.

Equity

9 Months Ended

Sep. 30, 2024

Equity [Abstract]

Stockholders' Equity Note Disclosure

Stockholders' Equity

Shareholders Agreement

At the completion of the Smiths Medical acquisition in 2022, Smiths owned approximately 10.5% of the total outstanding shares of our common stock (see Note 3: Restructuring, Strategic Transaction and Integration). At closing, in connection with the issuance of the share consideration, we entered into a Shareholders Agreement (the “Shareholders Agreement”) with Smiths. The Shareholders Agreement permits Smiths to designate one individual for election to our Board of Directors (the "Board") so long as Smiths beneficially owns at least 5.0% of the total outstanding shares of our common stock. On February 28, 2024, Smiths designated board member, Mr. William Seeger, notified us of his resignation from our Board in anticipation of his retirement from the Board of Directors of Smiths. See our Current Report on Form 8-K filed on February 29, 2024 for additional information. During July 2024 Smiths sold a portion of their outstanding shares of our common stock which when combined with other sales in prior periods left Smiths with an ownership percentage under the required 5.0% needed for the right to designate a board member.

Treasury Stock

In August 2019, our Board approved a share purchase plan to purchase up to $100.0 million of our common stock. This plan has no expiration date. During the three and nine months ended September 30, 2024, we did not purchase any shares of our common stock under our share purchase plan. As of September 30, 2024, all of the $100.0 million available for purchase was remaining under the plan. We are currently limited on share purchases in accordance with the terms and conditions of our Credit Agreement (see Note 16: Long-Term Debt).

For the nine months ended September 30, 2024, we withheld 114,023 shares of our common stock from employee vested restricted stock units in consideration for $11.9 million in payments made on the employees' behalf for their minimum statutory income tax withholding obligations. For the nine months ended September 30, 2023, we withheld 58,089 shares of our common stock from employee vested restricted stock units in consideration for $9.2 million in payments made on the employees' behalf for their minimum statutory income tax withholding obligations. Treasury stock is used 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, 2024	$	(76,784)	$	21,884	$	1,819	$	(53,081)
Other comprehensive (loss) income before reclassifications	(22,817)		13,908		—		(8,909)
Amounts reclassified from AOCI	—		(7,548)		—		(7,548)
Other comprehensive (loss) income	(22,817)		6,360		—		(16,457)
Balance as of March 31, 2024	$	(99,601)	$	28,244	$	1,819	$	(69,538)
Other comprehensive (loss) income before reclassifications	(15,865)		436		—		(15,429)
Amounts reclassified from AOCI	—		(6,818)		—		(6,818)
Other comprehensive loss	(15,865)		(6,382)		—		(22,247)
Balance as of June 30, 2024	$	(115,466)	$	21,862	$	1,819	$	(91,785)
Other comprehensive income (loss) before reclassifications	49,581		(14,975)		—		34,606
Amounts reclassified from AOCI	—		(5,257)		—		(5,257)
Other comprehensive income (loss)	49,581		(20,232)		—		29,349
Balance as of September 30, 2024	$	(65,885)	$	1,630	$	1,819	$	(62,436)


	Foreign Currency Translation Adjustments		Unrealized Gains (Losses) on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2023	$	(122,973)	$	40,779	$	1,216	$	(80,978)
Other comprehensive income (loss) before reclassifications	24,983		(113)		(31)		24,839
Amounts reclassified from AOCI	—		(5,464)		—		(5,464)
Other comprehensive income (loss)	24,983		(5,577)		(31)		19,375
Balance as of March 31, 2023	$	(97,990)	$	35,202	$	1,185	$	(61,603)
Other comprehensive income (loss) before reclassifications	7,569		13,175		(34)		20,710
Amounts reclassified from AOCI	—		(7,901)		—		(7,901)
Other comprehensive income (loss)	7,569		5,274		(34)		12,809
Balance as of June 30, 2023	$	(90,421)	$	40,476	$	1,151	$	(48,794)
Other comprehensive (loss) income before reclassifications	(37,557)		10,824		(35)		(26,768)
Amounts reclassified from AOCI	—		(9,165)		—		(9,165)
Other comprehensive (loss) income	(37,557)		1,659		(35)		(35,933)
Balance as of September 30, 2023	$	(127,978)	$	42,135	$	1,116	$	(84,727)

The entire disclosure for equity.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-13

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-14

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 235
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477968/946-235-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 235
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477968/946-235-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 505
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478448/946-505-50-6

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 815
-SubTopic 40
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480237/815-40-50-6

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.3-04)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480008/505-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(e)(1))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-1

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 505
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org/505/tableOfContent

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-13

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-13

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-13

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-14

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-14

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 16
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-16

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-18

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-18

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-18

Transfer of Financial Assets Accounted for as Sales

Basis of Presentation:	9 Months Ended
Basis of Presentation:	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation [Text Block]	Basis of Presentation The accompanying unaudited interim condensed consolidated financial statements of ICU Medical, Inc., ("ICU" or the "Company"), a Delaware corporation, have been prepared in accordance with accounting principles generally accepted in the United States of America ("U.S.") and pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) and reflect all adjustments, consisting of only normal recurring adjustments, which are, in the opinion of management, necessary for a fair statement of the consolidated results for the interim periods presented. Results for the interim period are not necessarily indicative of results for the full year. Certain information and footnote disclosures normally included in annual consolidated financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted pursuant to such rules and regulations. The condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Annual Report on Form 10-K of ICU for the year ended December 31, 2023. We develop, manufacture and sell 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. 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. All subsidiaries are wholly owned and are included in the condensed consolidated financial statements. All intercompany balances and transactions have been eliminated. Certain reclassifications have been made to the prior year cash flows from operating activities within the condensed consolidated statements of cash flows to conform to the presentation used in the current year. We reclassified bond premium amortization to other. The reclassification had no impact on cash flows from operating activities as previously reported.

Accrued Liabilities Long-term liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Accrued Liabilities [Abstract]
Operating Lease, Liability, Noncurrent	$ 45,328	$ 52,972
Accrued Employee Benefits	3,909	4,207
Accrued Rent	699	841
Finance Lease, Liability, Noncurrent	2,240	1,954
Contract with Customer, Liability, Noncurrent	10,036	10,585
Other Accrued Liabilities, Noncurrent	5,578	3,882
OTHER LONG-TERM LIABILITIES	80,389	100,497
Product Liability Contingency [Line Items]
Product Liability Accrual, Component Amount	51,200
Long Term
Product Liability Contingency [Line Items]
Product Liability Accrual, Component Amount	$ 12,599	$ 26,056

Transfers and Servicing (Tables)

9 Months Ended

Sep. 30, 2024

Transfers and Servicing [Abstract]

The following table presents information in connection with the purchase program (in thousands):


	Three months ended September 30,				Nine months ended September 30,
	2024		2023		2024		2023
Trade receivables sold(1)	$	86,991	$	162,369	$	435,438	$	452,640
Cash received in exchange for trade receivables sold(2)	86,521		$	161,398	432,803		$	449,984
Loss on sale of receivables(3)	469		$	971	2,635		$	2,655

Derivative Financial Instruments Derivative Instruments and Hedging Activities - FV of Derivative Instruments Included Within Consolidated Balance Sheet (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Derivatives, Fair Value [Line Items]
Derivative Asset, Current, Statement of Financial Position [Extensible Enumeration]	Prepaid expenses and other current assets	Prepaid expenses and other current assets
Derivative Asset, Current	$ 16,296	$ 29,850
Derivative Asset, Noncurrent, Statement of Financial Position [Extensible Enumeration]	OTHER ASSETS	OTHER ASSETS
Derivative Asset, Noncurrent	$ 177	$ 5,549
Derivative Asset	$ 16,473	$ 35,399
Derivative Liability, Current, Statement of Financial Position [Extensible Enumeration]	Accrued liabilities	Accrued liabilities
Derivative Liability, Current	$ 9,878	$ 2,590
Derivative Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Other long-term liabilities	Other long-term liabilities
Derivative Liability, Noncurrent	$ 1,625	$ 240
Derivative Liability	11,503	2,830
Foreign Exchange Contract
Derivatives, Fair Value [Line Items]
Derivative Asset, Current	5,356	6,785
Derivative Asset, Noncurrent	177	673
Derivative Asset	5,533	7,458
Derivative Liability, Current	9,878	2,590
Derivative Liability, Noncurrent	226	240
Derivative Liability	10,104	2,830
Interest Rate Swap
Derivatives, Fair Value [Line Items]
Derivative Asset, Current	10,940	23,065
Derivative Asset, Noncurrent	0	4,876
Derivative Asset	10,940	27,941
Derivative Liability, Current	0	0
Derivative Liability, Noncurrent	1,399	0
Derivative Liability	$ 1,399	$ 0

Fair Value Measures and Disclosures (Tables)

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

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

The following tables provide a reconciliation of the Level 3 earn-out liabilities measured at estimated fair value (in thousands):


	Earn-out Liability
Accrued balance, January 1, 2024	$	5,491

Change in fair value of earn-out (included in income from operations as a separate line item)(1)	295


Accrued balance, March 31, 2024	5,786
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(339)


Accrued balance, June 30, 2024	5,447
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(3,947)



Accrued balance, September 30, 2024	$	1,500


	Earn-out Liability
Accrued balance, January 1, 2023	$	25,572
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(700)

Currency translation	33
Accrued balance, March 31, 2023	24,905
Change in fair value of earn-out (included in income from operations as a separate line item)(2)	4,016
Other	11
Currency translation	1
Accrued balance, June 30, 2023	28,933
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(15,572)
Other	58
Currency translation	(58)
Accrued balance, September 30, 2023	$	13,361

_______________________________

(1) Relates to the change in fair value of our Smiths Medical earn-out.

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

Fair Value Measurement Inputs and Valuation Techniques

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

Smiths Medical Earn-out Liability


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

Fair Value, by Balance Sheet Grouping

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 September 30, 2024
	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:






Foreign exchange contracts:
Prepaid expenses and other current assets	$	5,356	$	—	$	5,356	$	—
Other assets	177		—		177		—


Interest rate contracts:
Prepaid expenses and other current assets	10,940		—		10,940		—
Other assets	—		—		—		—
Total Assets	$	16,473	$	—	$	16,473	$	—

Liabilities:
Contingent earn-out liability - ST	$	1,500	$	—	$	—	$	1,500

Foreign exchange contracts:
Accrued liabilities	9,878		—		9,878		—
Other long-term liabilities	226		—		$	226	—
Interest rate swaps:
Other long-term liabilities	1,399		—		1,399		—
Total Liabilities	$	13,003	$	—	$	11,503	$	1,500


	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

Long-Term Obligations (Tables)

9 Months Ended

Sep. 30, 2024

LOng-Term Obligations Disclosure [Abstract]

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 September 30, 2024		Effective Interest Rate		As of December 31, 2023

Senior Secured Credit Facilities:
Term Loan A — principal	8.22	%	$	780,938	7.67	%	$	812,813
Term Loan B — principal	8.57	%	828,750		8.00	%	835,125
Revolving Credit Facility — principal	—	%	—		—	%	—
Less unamortized debt issuance costs(1)			(15,346)				(19,168)
Total carrying value of long-term debt			1,594,342				1,628,770
Less current portion of long-term debt			51,000				51,000
Long-term debt, net			$	1,543,342			$	1,577,770

_______________________________

(1) Comprised of $6.9 million and $8.4 million relating to the Term Loan A and the Term Loan B, respectively, as of September 30, 2024.

Schedule of Maturities of Long-term Debt


Remainder of 2024	$	12,750
2025	51,000
2026	72,250
2027	672,563
2028	8,500
2029	792,625
Thereafter	—
Total	$	1,609,688

Interest expense on long term debt

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


	Three months ended September 30,				Nine months ended September 30,
	2024		2023		2024		2023
Contractual interest	$	32,059	$	32,494	$	96,186	$	92,593
Amortization of debt issuance costs	1,700		1,704		5,111		5,108
Commitment fee — Revolving Credit Facility	384		384		1,141		1,135
Total long-term debt-related interest expense	$	34,143	$	34,582	102,438		98,836

Applicable Margin Based on Leverage Ratio


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%

Leverage Ratio


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%

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.

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(22))
-SubTopic 10
-Topic 210
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480566/210-10-S99-1

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 69B
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481568/470-20-55-69B

Reference 3: http://www.xbrl.org/2003/role/exampleRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 69E
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481568/470-20-55-69E

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 3
-Subparagraph (SX 210.12-04(a))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-3

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 835
-SubTopic 30
-Name Accounting Standards Codification
-Section 45
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482925/835-30-45-2

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-3

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Topic 942
-SubTopic 470
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477734/942-470-50-3

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 8
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-8

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-6

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 7
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-7

Transfers and Servicing of Financial Assets

Transfers and Servicing

9 Months Ended

Sep. 30, 2024

Transfers and Servicing [Abstract]

Accounts Receivable Purchase Program

On January 19, 2023, we entered into a revolving $150 million uncommitted receivables purchase agreement with Bank of The West, 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, 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 BMO has the right upon purchase to pledge and/or exchange the transferred assets without restrictions. The Company acts as collection agent for BMO and collection services are undertaken by our accounts receivable personnel in their normal course of business and collected funds are remitted to BMO. 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.

The following table presents information in connection with the purchase program (in thousands):


	Three months ended September 30,				Nine months ended September 30,
	2024		2023		2024		2023
Trade receivables sold(1)	$	86,991	$	162,369	$	435,438	$	452,640
Cash received in exchange for trade receivables sold(2)	86,521		$	161,398	432,803		$	449,984
Loss on sale of receivables(3)	469		$	971	2,635		$	2,655

_______________________________

(1) Represents carrying value of trade receivables sold to BMO.

(2) Cash proceeds received from BMO.

(3) Reflected in other expense, net in our condensed consolidated statement of operations.

As of September 30, 2024 and December 31, 2023, cash remaining to be collected on behalf of BMO was $27.0 million and $75.9 million, respectively, which has been removed from our condensed consolidated balance sheets as of September 30, 2024 and December 31, 2023, respectively and is reflected as cash provided by operating activities in the condensed consolidated statement of cash flows in each respective period. The carrying value of the sold receivables approximated the fair value at September 30, 2024.

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.

Reference 1: 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/1943274/2147479170/946-210-S99-1

Reference 2: 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 3: 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 4: 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 5: 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 6: 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 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
-Publisher FASB
-URI https://asc.fasb.org/860/tableOfContent

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 20
-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
-Paragraph 4
-Subparagraph (a)(5)(ii)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481326/860-20-50-4

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-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
-SubTopic 20
-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
-Paragraph 7
-Subparagraph (c)
-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
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481229/860-50-50-2

Reference 20: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 50
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481229/860-50-50-2

Reference 21: http://www.xbrl.org/2003/role/disclosureRef
-Topic 860
-SubTopic 50
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481229/860-50-50-4

Revenue from Contract with Customer [Abstract]

Revenue (Notes)

9 Months Ended

Sep. 30, 2024

Revenue from Contract with Customer [Text Block]

Revenue

Revenue Recognition

Our business units are Consumables, Infusion Systems and Vital Care. The vast majority of our sales of 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. 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.

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. Distributor chargebacks represent the majority and are 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 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, 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 stand-alone selling price, and recognize revenue over the period the warranty service is provided.

Arrangements with Multiple Performance Obligations

We also enter into arrangements which include multiple performance obligations. 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):


	Three months ended September 30,				Nine months ended September 30,
Product line	2024		2023		2024		2023
Consumables	$	264,875	$	242,010	$	770,730	$	715,108
Infusion Systems	159,769		148,981		480,745		463,836
Vital Care	164,487		162,320		500,766		492,326
Total Revenues	$	589,131	$	553,311	$	1,752,241	$	1,671,270

For the three and nine months ended September 30, 2024, net sales to Medline made up approximately 18% and 17% of total revenues, respectively. For the three and nine months ended September 30, 2023, net sales to Medline made up approximately 18% and 16% of total revenues, respectively.

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


	Three months ended September 30,				Nine months ended September 30,
Geography	2024		2023		2024		2023
United States	$	369,515	$	355,984	$	1,118,810	$	1,063,037
Europe, the Middle East and Africa	101,710		88,014		295,409		276,994
APAC	60,288		59,064		173,365		177,719
Other Foreign	57,618		50,249		164,657		153,520
Total Revenues	$	589,131	$	553,311	$	1,752,241	$	1,671,270

Contract Balances

The following table presents the changes in our contract balances for the nine months ended September 30, 2024 and 2023 (in thousands), which is included in accrued liabilities and other long-term liabilities on the condensed consolidated balance sheets:


	Contract Liabilities
Beginning balance, January 1, 2024	$	42,177

Equipment revenue recognized	(41,392)
Equipment revenue deferred due to implementation	38,825
Software revenue recognized	(23,591)
Software revenue deferred due to implementation	24,559
Government grant income recognized(1)	(1,551)
Government grant income deferred	—
Other deferred revenue	503
Other deferred revenue recognized	(2,562)
Ending balance, September 30, 2024	$	36,968

Beginning balance, January 1, 2023	$	45,866

Equipment revenue recognized	(24,872)
Equipment revenue deferred due to implementation	25,620
Software revenue recognized	(13,546)
Software revenue deferred due to implementation	12,797
Government grant income deferred	944
Government grant income recognized(1)	(3,164)
Other deferred revenue	1,674
Other deferred revenue recognized	(4,748)
Ending balance, September 30, 2023	$	40,571

____________________________

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

Our contract liabilities are included in accrued liabilities or other long-term liabilities in our condensed consolidated balance sheet based on the expected timing of revenue recognition.

As of September 30, 2024, revenue from remaining performance obligations is as follows:


	Recognition Timing
(in thousands)	< 12 Months		> 12 Months
Equipment deferred revenue	$	14,641	$	1,713
Software deferred revenue	10,185		459
Government grant deferred income(1)	2,064		7,864
Other deferred revenue(2)	42		—
Total	$	26,932	$	10,036

_________________________________

(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.

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.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-9

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-10

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-15

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-13

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

Revenue from Contract with Customer [Abstract]

Revenue (Tables)

9 Months Ended

Sep. 30, 2024

Disaggregation of Revenue [Table Text Block]

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


	Three months ended September 30,				Nine months ended September 30,
Product line	2024		2023		2024		2023
Consumables	$	264,875	$	242,010	$	770,730	$	715,108
Infusion Systems	159,769		148,981		480,745		463,836
Vital Care	164,487		162,320		500,766		492,326
Total Revenues	$	589,131	$	553,311	$	1,752,241	$	1,671,270

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


	Three months ended September 30,				Nine months ended September 30,
Geography	2024		2023		2024		2023
United States	$	369,515	$	355,984	$	1,118,810	$	1,063,037
Europe, the Middle East and Africa	101,710		88,014		295,409		276,994
APAC	60,288		59,064		173,365		177,719
Other Foreign	57,618		50,249		164,657		153,520
Total Revenues	$	589,131	$	553,311	$	1,752,241	$	1,671,270

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


	Contract Liabilities
Beginning balance, January 1, 2024	$	42,177

Equipment revenue recognized	(41,392)
Equipment revenue deferred due to implementation	38,825
Software revenue recognized	(23,591)
Software revenue deferred due to implementation	24,559
Government grant income recognized(1)	(1,551)
Government grant income deferred	—
Other deferred revenue	503
Other deferred revenue recognized	(2,562)
Ending balance, September 30, 2024	$	36,968

Beginning balance, January 1, 2023	$	45,866

Equipment revenue recognized	(24,872)
Equipment revenue deferred due to implementation	25,620
Software revenue recognized	(13,546)
Software revenue deferred due to implementation	12,797
Government grant income deferred	944
Government grant income recognized(1)	(3,164)
Other deferred revenue	1,674
Other deferred revenue recognized	(4,748)
Ending balance, September 30, 2023	$	40,571

Deferred Revenue, by Arrangement, Disclosure

As of September 30, 2024, revenue from remaining performance obligations is as follows:


	Recognition Timing
(in thousands)	< 12 Months		> 12 Months
Equipment deferred revenue	$	14,641	$	1,713
Software deferred revenue	10,185		459
Government grant deferred income(1)	2,064		7,864
Other deferred revenue(2)	42		—
Total	$	26,932	$	10,036

_________________________________

(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.

Restructuring and Related Activities -Smiths Medical Related Party (Details) - SmithsMedical - USD ($) shares in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023
Business Acquisition [Line Items]
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares		2.5
Related Party Transaction, Purchases from Related Party	$ 300,000	$ 8,300,000

Derivative Financial Instruments Foreign Exchange Forward Contracts(Details)	Sep. 30, 2024 USD ($)
Derivative [Line Items]
Derivative, Notional Amount	$ 162,300,000
other currencies
Derivative [Line Items]
Derivative, Notional Amount	5,400,000
Euro Member Countries, Euro
Derivative [Line Items]
Derivative, Notional Amount	14,500,000
Japan, Yen
Derivative [Line Items]
Derivative, Notional Amount	7,200,000
Canada, Dollars
Derivative [Line Items]
Derivative, Notional Amount	7,400,000
Australia, Dollars
Derivative [Line Items]
Derivative, Notional Amount	8,800,000
United States of America, Dollars
Derivative [Line Items]
Derivative, Notional Amount	41,400,000
Mexico, Pesos
Derivative [Line Items]
Derivative, Notional Amount	71,100,000
Czech Republic, Koruny
Derivative [Line Items]
Derivative, Notional Amount	$ 6,500,000

Accrued Liabilities (Notes)

9 Months Ended

Sep. 30, 2024

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
	September 30, 2024		December 31, 2023
Salaries and benefits	$	68,206	$	52,250
Incentive compensation	53,884		37,992

Operating lease liability-ST	17,094		20,161



Accrued sales taxes	4,931		6,748
Restructuring accrual	10,763		3,568

Deferred revenue	26,932		31,640
Accrued other taxes	6,846		3,024
Accrued professional fees	4,503		2,803
Italy medical device payback provision(1)	25,169		23,176
Legal accrual	2,715		1,874

Distribution fees	20,778		13,049
Warranties and returns	3,564		3,682
Field service corrective action(2)	38,599		30,281
Accrued freight	16,118		17,215
Foreign exchange contracts	9,878		2,590




Accrued audit fees	4,943		5,492
Defined benefit plan	2,019		2,575

Accrued interest	680		1,431
Other	8,106		8,664
	$	325,728	$	268,215

___________________________

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


	As of
	September 30, 2024		December 31, 2023

Operating lease liability-LT	$	45,328	$	52,972
Benefits	3,909		4,207
Accrued rent	699		841




Finance lease liability-LT	2,240		1,954
Deferred revenue	10,036		10,585
Field service corrective action(1)	12,599		26,056
Other	5,578		3,882
	$	80,389	$	100,497

______________________________

(1) Primarily related to field service corrective actions associated with certain products in connection with a 2021 Warning Letter (as defined below) received by Smiths Medical from the FDA following an inspection of Smiths Medical’s Oakdale, Minnesota Facility (see Note 18: Commitments and Contingencies for further details).

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Accounts Receivable, Allowance for Credit Loss	$ 9,553	$ 11,064
Convertible preferred stock, par value	$ 1.00
Convertible preferred stock, authorized shares	500,000
Convertible preferred stock, issued shares	0	0
Convertible preferred stock, outstanding shares	0	0
Common stock, par value	$ 0.10
Common stock, shares authorized	80,000,000
Common stock, shares issued	24,461,000	24,144,000
Common stock, shares outstanding	24,459,000	24,141,000
Treasury Stock, Common, Shares	1,392	2,428

Revenue Contract Liabilities (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Movement in Deferred Revenue [Roll Forward]
Contract with Customer, Liability	$ (42,177)	$ (45,866)
Contract with Customer, Liability	(36,968)	(40,571)
Equipment revenue [Member]
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	(41,392)	(24,872)
Deferred Revenue, Additions	38,825	25,620
Software revenue [Member]
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	(23,591)	(13,546)
Deferred Revenue, Additions	24,559	12,797
Government Grant Revenue
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	(1,551)	(3,164)
Deferred Revenue, Additions	0	944
Other deferred revenue
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	(2,562)	(4,748)
Deferred Revenue, Additions	$ 503	$ 1,674

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
REVENUES:
TOTAL REVENUES	$ 589,131	$ 553,311	$ 1,752,241	$ 1,671,270
Cost of goods sold	384,279	369,391	1,154,717	1,102,982
Gross Profit	204,852	183,920	597,524	568,288
OPERATING EXPENSES:
Selling, general and administrative	162,707	148,609	479,913	452,076
Research and development	21,028	20,870	66,260	62,933
Restructuring, strategic transaction and integration	16,828	7,160	50,069	30,527
Change in fair value of contingent earn-out	(3,947)	(15,572)	(3,991)	(12,256)
TOTAL OPERATING EXPENSES	196,616	161,067	592,251	533,280
(LOSS) INCOME FROM OPERATIONS	8,236	22,853	5,273	35,008
Interest Expense,net	(24,683)	(24,175)	(72,296)	(70,811)
OTHER EXPENSE, net	(1,481)	(4,044)	(7,206)	(5,815)
Loss before income taxes	(17,928)	(5,366)	(74,229)	(41,618)
BENEFIT FOR INCOME TAXES	(15,055)	12,604	(19,631)	29,110
NET LOSS	$ (32,983)	$ 7,238	$ (93,860)	$ (12,508)
NET LOSS PER SHARE
Basic (in dollars per share)	$ (1.35)	$ 0.30	$ (3.85)	$ (0.52)
Diluted (in dollars per share)	$ (1.35)	$ 0.30	$ (3.85)	$ (0.52)
WEIGHTED AVERAGE NUMBER OF SHARES
Basic (in shares)	24,438	24,132	24,353	24,075
Diluted (in shares)	24,438	24,368	24,353	24,075

Strategic Transaction and Integration (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Restructuring and Related Activities [Abstract]
Strategic Transaction and Integration	$ 13.2	$ 6.1	$ 33.5	$ 25.4

Leases (Tables)

9 Months Ended

Sep. 30, 2024

Leases [Abstract]

Lease, Cost [Table Text Block]

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


	Three months ended September 30,				Nine months ended September 30,
	2024		2023		2024		2023
Operating lease cost	$	5,786	$	5,968	$	17,239	$	18,162
Finance lease cost — interest	45		32		126		91
Finance lease cost — reduction of ROU asset	292		279		847		757
Short-term lease cost	3		3		3		29


Total lease cost	$	6,126	$	6,282	$	18,215	$	19,039

Operating and Finance Lease Right-of-Use Assets and Lease Liabilities [Table Text Block]

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


	As of
	September 30, 2024			December 31, 2023
Operating leases
Operating lease right-of-use assets	$	59,757		$	69,909

Accrued liabilities	$	17,094		$	20,161
Other long-term liabilities	45,328			52,972
Total operating lease liabilities	$	62,422		$	73,133

Weighted-Average Remaining Lease Term
Operating leases	5.8 years			5.6 years

Weighted-Average Discount Rate
Operating leases	4.80		%	4.31		%

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


	As of
	September 30, 2024			December 31, 2023
Finance leases
Finance lease right-of-use assets	$	3,144		$	2,707

Accrued liabilities	$	1,039		$	860
Other long-term liabilities	2,240			1,954
Total finance lease liabilities	$	3,279		$	2,814

Weighted-Average Remaining Lease Term
Finance leases	3.7 years			4.1 years

Weighted-Average Discount Rate
Finance leases	5.52		%	4.93		%

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

As of September 30, 2024, the maturities of our operating and finance lease liabilities for each of the next five years and thereafter are approximately (in thousands):


	Operating Leases		Finance Leases
Remainder of 2024	$	5,885	$	301
2025	17,697		1,130
2026	13,988		981
2027	9,396		632
2028	6,863		307
2029	5,143		194
Thereafter	11,625		47
Total Lease Payments	70,597		3,592
Less imputed interest	(8,175)		(313)
Total	$	62,422	$	3,279

Supplemental Cash Flow Information - Leases

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


	Nine months ended September 30,
	2024		2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	19,175	$	18,477
Operating cash flows from finance leases	$	126	$	91

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	10,340	$	14,423
Finance leases	$	1,257	$	932

Derivative Financial Instruments Derivative Instruments and Hedging Activities - Amounts Affecting Consolidated Statements of Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Derivative Instruments, Gain (Loss) [Line Items]
Derivative, Net Hedge Ineffectiveness Gain (Loss)	$ 0	$ 0	$ 0	$ 229
Foreign Currency Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months	4,500		4,500
Interest Rate Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months, Net	11,200		11,200
Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instruments, Gain Reclassified from Accumulated OCI into Income, Effective Portion	6,917	12,079	$ 25,843	29,683
Foreign Exchange Contract \| Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]			TOTAL REVENUES
Gain on Discontinuation of Cash Flow Hedge Due to Forecasted Transaction Probable of Not Occurring	0	0	$ 0	13
Foreign Exchange Contract \| Trading Revenue \| Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	(740)	(1,019)	$ 2,073	(429)
Foreign Exchange Contract \| Cost of Sales [Member] \| Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]			Cost of goods sold
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	843	(2,247)	$ 1,497	6,063
Interest Rate Swap \| Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]			Interest Expense, Operating and Nonoperating
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	$ (7,020)	$ 8,813	$ 22,273	$ 23,807

Prepaids and Other Current Assets (Tables)

9 Months Ended

Sep. 30, 2024

Prepaid Expense and Other Assets [Abstract]

Prepaid Expenses and Other Current Assets [Table Text Block]

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


	As of
	September 30, 2024		December 31, 2023
Other prepaid expenses and receivables	$	21,054	$	17,833
Prepaid vendor expenses	1,657		1,309
Deferred costs	13,393		1,668
Prepaid insurance and property taxes	4,974		9,547
VAT/GST receivable	3,739		2,748
Deferred tax charge	6,652		5,822
Foreign exchange contracts	5,356		6,785
Interest rate contracts	10,940		23,065

Deposits	1,387		1,196
Other	4,583		3,667
	$	73,735	$	73,640

Schedule of Other Assets, Noncurrent[TableTextBlock]

Other assets consist of the following (in thousands):


	As of
	September 30, 2024		December 31, 2023
Pump lease receivables	$	25,913	$	30,627
Spare parts	50,331		46,496
Equity method investment	3,080		3,120
Deferred debt issuance costs	2,355		3,439
Finance lease right-of-use assets	3,144		2,707
Interest rate contracts	—		4,876

Other	2,014		2,755
	$	86,837	$	94,020

Transfers and Servicing (Details) - USD ($)	3 Months Ended		9 Months Ended
Transfers and Servicing (Details) - USD ($)	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Transfers and Servicing [Abstract]
Financing Receivable, Revolving	$ 150,000,000		$ 150,000,000
Trade receivables sold	86,991,000	$ 162,369,000	435,438,000	$ 452,640,000
Cash received in exchange for trade receivables sold	86,521,000	161,398,000	432,803,000	449,984,000
Loss on Sale of Accounts Receivable	469,000	$ 971,000	2,635,000	$ 2,655,000
Trade receivables derecognized, remaining to be collected	$ 27,000,000		$ 27,000,000		$ 75,900,000

Equity Method Investments (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Equity Securities without Readily Determinable Fair Value [Line Items]
Equity Method Investment, Aggregate Cost	$ 3,300
Equity Method Investments	$ 3,080	$ 3,120
Non Public Company
Equity Securities without Readily Determinable Fair Value [Line Items]
Equity Method Investment, Ownership Percentage	20.00%

This item represents the carrying amount on the entity's balance sheet of its investment in common stock of an equity method investee. This is not an indicator of the fair value of the investment, rather it is the initial cost adjusted for the entity's share of earnings and losses of the investee, adjusted for any distributions (dividends) and other than temporary impairment (OTTI) losses recognized.

Property, Plant and Equipment [Abstract]

Property and Equipment (Details) - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

Machinery and Equipment, Gross

$ 498,423

$ 483,382

Land, building and building improvements, Gross

295,267

278,251

Molds, Gross

94,436

89,573

Computer equipment and software, Gross

124,509

122,038

Furniture and Fixtures, Gross

29,135

30,662

Instruments placed with customers, Gross

127,796

115,672

Construction in Progress, Gross

111,077

117,219

Total property and equipment, cost

1,280,643

1,236,797

Accumulated depreciation

(685,016)

(623,888)

Net property and equipment

$ 595,627

$ 612,909

^[1]

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Revenue Disaggregated Revenue by Geography (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue [Line Items]
Revenues	$ 589,131	$ 553,311	$ 1,752,241	$ 1,671,270
UNITED STATES
Disaggregation of Revenue [Line Items]
Revenues	369,515	355,984	1,118,810	1,063,037
EMEA [Member]
Disaggregation of Revenue [Line Items]
Revenues	101,710	88,014	295,409	276,994
Asia Pacific
Disaggregation of Revenue [Line Items]
Revenues	60,288	59,064	173,365	177,719
Other foreign countries [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 57,618	$ 50,249	$ 164,657	$ 153,520

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.

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).

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 48
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482785/280-10-55-48

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-41

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 270
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482964/270-10-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (ee)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 5: http://fasb.org/us-gaap/role/ref/otherTransitionRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 6: http://fasb.org/us-gaap/role/ref/otherTransitionRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 7: 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 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 323
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481687/323-10-50-3

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 825
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 28
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482907/825-10-50-28

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(i))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(ii))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(iii)(A))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(iv))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(5))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(i))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iii)(A))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iii)(B))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iv))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(5))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 20: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 30
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-30

Reference 21: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-42

Reference 22: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-22

Reference 23: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 40
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-40

Reference 24: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-22

Reference 25: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
-SubTopic 235
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477314/942-235-S99-1

Reference 26: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(1))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483621/220-10-S99-2

Property, Plant and Equipment [Abstract]

DEI Document - shares	9 Months Ended
DEI Document - shares	Sep. 30, 2024	Nov. 05, 2024
Document And Entity Information [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	001-34634
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
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
Entity Shell Company	false
Title of 12(b) Security	Common stock, par value $0.10 per share
Trading Symbol	ICUI
Security Exchange Name	NASDAQ
Entity Common Stock, Shares Outstanding		24,484,266
Entity Central Index Key	0000883984
Entity Registrant Name	ICU MEDICAL INC/DE
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3

Subsequent Events (Details) $ in Millions	Sep. 30, 2024 USD ($)
Subsequent Event [Line Items]
EstimatedProceedsLLCEquityInterest	$ 200

Property and Equipment:

9 Months Ended

Sep. 30, 2024

Property and Equipment [Text Block]

Property, Plant and Equipment

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


	As of
	September 30, 2024		December 31, 2023
Machinery and equipment	$	498,423	$	483,382
Land, building and building improvements	295,267		278,251
Molds	94,436		89,573
Computer equipment and software	124,509		122,038
Furniture and fixtures	29,135		30,662
Instruments placed with customers(1)	127,796		115,672
Construction in progress	111,077		117,219
Total property, plant and equipment, cost	1,280,643		1,236,797
Accumulated depreciation	(685,016)		(623,888)
Property, plant and equipment, net	$	595,627	$	612,909

______________________________

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

Depreciation expense was $21.4 million and $66.0 million for the three and nine months ended September 30, 2024, respectively, of which $18.5 million and $57.2 million, respectively, are included in cost of goods sold, and $25.0 million and $72.8 million for the three and nine months ended September 30, 2023, respectively, of which $19.3 million and $56.2 million, respectively, are included in cost of goods sold.

Prepaids and Other Current Assets Prepaids and Other Assets (Details) - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

Prepaid Expense and Other Assets [Abstract]

Other Prepaid Expense, Current

$ 21,054

$ 17,833

Prepaid vendor expenses

1,657

1,309

Deferred Costs and Other Assets

13,393

1,668

Prepaid insurance and property taxes

4,974

9,547

Prepaid Taxes

3,739

2,748

Deferred tax charge

6,652

5,822

Deposit Assets

1,387

1,196

Other Assets, Current

4,583

3,667

Prepaid expenses and other current assets

73,735

73,640

^[1]

Prepaid Expenses and Other Current Assets [Member]

Foreign Currency Contract, Asset, Fair Value Disclosure

5,356

6,785

$ 10,940

$ 23,065

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Fair Value Measures and Disclosures (Notes)

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

Fair Value Disclosures

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. There are three levels of inputs that may be used to measure fair value:

•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 2022, we acquired Smiths Medical with a combination of cash consideration and share consideration issued at closing. Total consideration for the acquisition included a potential earn-out payment of $100.0 million in cash contingent on our common stock achieving a certain volume-weighted average price (the "Price Targets") from the closing date to either the third or fourth anniversary of closing 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. The initial fair value of the earn-out was determined 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 remeasured the earn-out liability and recognized any changes in its fair value in the Company's consolidated statements of operations. If the probability of achieving the Price Targets during their respective measurement periods was significantly greater than initially anticipated, the realization of an additional liability and related expense would have had a significant impact on the Company's consolidated financial statements in the period recognized. As of December 31, 2023, the estimated fair value of the contingent earn-out was $4.0 million. During July 2024, Smiths sold 1.2 million common shares of ICU Medical, Inc. The sale of shares when combined with other sales in

prior periods renders Smiths unable to achieve the contingent consideration based on certain price targets during the third and fourth anniversary of closing as Smiths no longer meets the required minimum beneficial ownership percentage. Accordingly, the valuation of the contingent earn-out liability as of September 30, 2024 has been reduced to zero.

In November 2021, we acquired a small foreign infusion systems supplier. Total consideration for the acquisition included 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 ended December 31, 2022 and, separately, (ii) a cash payment of $1.5 million contingent upon obtaining certain product-related regulatory certifications. 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 the fair value of the contingent earn-out was determined to be zero as the minimum threshold for earning the earn-out was not met. As of September 30, 2024, the estimated fair value of the contingent consideration related to certain product-related regulatory certifications was estimated to be $1.5 million.

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 ended September 2024. The terms of the agreement included a contingent earn-out payment. The contingent earn-out payment could not exceed $6.0 million and was to 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 during the three months ended March 31, 2024.

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

The following tables provide a reconciliation of the Level 3 earn-out liabilities measured at estimated fair value (in thousands):


	Earn-out Liability
Accrued balance, January 1, 2024	$	5,491

Change in fair value of earn-out (included in income from operations as a separate line item)(1)	295


Accrued balance, March 31, 2024	5,786
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(339)


Accrued balance, June 30, 2024	5,447
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(3,947)



Accrued balance, September 30, 2024	$	1,500


	Earn-out Liability
Accrued balance, January 1, 2023	$	25,572
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(700)

Currency translation	33
Accrued balance, March 31, 2023	24,905
Change in fair value of earn-out (included in income from operations as a separate line item)(2)	4,016
Other	11
Currency translation	1
Accrued balance, June 30, 2023	28,933
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(15,572)
Other	58
Currency translation	(58)
Accrued balance, September 30, 2023	$	13,361

_______________________________

(1) Relates to the change in fair value of our Smiths Medical earn-out.

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

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

Smiths Medical Earn-out Liability


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

Investments, Foreign Exchange Contracts and Interest Rate Contracts

As of September 30, 2024, we do not have any investment securities. Our investments historically consisted of corporate, government bonds and U.S. treasury securities. The fair value of our corporate and government bonds were 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 were 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 foreign exchange 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.

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 September 30, 2024
	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:






Foreign exchange contracts:
Prepaid expenses and other current assets	$	5,356	$	—	$	5,356	$	—
Other assets	177		—		177		—


Interest rate contracts:
Prepaid expenses and other current assets	10,940		—		10,940		—
Other assets	—		—		—		—
Total Assets	$	16,473	$	—	$	16,473	$	—

Liabilities:
Contingent earn-out liability - ST	$	1,500	$	—	$	—	$	1,500

Foreign exchange contracts:
Accrued liabilities	9,878		—		9,878		—
Other long-term liabilities	226		—		$	226	—
Interest rate swaps:
Other long-term liabilities	1,399		—		1,399		—
Total Liabilities	$	13,003	$	—	$	11,503	$	1,500


	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

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.

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 107
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482078/820-10-55-107

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 100
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482078/820-10-55-100

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(3)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-2

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2E
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-2E

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-2

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-2

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 940
-SubTopic 820
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478119/940-820-50-1

Income Taxes:	9 Months Ended
Income Taxes:	Sep. 30, 2024
Income Tax Disclosure [Abstract]
Income Tax Disclosure [Text Block]	Income Taxes Income taxes were accrued at an estimated effective tax rate of (84)% and (26)% for the three and nine months ended September 30, 2024, respectively, as compared to 235% and 70% for the three and nine months ended September 30, 2023, respectively. The effective tax rate for the three and nine months ended September 30, 2024 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, section 162(m) excess compensation, tax credits, and a valuation allowance against certain U.S. federal and state deferred tax assets and the following discrete items recognized during the interim period: •Excess tax benefit recognized on stock option exercises and the vesting of restricted stock units during the three and nine months ended September 30, 2024 of $0.8 million and $3.8 million, respectively. •Unrecognized tax benefits released as a result of the expiration of statute of limitations during the three and nine months ended September 30, 2024 of $0.0 million and $4.0 million, respectively. •U.S. federal return-to-provision adjustments net of related tax reserves for the year ended December 31, 2023 resulted in a tax expense of $1.6 million for both the three and nine months ended September 30, 2024. The adjustments related primarily to changes in estimate for the research and development credit and an increase to the U.S. valuation allowance. The Company regularly assesses the realizability of deferred tax assets and records a valuation allowance to reduce the deferred tax assets to the amount that is more likely than not to be realized. In assessing the realizability of our deferred tax assets, we weigh all available positive and negative evidence. This evidence includes, but is not limited to, historical earnings, scheduled reversal of taxable temporary differences, tax planning strategies and projected future taxable income. Due to the weight of objectively verifiable negative evidence, the Company recorded a valuation allowance of $22.4 million and $42.9 million tax expense against certain U.S. federal and state deferred tax assets during the three and nine months ended September 30, 2024, respectively. The significant piece of objectively verifiable negative evidence evaluated was the recent U.S. cumulative losses. Our ability to use our deferred tax assets depends on the amount of taxable income in future periods. Based on current earnings and anticipated future earnings along with expected changes in our deferred tax asset and liability balances, it is likely that the current valuation allowance position will be adjusted during the year. An additional valuation allowance may be required beyond the current year if future earnings are not sufficient to support the realization of deferred tax assets. In 2021, the Organization for Economic Cooperation and Development ("OECD") released model rules for a 15% global minimum tax, known as Pillar Two. On December 15, 2022, the European Union agreed to implement the OECD’s global minimum tax 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. We considered the applicable tax law changes on Pillar Two implementation in the relevant countries, and there was no material impact to our tax provision for the three and nine months ended September 30, 2024. We do not expect the provisions currently in effect for 2024 to have a material impact on our tax provision and effective tax rate for the remainder of 2024 but will continue to assess the impact of tax legislation in the jurisdictions in which we operate. The effective tax rate for the three and nine months ended September 30, 2023 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, section 162(m) excess compensation, foreign-derived intangible income ("FDII"), tax credits, and the following discrete items recognized during the interim period: •Excess tax benefit recognized on stock option exercises and the vesting of restricted stock units during the three and nine months ended September 30, 2023 of $0.6 million and $0.8 million, respectively. •Net unrecognized tax benefits resulting primarily from the expiration of statute of limitations during the three and nine months ended September 30, 2023 of $0.0 million and $6.0 million, respectively. •U.S. federal return-to-provision adjustments net of related tax reserves for the year ended December 31, 2022 resulted in a tax benefit of $7.5 million during the three and nine months ended September 30, 2023. The adjustments related primarily to changes in estimates for the research and development credit and foreign tax credits. •The revaluation of the contingent consideration during the three and nine months ended September 30, 2023 of $15.6 million and $12.3 million, respectively, resulted in a tax expense of $0.0 million for both periods.

The entire disclosure for income tax.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482685/740-10-50-12

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 231
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482663/740-10-55-231

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12C
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482685/740-10-50-12C

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12B
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482685/740-10-50-12B

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 270
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477891/740-270-50-1

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 6.I.5.Q1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479360/740-10-S99-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480990/946-20-50-13

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org/740/tableOfContent

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482685/740-10-50-14

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482685/740-10-50-21

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 17
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482685/740-10-50-17

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479360/740-10-S99-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482603/740-30-50-2

Operating Lease Right-of-Use Asset

Goodwill and Intangible Assets Text (Details) - USD ($)	3 Months Ended		9 Months Ended
Goodwill and Intangible Assets Text (Details) - USD ($)	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of Intangible Assets	$ 34,300,000	$ 33,400,000	$ 100,500,000	$ 98,800,000
Depreciation	21,400,000	$ 25,000,000	$ 66,000,000	$ 72,800,000
Cost, Amortization	$ 700,000

Leases Assets and Liabilities, Lessee (Details) - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

Leases [Abstract]

$ 59,757

$ 69,909

^[1]

Operating Lease, Liability, Current

17,094

20,161

Operating Lease, Liability, Noncurrent

45,328

52,972

Operating Lease, Liability

$ 62,422

$ 73,133

Operating Lease, Weighted Average Remaining Lease Term

5 years 9 months 18 days

5 years 7 months 6 days

Operating Lease, Weighted Average Discount Rate, Percent

4.80%

4.31%

Finance Lease, Right-of-Use Asset

$ 3,144

$ 2,707

Finance Lease, Liability, Current

1,039

860

Finance Lease, Liability, Noncurrent

2,240

1,954

Finance Lease, Liability

$ 3,279

$ 2,814

Finance Lease, Weighted Average Remaining Lease Term

3 years 8 months 12 days

4 years 1 month 6 days

Finance Lease, Weighted Average Discount Rate, Percent

5.52%

4.93%

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Fair Value Measures and Disclosures Liability Measurement Inputs (Details) - SmithsMedical	Dec. 31, 2023
Measurement Input, Price Volatility
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.4700
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

Condensed Consolidated Statements of Stockholders' Equity Statement - USD ($) $ in Thousands	Total	Common Stock Shares [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Treasury Stock, Common	Retained Earnings [Member]	AOCI Attributable to Parent [Member]
Common Stock, Shares, Issued at Dec. 31, 2022		23,995,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		172,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(53,000)
Common Stock, Shares, Issued at Mar. 31, 2023		24,114,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2022	$ 2,089,928		$ 2,399	$ 1,331,249	$ (243)	$ 837,501	$ (80,978)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	171		12	(503)	662
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(8,425)				(8,425)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	9,158			9,158
Adjustments to Additional Paid in Capital, Other				4
Other Comprehensive income (loss), net of Tax	19,375						19,375
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	19,379
Net Income Attributable to Parent	(9,812)					(9,812)
Stockholders' Equity Attributable to Parent at Mar. 31, 2023	$ 2,100,399		2,411	1,339,908	(8,006)	827,689	(61,603)
Common Stock, Shares, Issued at Dec. 31, 2022		23,995,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	(58,089)
Common Stock, Shares, Issued at Sep. 30, 2023		24,144,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2022	$ 2,089,928		2,399	1,331,249	(243)	837,501	(80,978)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Other Comprehensive income (loss), net of Tax	(3,749)
Stockholders' Equity Attributable to Parent at Sep. 30, 2023	2,098,356		2,414	1,356,348	(672)	824,993	(84,727)
Common Stock, Shares, Issued at Mar. 31, 2023		24,114,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		2,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(2,000)
Common Stock, Shares, Issued at Jun. 30, 2023		24,114,000
Stockholders' Equity Attributable to Parent at Mar. 31, 2023	2,100,399		2,411	1,339,908	(8,006)	827,689	(61,603)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	2,062		0	(4,626)	6,688
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(293)				(293)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	9,773			9,773
Adjustments to Additional Paid in Capital, Other				2
Other Comprehensive income (loss), net of Tax	12,809						12,809
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	12,811
Net Income Attributable to Parent	(9,934)					(9,934)
Stockholders' Equity Attributable to Parent at Jun. 30, 2023	2,114,818		2,411	1,345,057	(1,611)	817,755	(48,794)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		34,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(4,000)
Common Stock, Shares, Issued at Sep. 30, 2023		24,144,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	1,789		3	344	1,442
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(503)				(503)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	10,947			10,947
Other Comprehensive income (loss), net of Tax	(35,933)						(35,933)
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	(35,933)
Net Income Attributable to Parent	7,238					7,238
Stockholders' Equity Attributable to Parent at Sep. 30, 2023	$ 2,098,356		2,414	1,356,348	(672)	824,993	(84,727)
Common Stock, Shares, Issued at Dec. 31, 2023	24,144,000	24,144,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		378,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(110,000)
Common Stock, Shares, Issued at Mar. 31, 2024		24,412,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2023	$ 2,123,410		2,414	1,366,493	(262)	807,846	(53,081)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	150		27	(6,847)	6,970
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(11,400)				(11,400)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	11,598			11,598
Adjustments to Additional Paid in Capital, Other				0
Other Comprehensive income (loss), net of Tax	(16,457)						(16,457)
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	(16,457)
Net Income Attributable to Parent	(39,471)					(39,471)
Stockholders' Equity Attributable to Parent at Mar. 31, 2024	$ 2,067,830		2,441	1,371,244	(4,692)	768,375	(69,538)
Common Stock, Shares, Issued at Dec. 31, 2023	24,144,000	24,144,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	(114,023)
Common Stock, Shares, Issued at Sep. 30, 2024	24,461,000	24,461,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2023	$ 2,123,410		2,414	1,366,493	(262)	807,846	(53,081)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Other Comprehensive income (loss), net of Tax	(9,355)
Stockholders' Equity Attributable to Parent at Sep. 30, 2024	2,048,587		2,446	1,394,799	(208)	713,986	(62,436)
Common Stock, Shares, Issued at Mar. 31, 2024		24,412,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		21,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(3,000)
Common Stock, Shares, Issued at Jun. 30, 2024		24,430,000
Stockholders' Equity Attributable to Parent at Mar. 31, 2024	2,067,830		2,441	1,371,244	(4,692)	768,375	(69,538)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	2,924		2	(1,537)	4,459
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(285)				(285)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	10,998			10,998
Adjustments to Additional Paid in Capital, Other				(2)
Other Comprehensive income (loss), net of Tax	(22,247)						(22,247)
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	(22,249)
Net Income Attributable to Parent	(21,406)					(21,406)
Stockholders' Equity Attributable to Parent at Jun. 30, 2024	$ 2,037,812		2,443	1,380,703	(518)	746,969	(91,785)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		32,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(1,000)
Common Stock, Shares, Issued at Sep. 30, 2024	24,461,000	24,461,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	$ 2,809		3	2,314	492
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(182)				(182)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	11,770			11,770
Adjustments to Additional Paid in Capital, Other				12
Other Comprehensive income (loss), net of Tax	29,349						29,349
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	29,361
Net Income Attributable to Parent	(32,983)					(32,983)
Stockholders' Equity Attributable to Parent at Sep. 30, 2024	$ 2,048,587		$ 2,446	$ 1,394,799	$ (208)	$ 713,986	$ (62,436)

Goodwill and Intangible Assets Goodwill Table (Details) - USD ($)
$ in Thousands

9 Months Ended

Sep. 30, 2024

Dec. 31, 2023

^[1]

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL

$ 1,478,293

$ 1,472,446

Goodwill, Foreign Currency Translation Gain (Loss)

$ 5,847

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Amount, after accumulated impairment loss, of asset representing future economic benefit arising from other asset acquired in business combination or from joint venture formation or both, that is not individually identified and separately recognized.

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 49
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482785/280-10-55-49

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482548/350-20-55-24

Reference 3: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 100
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482078/820-10-55-100

Reference 4: http://www.xbrl.org/2003/role/exampleRef
-Topic 852
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481372/852-10-55-10

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 210
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(15))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480566/210-10-S99-1

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 45
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482598/350-20-45-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
-SubTopic 210
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-03(10)(1))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478546/942-210-S99-1

Revenue Disaggregated Revenue by Product Line (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)
Disaggregation of Revenue [Line Items]
Revenues	$ 589,131	$ 553,311	$ 1,752,241	$ 1,671,270
% Revenue to Medline	0.18	0.18	0.17	0.16
Infusion Consumables [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 264,875	$ 242,010	$ 770,730	$ 715,108
Infusion Systems [Member]
Disaggregation of Revenue [Line Items]
Revenues	159,769	148,981	480,745	463,836
Vital Care
Disaggregation of Revenue [Line Items]
Revenues	$ 164,487	$ 162,320	$ 500,766	$ 492,326

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.

Investments, Debt and Equity Securities [Abstract]

Label	Element	Value
Payment for Contingent Consideration Liability, Financing Activities	us-gaap_PaymentForContingentConsiderationLiabilityFinancingActivities	$ 0

Leases Maturity (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Leases [Abstract]
Lessee, Operating Lease, Liability, Payments, Remainder of Fiscal Year	$ 5,885
Lessee, Operating Lease, Liability, Payments, Due Next Twelve Months	17,697
Lessee, Operating Lease, Liability, Payments, Due Year Two	13,988
Lessee, Operating Lease, Liability, Payments, Due Year Three	9,396
Lessee, Operating Lease, Liability, Payments, Due Year Four	6,863
Lessee, Operating Lease, Liability, Payments, Due Year Five	5,143
Lessee, Operating Lease, Liability, Payments, Due after Year Five	11,625
Lessee, Operating Lease, Liability, Payments, Due	70,597
Lessee, Operating Lease, Liability, Undiscounted Excess Amount	(8,175)
Operating Lease, Liability	62,422	$ 73,133
Finance Lease, Liability, Payments, Remainder of Fiscal Year	301
Finance Lease, Liability, Payments, Due Next Twelve Months	1,130
Finance Lease, Liability, Payments, Due Year Two	981
Finance Lease, Liability, Payments, Due Year Three	632
Finance Lease, Liability, Payments, Due Year Four	307
Finance Lease, Liability, Payments, Due Year Five	194
Finance Lease, Liability, Payments, Due after Year Five	47
Finance Lease, Liability, Payment, Due	3,592
Finance Lease, Liability, Undiscounted Excess Amount	(313)
Finance Lease, Liability	$ 3,279	$ 2,814

Restructuring, Strategic Transaction and Integration Restructuring (Details) - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Restructuring and Related Activities [Abstract]
Restructuring, strategic transaction and integration	$ 16,800		$ 7,200	$ 50,100	$ 30,500
Restructuring Costs	3,600		$ 1,100	$ 16,600	5,100
Restructuring Reserve, Accrual Adjustment	$ 134	$ 41			$ 200

Investment Securities (Tables)

9 Months Ended

Sep. 30, 2024

Schedule of Available-for-sale Securities Reconciliation [Table Text Block]

As of September 30, 2024, we did not have any investment securities. As of December 31, 2023, the amortized cost, unrealized holding gains (losses) and fair value of our available-for-sale investment securities were as follows (in thousands):










	As of December 31, 2023
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	501	$	—	$	501

Equity Method Investments [Table Text Block]

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


	As of
	September 30, 2024		December 31, 2023
Equity method investment	$	3,080	$	3,120

Net Income Per Share (Tables)

9 Months Ended

Sep. 30, 2024

Earnings Per Share [Abstract]

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):


	Three months ended September 30,				Nine months ended September 30,
	2024		2023		2024		2023
Net (loss) income	$	(32,983)	$	7,238	$	(93,860)	$	(12,508)

Weighted-average number of common shares outstanding (basic)	24,438		24,132		24,353		24,075
Dilutive securities(1)	—		236		—		—
Weighted-average common and common equivalent shares outstanding (diluted)	24,438		24,368		24,353		24,075
EPS — basic	$	(1.35)	$	0.30	$	(3.85)	$	(0.52)
EPS — diluted	$	(1.35)	$	0.30	$	(3.85)	$	(0.52)

Total anti-dilutive stock options and restricted stock awards	89		248		112		106

_______________________________

Condensed Consolidated Balance Sheets - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

CURRENT ASSETS:

Cash and Cash Equivalents

$ 312,512

$ 254,222

^[1]

TOTAL CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENT SECURITIES

501

^[1]

312,512

254,723

^[1]

Accounts receivable, net of allowance for doubtful accounts

173,983

161,566

^[1]

Inventories

692,038

709,360

^[1]

Prepaid income taxes

5,787

21,983

^[1]

Prepaid expenses and other current assets

73,735

73,640

^[1]

TOTAL CURRENT ASSETS

1,258,055

1,221,272

^[1]

PROPERTY, PLANT AND EQUIPMENT, net

595,627

612,909

^[1]

Operating Lease Right-of-Use Asset

59,757

69,909

^[1]

GOODWILL

1,478,293

1,472,446

^[1]

INTANGIBLE ASSETS, net

785,823

870,588

^[1]

Deferred Income Taxes

40,646

37,295

OTHER ASSETS

86,837

94,020

^[1]

TOTAL ASSETS

4,305,038

4,378,439

^[1]

CURRENT LIABILITIES:

Accounts payable

168,562

150,030

^[1]

Accrued liabilities

325,728

268,215

^[1]

Current portion of long-term debt

51,000

Income tax payable

2,767

7,714

^[1]

Contingent earn-out liability

1,500

4,879

TOTAL CURRENT LIABILITIES

549,557

481,838

^[1]

Contingent Earn-Out Liability

3,991

^[1]

Long-term Debt

1,543,342

1,577,770

Other long-term liabilities

80,389

100,497

DEFERRED INCOME TAXES

48,538

55,873

^[1]

INCOME TAX LIABILITY

34,625

35,060

^[1]

COMMITMENTS AND CONTINGENCIES

^[1]

STOCKHOLDERS' EQUITY:

Convertible preferred stock, $1.00 par value Authorized-500 shares; Issued and outstanding - none

^[1]

Common stock, $0.10 par value - Authorized-80,000 shares

2,446

2,414

^[1]

Additional paid-in capital

1,394,799

1,366,493

^[1]

Treasury Stock, at cost

(208)

(262)

^[1]

Retained earnings

713,986

807,846

^[1]

TOTAL STOCKHOLDERS' EQUITY

(62,436)

(53,081)

^[1]

2,048,587

2,123,410

^[1]

TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY

$ 4,305,038

$ 4,378,439

^[1]

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Equity (Tables)

9 Months Ended

Sep. 30, 2024

Equity [Abstract]

Schedule of Accumulated Other Comprehensive Income (Loss)

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, 2024	$	(76,784)	$	21,884	$	1,819	$	(53,081)
Other comprehensive (loss) income before reclassifications	(22,817)		13,908		—		(8,909)
Amounts reclassified from AOCI	—		(7,548)		—		(7,548)
Other comprehensive (loss) income	(22,817)		6,360		—		(16,457)
Balance as of March 31, 2024	$	(99,601)	$	28,244	$	1,819	$	(69,538)
Other comprehensive (loss) income before reclassifications	(15,865)		436		—		(15,429)
Amounts reclassified from AOCI	—		(6,818)		—		(6,818)
Other comprehensive loss	(15,865)		(6,382)		—		(22,247)
Balance as of June 30, 2024	$	(115,466)	$	21,862	$	1,819	$	(91,785)
Other comprehensive income (loss) before reclassifications	49,581		(14,975)		—		34,606
Amounts reclassified from AOCI	—		(5,257)		—		(5,257)
Other comprehensive income (loss)	49,581		(20,232)		—		29,349
Balance as of September 30, 2024	$	(65,885)	$	1,630	$	1,819	$	(62,436)


	Foreign Currency Translation Adjustments		Unrealized Gains (Losses) on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2023	$	(122,973)	$	40,779	$	1,216	$	(80,978)
Other comprehensive income (loss) before reclassifications	24,983		(113)		(31)		24,839
Amounts reclassified from AOCI	—		(5,464)		—		(5,464)
Other comprehensive income (loss)	24,983		(5,577)		(31)		19,375
Balance as of March 31, 2023	$	(97,990)	$	35,202	$	1,185	$	(61,603)
Other comprehensive income (loss) before reclassifications	7,569		13,175		(34)		20,710
Amounts reclassified from AOCI	—		(7,901)		—		(7,901)
Other comprehensive income (loss)	7,569		5,274		(34)		12,809
Balance as of June 30, 2023	$	(90,421)	$	40,476	$	1,151	$	(48,794)
Other comprehensive (loss) income before reclassifications	(37,557)		10,824		(35)		(26,768)
Amounts reclassified from AOCI	—		(9,165)		—		(9,165)
Other comprehensive (loss) income	(37,557)		1,659		(35)		(35,933)
Balance as of September 30, 2023	$	(127,978)	$	42,135	$	1,116	$	(84,727)

Equity (Details) $ in Thousands	9 Months Ended
Equity (Details) $ in Thousands	Sep. 30, 2024 USD ($) shares	Sep. 30, 2023 USD ($) shares
Equity [Abstract]
Treasury Stock Purchase Plan	$ 100,000
Share Repurchase Program, Remaining Authorized, Amount	$ 100,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation \| shares	114,023	58,089
Payment, Tax Withholding, Share-based Payment Arrangement	$ (11,867)	$ (9,221)
Smiths Group Ownership % Acquisition Shares Issued	0.105
Smiths Group Ownership % Required for Board Representation	0.050

Inventories (Tables)

9 Months Ended

Sep. 30, 2024

Inventory Disclosure [Abstract]

Schedule of Inventory, Current [Table Text Block]

Inventories consist of the following (in thousands):


	As of
	September 30, 2024		December 31, 2023
Raw materials	$	291,733	$	296,037
Work in process	78,549		58,906
Finished goods	321,756		354,417
Total inventories	$	692,038	$	709,360

Accrued Liabilities (Details) - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

Operating Lease, Liability, Current

Salaries and benefits

$ 68,206

$ 52,250

Incentive compensation

53,884

37,992

17,094

20,161

Sales taxes

4,931

6,748

Restructuring accrual

10,763

3,568

UnfavorablecontractliabilityST

26,932

31,640

Accrued other taxes

6,846

3,024

Accrued Professional Fees

4,503

2,803

Accrued liability Italy payment scheme

25,169

23,176

Legal accrual

2,715

1,874

Distribution Fees

20,778

13,049

Warranties and returns

3,564

3,682

Field service corrective action

38,599

30,281

Accrued freight

16,118

17,215

Liability, Defined Benefit Plan, Current

9,878

2,590

Accrued audit fees

4,943

5,492

2,019

2,575

Interest Payable

680

1,431

Other

8,106

8,664

Accrued liabilities

325,728

268,215

^[1]

Product Liability Contingency [Line Items]

9,878

2,590

Product Liability Accrual, Component Amount

51,200

Foreign Exchange

9,878

2,590

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

$ 9,878

$ 2,590

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Fair Value Measures and Disclosures Assets and Liabilities by Balance Sheet Grouping (Details) - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

$ 0

$ 501

^[1]

Derivative Asset, Current, Statement of Financial Position [Extensible Enumeration]

$ 16,473

$ 35,900

Prepaid expenses and other current assets

Derivative Asset, Noncurrent, Statement of Financial Position [Extensible Enumeration]

OTHER ASSETS

Derivative Liability, Current, Statement of Financial Position [Extensible Enumeration]

Accrued liabilities

Derivative Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]

Other long-term liabilities

current

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Foreign Currency Contract, Asset, Fair Value Disclosure

$ 5,356

$ 6,785

Foreign Currency Contracts, Liability, Fair Value Disclosure

10,940

23,065

9,878

2,590

noncurrent

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Foreign Currency Contract, Asset, Fair Value Disclosure

177

673

Foreign Currency Contracts, Liability, Fair Value Disclosure

4,876

226

240

Interest Rate Derivative Liabilities, at Fair Value

1,399

Corporate Bond Securities

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

501

ST Earnout Liability

Earn-out liability [Member]

1,500

4,879

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Liabilities, Total [Member]

3,991

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

11,700

Prepaid Expenses and Other Current Assets [Member]

13,003

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Foreign Currency Contract, Asset, Fair Value Disclosure

5,356

6,785

Fair Value, Inputs, Level 1 [Member]

10,940

23,065

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 1 [Member] | current

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Foreign Currency Contract, Asset, Fair Value Disclosure

Foreign Currency Contracts, Liability, Fair Value Disclosure

Fair Value, Inputs, Level 1 [Member] | noncurrent

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Foreign Currency Contract, Asset, Fair Value Disclosure

Foreign Currency Contracts, Liability, Fair Value Disclosure

Interest Rate Derivative Liabilities, at Fair Value

Fair Value, Inputs, Level 1 [Member] | Corporate Bond Securities

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 1 [Member] | Earn-out liability [Member]

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 1 [Member] | ST Earnout Liability

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 1 [Member] | Liabilities, Total [Member]

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 2 [Member]

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 2 [Member] | current

16,473

35,900

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Foreign Currency Contract, Asset, Fair Value Disclosure

5,356

6,785

Foreign Currency Contracts, Liability, Fair Value Disclosure

10,940

23,065

9,878

2,590

Fair Value, Inputs, Level 2 [Member] | noncurrent

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Foreign Currency Contract, Asset, Fair Value Disclosure

177

673

Foreign Currency Contracts, Liability, Fair Value Disclosure

4,876

226

240

Interest Rate Derivative Liabilities, at Fair Value

1,399

Fair Value, Inputs, Level 2 [Member] | Corporate Bond Securities

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 2 [Member] | ST Earnout Liability

501

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 2 [Member] | Earn-out liability [Member]

3,379

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 2 [Member] | Liabilities, Total [Member]

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

6,209

Fair Value, Inputs, Level 3 [Member]

11,503

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 3 [Member] | current

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Foreign Currency Contract, Asset, Fair Value Disclosure

Foreign Currency Contracts, Liability, Fair Value Disclosure

Fair Value, Inputs, Level 3 [Member] | noncurrent

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Foreign Currency Contract, Asset, Fair Value Disclosure

Foreign Currency Contracts, Liability, Fair Value Disclosure

Interest Rate Derivative Liabilities, at Fair Value

Fair Value, Inputs, Level 3 [Member] | Corporate Bond Securities

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 3 [Member] | ST Earnout Liability

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 3 [Member] | Earn-out liability [Member]

1,500

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

Fair Value, Inputs, Level 3 [Member] | Liabilities, Total [Member]

3,991

Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]

$ 5,491

$ 1,500

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Long-Term Obligations Principal Payment (Details)	9 Months Ended
Long-Term Obligations Principal Payment (Details)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)
Debt Disclosure [Abstract]
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
Debt Instrument, Periodic Payment, Principal	$ 38,300,000	$ 22,300,000

Restructuring, Strategic Transaction and Integration Liability (Details) - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	$ 10,763	$ 9,924	$ 5,923
Restructuring Charges	3,572	7,712	5,360
Payments for Restructuring	2,777	3,678	2,944
Restructuring Reserve, Accrual Adjustment	134		41	$ 200
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	(178)	33	20
Restructuring Reserve	9,924	5,923	3,568
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	10,331	9,063	5,062
Restructuring Charges	3,385	7,712	5,065
Payments for Restructuring	2,119	3,678	2,760
Restructuring Reserve, Accrual Adjustment	134		41
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	(136)	33	13
Restructuring Reserve	9,063	5,062	2,811
Facility Closing [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	432	861	861
Restructuring Charges	187	0	295
Payments for Restructuring	658	0	184
Restructuring Reserve, Accrual Adjustment	0		0
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	(42)	0	7
Restructuring Reserve	$ 861	$ 861	$ 757

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.

Lessee, Operating Leases [Text Block]

Leases (Notes)

9 Months Ended

Sep. 30, 2024

Leases [Abstract]

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 condensed consolidated balance sheets. Our lease liabilities are included in accrued liabilities and other long-term liabilities on our condensed 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. Lease expense for minimum lease payments is recognized on a straight-line basis over the lease term.

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 because we determined the exercise of options to extend is not reasonably certain.

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


	Three months ended September 30,				Nine months ended September 30,
	2024		2023		2024		2023
Operating lease cost	$	5,786	$	5,968	$	17,239	$	18,162
Finance lease cost — interest	45		32		126		91
Finance lease cost — reduction of ROU asset	292		279		847		757
Short-term lease cost	3		3		3		29


Total lease cost	$	6,126	$	6,282	$	18,215	$	19,039

Interest expense on our finance leases is included in interest expense, net in our condensed 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 condensed consolidated statements of operations.

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


	Nine months ended September 30,
	2024		2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	19,175	$	18,477
Operating cash flows from finance leases	$	126	$	91

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	10,340	$	14,423
Finance leases	$	1,257	$	932

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


	As of
	September 30, 2024			December 31, 2023
Operating leases
Operating lease right-of-use assets	$	59,757		$	69,909

Accrued liabilities	$	17,094		$	20,161
Other long-term liabilities	45,328			52,972
Total operating lease liabilities	$	62,422		$	73,133

Weighted-Average Remaining Lease Term
Operating leases	5.8 years			5.6 years

Weighted-Average Discount Rate
Operating leases	4.80		%	4.31		%

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


	As of
	September 30, 2024			December 31, 2023
Finance leases
Finance lease right-of-use assets	$	3,144		$	2,707

Accrued liabilities	$	1,039		$	860
Other long-term liabilities	2,240			1,954
Total finance lease liabilities	$	3,279		$	2,814

Weighted-Average Remaining Lease Term
Finance leases	3.7 years			4.1 years

Weighted-Average Discount Rate
Finance leases	5.52		%	4.93		%

As of September 30, 2024, the maturities of our operating and finance lease liabilities for each of the next five years and thereafter are approximately (in thousands):


	Operating Leases		Finance Leases
Remainder of 2024	$	5,885	$	301
2025	17,697		1,130
2026	13,988		981
2027	9,396		632
2028	6,863		307
2029	5,143		194
Thereafter	11,625		47
Total Lease Payments	70,597		3,592
Less imputed interest	(8,175)		(313)
Total	$	62,422	$	3,279

Long-Term Obligations Interest Rate Terms (Details)	9 Months Ended
Long-Term Obligations Interest Rate Terms (Details)	Sep. 30, 2024
Debt Disclosure [Abstract]
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%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.25%
Maximum [Member]
Debt Disclosure [Abstract]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0025
Applicable Margin Based on Leverage Ratio [Line Items]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0025
Minimum [Member]
Debt Disclosure [Abstract]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0010
Applicable Margin Based on Leverage Ratio [Line Items]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0010
greaterthan 4to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.35%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.35%
lessthan4to1butgreaterthan3to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.30%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.30%
lessthanorequal3to1butgreaterthan2point5to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.25%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.25%
lessthanorequalto2point5to1butgreaterthan2to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.20%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.20%
lessthanorequalto2to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.15%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.15%
Term Loan A
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0075
Applicable Margin Term SOFR Loans	0.0175
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0075
Applicable Margin Term SOFR Loans	0.0175
Term Loan A \| greaterthan 4to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0125
Applicable Margin Term SOFR Loans	0.0225
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0125
Applicable Margin Term SOFR Loans	0.0225
Term Loan A \| lessthan4to1butgreaterthan3to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0100
Applicable Margin Term SOFR Loans	0.0200
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0100
Applicable Margin Term SOFR Loans	0.0200
Term Loan A \| lessthanorequal3to1butgreaterthan2point5to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0075
Applicable Margin Term SOFR Loans	0.0175
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0075
Applicable Margin Term SOFR Loans	0.0175
Term Loan A \| lessthanorequalto2point5to1butgreaterthan2to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0050
Applicable Margin Term SOFR Loans	0.0150
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0050
Applicable Margin Term SOFR Loans	0.0150
Term Loan A \| lessthanorequalto2to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0025
Applicable Margin Term SOFR Loans	0.0125
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0025
Applicable Margin Term SOFR Loans	0.0125
Term Loan B
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.015
Applicable Margin Term SOFR Loans	0.025
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.015
Applicable Margin Term SOFR Loans	0.025
Term Loan B \| greaterthan2point75to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0150
Applicable Margin Term SOFR Loans	0.0250
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0150
Applicable Margin Term SOFR Loans	0.0250
Term Loan B \| lessthan2point75to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0125
Applicable Margin Term SOFR Loans	0.0225
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0125
Applicable Margin Term SOFR Loans	0.0225

Long-Term Obligations (Details) - USD ($) $ in Thousands	9 Months Ended
Long-Term Obligations (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
TotalSeniorSecuredCreditFacility	$ 2,200,000
Long-term Debt, Gross	1,609,688
Revolver Sub limits	50,000
Debt Issuance Costs, Gross	37,800
Leverage Ratio Calculation Ceiling Subtracted Amount	500,000
Term Loan A
Debt Instrument [Line Items]
Proceeds from Issuance of Debt	850,000
Long-term Debt, Gross	780,938	$ 812,813
Debt Issuance Costs, Gross	15,800
Long-term Debt	$ 834,200
Debt Instrument, Maturity Date	Jan. 06, 2027
Term Loan B
Debt Instrument [Line Items]
Proceeds from Issuance of Debt	$ 850,000
Long-term Debt, Gross	828,750	$ 835,125
Debt Issuance Costs, Gross	13,400
Long-term Debt	$ 836,600
Debt Instrument, Maturity Date	Jan. 06, 2029
Revolving Credit Facility
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 500,000
Debt Issuance Costs, Gross	$ 8,600

Revenue Deferred Revenue by Arrangement (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Short Term
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ 26,932
Short Term \| Equipment revenue [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	14,641
Short Term \| Software revenue [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	10,185
Short Term \| Government Grant Revenue
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	2,064
Short Term \| Other deferred revenue
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	42
Long Term
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	10,036
Long Term \| Equipment revenue [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	1,713
Long Term \| Software revenue [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	459
Long Term \| Government Grant Revenue
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	7,864
Long Term \| Other deferred revenue
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ 0

Net Income Per Share (Details 1) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share [Abstract]
Net Loss	$ (32,983)	$ 7,238	$ (93,860)	$ (12,508)
Basic (in shares)	24,438	24,132	24,353	24,075
Dilutive securities	0	236	0	0
Diluted (in shares)	24,438	24,368	24,353	24,075
Basic (in dollars per share)	$ (1.35)	$ 0.30	$ (3.85)	$ (0.52)
Diluted (in dollars per share)	$ (1.35)	$ 0.30	$ (3.85)	$ (0.52)
Total anti-dilutive stock options and restricted stock awards	89	248	112	106

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

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.

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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-6

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-9

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 805
-SubTopic 60
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476176/805-60-65-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 323
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(3)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478666/740-323-65-2

Reference 5: 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 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 323
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481687/323-10-50-3

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 825
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 28
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482907/825-10-50-28

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 815
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480175/815-40-65-1

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 8
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-8

Reference 11: http://www.xbrl.org/2003/role/exampleRef
-Topic 946
-SubTopic 830
-Name Accounting Standards Codification
-Section 55
-Paragraph 11
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479168/946-830-55-11

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 205
-Name Accounting Standards Codification
-Section 45
-Paragraph 3
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478009/946-205-45-3

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section 45
-Paragraph 7
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479105/946-220-45-7

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(16))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477250/944-220-S99-1

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.6-07(9))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479134/946-220-S99-1

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 3
-Subparagraph (SX 210.6-09(1)(d))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479134/946-220-S99-3

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 810
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 19
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481231/810-10-45-19

Reference 18: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482765/220-10-50-6

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(i))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 20: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(ii))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 21: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(iii)(A))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 22: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(iv))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 23: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(5))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1A

Reference 24: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(i))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 25: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iii)(A))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 26: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iii)(B))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 27: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iv))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 28: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(5))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 29: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
-SubTopic 235
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477314/942-235-S99-1

Reference 30: http://www.xbrl.org/2003/role/disclosureRef
-Topic 205
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 7
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483499/205-20-50-7

Reference 31: http://www.xbrl.org/2003/role/exampleRef
-Topic 810
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 4J
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481175/810-10-55-4J

Reference 32: http://www.xbrl.org/2003/role/exampleRef
-Topic 810
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 4K
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481175/810-10-55-4K

Reference 33: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 1A
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482790/220-10-45-1A

Reference 34: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 1B
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482790/220-10-45-1B

Reference 35: http://www.xbrl.org/2003/role/disclosureRef
-Topic 230
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482740/230-10-45-2

Reference 36: http://www.xbrl.org/2003/role/disclosureRef
-Topic 810
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Subparagraph (a)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481203/810-10-50-1A

Reference 37: http://www.xbrl.org/2003/role/disclosureRef
-Topic 810
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Subparagraph (c)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481203/810-10-50-1A

Property, Plant and Equipment [Abstract]

Collaborative and Other Arrangements (Notes)	9 Months Ended
Collaborative and Other Arrangements (Notes)	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [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 would 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.

Property and Equipment (Tables)

9 Months Ended

Sep. 30, 2024

Property, Plant and Equipment [Table Text Block]

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


	As of
	September 30, 2024		December 31, 2023
Machinery and equipment	$	498,423	$	483,382
Land, building and building improvements	295,267		278,251
Molds	94,436		89,573
Computer equipment and software	124,509		122,038
Furniture and fixtures	29,135		30,662
Instruments placed with customers(1)	127,796		115,672
Construction in progress	111,077		117,219
Total property, plant and equipment, cost	1,280,643		1,236,797
Accumulated depreciation	(685,016)		(623,888)
Property, plant and equipment, net	$	595,627	$	612,909

Commitments and Contingencies Contingency (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2024	Jan. 06, 2022
Business Acquisition, Contingent Consideration [Line Items]
Contingent Consideration, Gross ST		$ 1,000
Contingent Consideration, Gross LT		1,500
Business Combination, Contingent Consideration, Liability	$ 3,900	3,900
Product Liability Accrual, Component Amount	51,200	51,200
Loss Contingency Accrual, Provision	800	5,200
SmithsMedical
Business Acquisition, Contingent Consideration [Line Items]
contingent consideration gross		100,000
Business Combination, Contingent Consideration, Liability			$ 53,500
Product Liability Accrual, Component Amount	43,900	43,900	$ 55,100
Foreign Infusion System Supplier
Business Acquisition, Contingent Consideration [Line Items]
contingent consideration gross		2,500
Business Combination, Contingent Consideration, Liability	$ 1,500	1,500
International Distributor
Business Acquisition, Contingent Consideration [Line Items]
contingent consideration gross		$ 6,000

Goodwill and Intangible Assets (Tables)

9 Months Ended

Sep. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Goodwill [Table Text Block]

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


	Total
Balance as of January 1, 2024	$	1,472,446


Currency translation	5,847
Balance as of September 30, 2024	$	1,478,293

Schedule of Intangible Assets and Goodwill [Table Text Block]

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


	Weighted-Average Amortization Life in Years	September 30, 2024
		Cost		Accumulated Amortization		Net
Patents	10	$	35,880	$	22,320	$	13,560
Customer contracts	12	9,928		6,958		2,970
Non-contractual customer relationships	8	562,067		225,145		336,922
Trademarks	1	5,425		5,425		—
Trade name	15	18,254		8,070		10,184
Developed technology	10	625,128		213,734		411,394
Non-compete	3	9,100		9,100		—
Total amortized intangible assets		$	1,265,782	$	490,752	$	775,030

Internally developed software(1)		$	10,793			$	10,793

Total intangible assets		$	1,276,575	$	490,752	$	785,823

______________________________

(1) 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, 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(1)		$	38,320			$	38,320

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

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

As of September 30, 2024 estimated annual amortization for our intangible assets for each of the next five years and thereafter is approximately (in thousands):


Remainder of 2024	$	34,116
2025	132,064
2026	129,927
2027	119,765
2028	119,167
2029	116,077
Thereafter	123,914
Total	$	775,030

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482548/350-20-55-24

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1A

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-2

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
CASH FLOWS FROM OPERATING ACTIVITIES:
Net Loss	$ (93,860)	$ (12,508)
Depreciation and amortization	166,519	171,615
Noncash lease expense	16,008	16,543
Provision for doubtful accounts	1,381	865
Provision for warranty and returns and field action	1,801	5,597
Stock compensation	34,366	29,878
(Gain) loss on disposal of property and equipment	184	1,757
Debt Issuance Costs amortization	5,111	5,108
Change in fair value of contingent earn-out	(3,991)	(12,256)
Usage of spare parts	13,965	13,587
Other	7,256	4,407
Accounts receivable	(11,517)	43,086
Inventories	9,416	(66,662)
Prepaid expenses and other current assets	(11,188)	11,295
Other Assets	(17,540)	(18,860)
Accounts payable	21,086	(65,049)
Accrued liabilities	20,484	(10,532)
Income taxes, including excess tax benefits and deferred income taxes	4,360	(42,939)
Net cash provided by operating activities	163,841	74,932
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property, plant and equipment	(55,292)	(53,956)
Proceeds from sale of asset	695	1,481
Intangible assets additions	(8,317)	(7,742)
Proceeds from sale of investment securities	500	2,920
Net cash used in investing activities	(62,414)	(57,297)
CASH FLOWS FROM FINANCING ACTIVITIES:
Repayments of Long-term Debt	38,250	22,250
Proceeds from exercise of stock options	5,883	4,022
Payments on finance leases	(775)	(681)
Payment for Contingent Consideration Liability, Financing Activities	(2,600)
Payment, Tax Withholding, Share-based Payment Arrangement	11,867	9,221
Net cash used in by financing activities	(47,609)	(28,130)
Effect of Exchange Rate on Cash [Abstract]
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Continuing Operations	4,472	(1,097)
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect	58,290	(11,592)
Cash and Cash Equivalents	312,512	197,192
Supplemental Cash Flow Information [Abstract]
Capital Expenditures Incurred but Not yet Paid	$ 4,022	$ 3,712

Other Assets Noncurrent(Details) - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

Lessor, Operating Lease, Payments to be Received

$ 177

$ 5,549

25,913

30,627

Spare parts

50,331

46,496

Equity Method Investments

3,080

3,120

Debt Issuance Costs, Noncurrent, Net

2,355

3,439

Finance Lease, Right-of-Use Asset

3,144

2,707

Other Assets, Miscellaneous, Noncurrent

177

5,549

2,014

2,755

OTHER ASSETS

86,837

94,020

^[1]

Interest Rate Swap

4,876

$ 0

$ 4,876

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Derivative Financial Instruments Derivative Instruments and Hedging Activities - Cash Flow Hedge Activity Included in Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	$ (19,743)	$ 14,253	$ (864)	$ 31,496
Foreign Exchange Contract
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	(5,713)	1,757	(4,738)	10,260
Interest Rate Swap
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	$ (14,030)	$ 12,496	$ 3,874	$ 21,236

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

Inventory, Raw Materials, Net of Reserves

Property and Equipment Text (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Property, Plant and Equipment [Abstract]
Depreciation	$ 21.4	$ 25.0	$ 66.0	$ 72.8
Cost, Depreciation	$ 18.5	$ 19.3	$ 57.2	$ 56.2

Investment Securities (Details) $ in Millions	9 Months Ended
Investment Securities (Details) $ in Millions	Sep. 30, 2024 USD ($)
Investments, Debt and Equity Securities [Abstract]
Gain (Loss) on Sale of Investments	$ 0

Long-Term Obligations Interest Expense (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Debt Disclosure [Abstract]
Interest Expense, Debt, Excluding Amortization	$ 32,059,000	$ 32,494,000	$ 96,186,000	$ 92,593,000
Amortization of Debt Issuance Costs and Discounts	1,700,000	1,704,000	5,111,000	5,108,000
Line of Credit Facility, Commitment Fee Amount	384,000	384,000	1,141,000	1,135,000
Interest Expense, Debt	$ 34,143,000	$ 34,582,000	$ 102,438,000	$ 98,836,000

Long-Term Obligations Table (Details) - USD ($)	9 Months Ended	12 Months Ended
Long-Term Obligations Table (Details) - USD ($)	Sep. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 1,609,688,000
Line of Credit Facility, Fair Value of Amount Outstanding	0	$ 0
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	(15,346,000)	(19,168,000)
Debt, Long-term and Short-term, Combined Amount	1,594,342,000	1,628,770,000
Debt, Current	51,000,000	51,000,000
Long-term Debt	1,543,342,000	$ 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%	0.00%
Term Loan A
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 780,938,000	$ 812,813,000
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	$ 6,900,000
Debt Instrument, Interest Rate During Period	8.22%	7.67%
Term Loan B
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 828,750,000	$ 835,125,000
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	$ 8,400,000
Debt Instrument, Interest Rate During Period	8.57%	8.00%

Income Taxes Effective tax rate (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Business Acquisition, Contingent Consideration [Line Items]
Change in fair value of contingent earn-out	$ (3,947)	$ (15,572)	$ (3,991)	$ (12,256)
ReturntoProvision	1,600	7,500	1,600	7,500
contingent consideration, tax expense		0		0
Share-based Payment Arrangement, Expense, Tax Benefit	800	600	3,800	800
Valuation Allowance, Deferred Tax Asset, Increase (Decrease), Amount	22,400		42,900
Unrecognized Tax Benefits, Reduction Resulting from Lapse of Applicable Statute of Limitations	$ 0	$ 0	$ 4,000	$ 6,000
Effective Income Tax Rate	(84.00%)	235.00%	(26.00%)	70.00%
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent			21.00%	21.00%
ReturntoProvision	$ 1,600	$ 7,500	$ 1,600	$ 7,500
SmithsMedical
Business Acquisition, Contingent Consideration [Line Items]
Change in fair value of contingent earn-out		$ 15,600		$ 12,300

Commitments and Contingencies:	9 Months Ended
Commitments and Contingencies:	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies [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 or other matters related to sales of our products. There is no maximum limit on the indemnification that may be required under these agreements. Although we can provide no assurances, we have never incurred, nor do we expect to incur, any material liability for indemnification. Contingencies In January 2022, we acquired Smiths Medical. Total consideration for the acquisition included a potential earn-out payment of $100.0 million in cash contingent on our common stock achieving the Price Targets from the closing date to either the third or fourth anniversary of closing and provided Smiths beneficially owned at least 50.0% of the shares of common stock issued at closing at the time the Price Target is achieved. As of June 30, 2024, the estimated fair value of the contingent earn-out was $3.9 million (see Note 8: Fair Value Measurements). During July 2024, Smiths sold 1.2 million common shares of ICU Medical, Inc. which were issued as partial consideration for the 2022 acquisition of Smiths Medical. The sale of shares when combined with other sales in prior periods renders Smiths unable to achieve the contingent consideration based on certain price targets during the third and fourth anniversary of closing as Smiths no longer meets the required minimum beneficial ownership percentage. Accordingly, the valuation of the contingent earn-out liability as of September 30, 2024 has been reduced to zero. 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 "2021 Warning Letter"). The 2021 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 in the amount of $55.1 million. 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 three and nine months ended September 30, 2024, we recorded a provision of $0.8 million and a net reversal to the provision of $5.2 million, respectively, to adjust the estimated cost to complete the field corrective actions to the amounts expected to be incurred based on historical experience. As of September 30, 2024, approximately $43.9 million of the $51.2 million of accrued field service corrective action recorded was related to the 2021 Warning Letter. In November 2021, we acquired a small foreign infusion systems supplier. Total consideration for the acquisition included 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 ended December 31, 2022 and, separately, (ii) a cash payment of $1.5 million contingent upon obtaining certain product-related regulatory certifications. As of December 31, 2022, the measurement period related to (i) above ended and based on the actual revenue achieved during the measurement period we determined that the fair value of the contingent earn-out was zero as the minimum threshold for earning the earn-out was not met. As of September 30, 2024, the estimated fair value of the contingent earn-out related to certain product-related regulatory certification was estimated to be $1.5 million (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 ended September 2024. The terms of the agreement included a contingent earn-out payment. The contingent earn-out could not exceed $6.0 million, and was to 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 during the three months ended March 31, 2024 (see Note 8: Fair Value Measurements). In 2015, legislation was enacted in Italy which requires medical device companies to make payments to the Italian government if Italy's medical device expenditures for certain years exceeded annual regional expenditure ceilings. Since its enactment, the legislation has been subject to appeals in the Italy court system. In the third quarter of 2024, Italy's Constitutional Court issued two judgments, one of which confirmed the legitimacy of the legislation on the Italy Medical Device Payback ("IMDP"). However, litigation proceedings are still pending and the ultimate resolution remains unknown. The timing and amount of payments could ultimately differ from our current expectations (see Note 14: Accrued Liabilities and Other Long-Term Liabilities for details on amounts accrued for potential payments related to the IMDP). Commitments We have non-cancelable operating lease agreements where we are contractually obligated to pay certain lease payment amounts (see Note 5: Leases).

Inventories (Details) - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

Inventory Disclosure [Abstract]

$ 291,733

$ 296,037

Inventory, Work in Process, Net of Reserves

78,549

58,906

Inventory, Finished Goods, Net of Reserves

321,756

354,417

Total

$ 692,038

$ 709,360

^[1]

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Goodwill and Intangible Assets Intangibles Table (Details) - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

Finite-Lived Intangible Assets, Accumulated Amortization

$ 1,265,782

$ 1,218,889

490,752

386,621

Indefinite-lived Intangible Assets (Excluding Goodwill)

775,030

832,268

10,793

38,320

Intangible Assets, Gross (Excluding Goodwill)

1,276,575

1,257,209

INTANGIBLE ASSETS, net

$ 785,823

$ 870,588

^[1]

Patents [Member]

10 years

Finite-Lived Intangible Assets, Accumulated Amortization

$ 35,880

$ 33,261

22,320

20,637

Customer Contracts [Member]

$ 13,560

$ 12,624

12 years

Finite-Lived Intangible Assets, Accumulated Amortization

$ 9,928

$ 10,018

6,958

6,755

$ 2,970

$ 3,263

8 years

Finite-Lived Intangible Assets, Accumulated Amortization

$ 562,067

$ 554,982

225,145

171,279

$ 336,922

$ 383,703

Trademarks [Member]

1 year

Finite-Lived Intangible Assets, Accumulated Amortization

$ 5,425

5,425

$ 0

Trade Names [Member]

15 years

Finite-Lived Intangible Assets, Accumulated Amortization

$ 18,254

$ 18,251

8,070

7,162

Developed Technology Rights [Member]

$ 10,184

$ 11,089

10 years

Finite-Lived Intangible Assets, Accumulated Amortization

$ 625,128

$ 587,852

213,734

167,913

Noncompete Agreements [Member]

$ 411,394

$ 419,939

3 years

Finite-Lived Intangible Assets, Accumulated Amortization

$ 9,100

9,100

7,450

$ 0

$ 1,650

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

Inventories:

9 Months Ended

Sep. 30, 2024

Inventory Disclosure [Abstract]

Inventories [Text Block]

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
	September 30, 2024		December 31, 2023
Raw materials	$	291,733	$	296,037
Work in process	78,549		58,906
Finished goods	321,756		354,417
Total inventories	$	692,038	$	709,360

Subsequent Events	9 Months Ended
Subsequent Events	Sep. 30, 2024
Subsequent Events [Abstract]
Subsequent Events	Subsequent Event On November 12, 2024, the Company and ICU Medical Sales, Inc., a Delaware corporation (collectively, the "ICU Medical Entities") entered into a purchase agreement (the "Agreement") with Otsuka Pharmaceutical Factory America, Inc., a Delaware corporation ("OPF"). Pursuant to the Agreement, prior to the closing, the ICU Medical Entities will form a Delaware limited liability company (the "LLC") and the ICU Medical Entities, and the LLC shall enter into a contribution agreement under which the ICU Medical Entities shall transfer the assets, liabilities and operations that comprise the IV Solutions product line to the LLC. At the closing, OPF will acquire a 60% equity interest in the LLC from the ICU Medical Entities. Pursuant to the Agreement, the consideration receivable by the ICU Medical Entities is comprised of (a) estimated cash consideration of approximately $200 million at closing and (b) a milestone payment paid by OPF to the Company for any incremental revenue and incremental gross profit recognized by the LLC, as calculated under the terms of the Agreement upon the final determination of the LLC's audited financial statements for the year-ending and as of December 31, 2026. Additionally, at closing, the LLC, ICU Medical Entities and OPF shall enter into an operating agreement, and the LLC and the Company shall enter into one or more commercial agreements, a services agreement and a license agreement, which will provide for, among other things, certain administrative, marketing, distribution, sales support and logistic services to the LLC for a specified period of time. The transaction is expected to be completed during the first half of 2025. The Company cannot currently estimate the financial effect this transaction will have on its condensed consolidated financial statements.

Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Net Loss	$ (32,983)	$ 7,238	$ (93,860)	$ (12,508)
Other comprehensive income (loss), net of tax
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), after Reclassification and Tax	(20,232)	1,659	(20,254)	1,356
Foreign currency translation adjustment, net of taxes of $0 for all periods	49,581	(37,557)	10,899	(5,005)
Other Comprehensive Income (Loss), Other Adjustments, after Tax	0	(35)	0	(100)
Other comprehensive income (loss), net of taxes	29,349	(35,933)	(9,355)	(3,749)
Comprehensive Income	$ (3,634)	$ (28,695)	$ (103,215)	$ (16,257)

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

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

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-SubTopic 10
-Topic 505
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-2

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-6

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 830
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481674/830-30-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 830
-SubTopic 30
-Name Accounting Standards Codification
-Section 45
-Paragraph 17
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481694/830-30-45-17

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(19))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477250/944-220-S99-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482765/220-10-50-4

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 5
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482765/220-10-50-5

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 830
-SubTopic 30
-Name Accounting Standards Codification
-Section 45
-Paragraph 20
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481694/830-30-45-20

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(21))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483621/220-10-S99-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(23))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478524/942-220-S99-1

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 1B
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482790/220-10-45-1B

Reference 12: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Section 55
-Paragraph 15
-SubTopic 10
-Topic 220
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482739/220-10-55-15

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 1A
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482790/220-10-45-1A

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

New Accounting Pronouncements:	9 Months Ended
New Accounting Pronouncements:	Sep. 30, 2024
Accounting Standards Update and Change in Accounting Principle [Abstract]
New Accounting Pronouncements and Changes in Accounting Principles [Text Block]	New Accounting Pronouncements Recently Issued Accounting Standards Not Yet Adopted 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. We are currently assessing the effect of this update on the Company's 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 the Company's consolidated financial statements and related disclosures.

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.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476173/280-10-65-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)(4)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 105
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 7
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479343/105-10-65-7

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 805
-SubTopic 60
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476176/805-60-65-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 848
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483550/848-10-65-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 323
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478666/740-323-65-2

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 323
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(4)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478666/740-323-65-2

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 323
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478666/740-323-65-2

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 848
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (d)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483550/848-10-65-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 848
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (e)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483550/848-10-65-1

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(2)(i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480016/944-40-65-2

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(2)(ii)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480016/944-40-65-2

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(2)(iii)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480016/944-40-65-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(2)(iv)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480016/944-40-65-2

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (h)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480016/944-40-65-2

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 5
-Subparagraph (SAB Topic 11.M.Q2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480530/250-10-S99-5

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 815
-SubTopic 20
-Name Accounting Standards Codification
-Section 65
-Paragraph 6
-Subparagraph (i)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480528/815-20-65-6

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-1

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 326
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 4
-Subparagraph (e)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479654/326-10-65-4

Reference 20: http://www.xbrl.org/2003/role/disclosureRef
-Topic 326
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 4
-Subparagraph (e)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479654/326-10-65-4

Reference 21: http://www.xbrl.org/2003/role/disclosureRef
-Topic 926
-SubTopic 20
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (f)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483194/926-20-65-2

Reference 22: http://www.xbrl.org/2003/role/disclosureRef
-Topic 926
-SubTopic 20
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (f)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483194/926-20-65-2

Reference 23: http://www.xbrl.org/2003/role/disclosureRef
-Topic 926
-SubTopic 20
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (f)(3)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483194/926-20-65-2

Reference 24: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480530/250-10-S99-6

Reference 25: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (c)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-1

Reference 26: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-1

Reference 27: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Topic 250
-Publisher FASB
-URI https://asc.fasb.org/250/tableOfContent

Reference 28: http://www.xbrl.org/2003/role/disclosureRef
-Topic 815
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (e)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480175/815-40-65-1

Investments, Debt and Equity Securities [Abstract]

Investment Securities (Notes)

9 Months Ended

Sep. 30, 2024

investments in Debt and Marketable Equity Securities and Equity Method Investments [Text Block]

Investment Securities

Investments in Available-for-sale Securities

Our available-for-sale investment securities historically consisted of corporate bonds, government bonds and U.S. treasury securities and were considered “investment grade” and were carried at fair value.










	As of December 31, 2023
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	501	$	—	$	501

The amortized cost of the debt securities are adjusted for the amortization of premiums computed under the effective interest method. Such amortization is included in interest expense, net in our condensed consolidated statements of operations.

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 amortized cost basis 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.

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. All short-term investment securities are callable within one year.

Investments in Non-Marketable Equity Securities

We own approximately 20% non-marketable equity interest in a nonpublic company and entered into a three-year distribution agreement where we have the exclusive rights to market, sell and distribute the company's products in exchange for a cash payment of $3.3 million. In addition, we were granted an exclusive license for all of the seller's intellectual property. At the expiration of the distribution agreement we have the right but not the obligation to acquire the remaining interest in the business.

We apply the equity method of accounting for investments when we determine we have a significant influence, but not a controlling interest in the investee. We determine whether we have significant influence by considering key factors such as ownership interest, representation on the board of directors, participation in policy making decisions, business relationship and material intra-entity transactions, among other factors. Our equity method investment is reported at cost and adjusted each period for our share of the investee's income or (loss) and dividend paid, if any. We eliminate any intra-entity profits to the extent of our beneficial interest. We report our proportionate share of the investee's income or (loss) resulting from this investment in other income, net in our condensed consolidated statements of operations. The carrying value of our equity method investment is reported in other assets on our condensed consolidated balance sheets (see Note 10: Prepaid Expenses and Other Current Assets and Other Assets). 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. Our recorded share of the investee's loss was not material for the three and nine months ended September 30, 2024 and 2023. We did not receive any dividend distributions from this investment during the three and nine months ended September 30, 2024 and 2023.

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


	As of
	September 30, 2024		December 31, 2023
Equity method investment	$	3,080	$	3,120

Restructuring, Strategic Transaction and Integration (Notes)

9 Months Ended

Sep. 30, 2024

Restructuring and Related Activities [Abstract]

Restructuring and Related Activities Disclosure

Restructuring, Strategic Transaction and Integration

Restructuring, strategic transaction and integration expenses were $16.8 million and $50.1 million for the three and nine months ended September 30, 2024, respectively, as compared to $7.2 million and $30.5 million for the three and nine months ended September 30, 2023, respectively.

Restructuring

During the three and nine months ended September 30, 2024, restructuring charges were $3.6 million and $16.6 million, respectively, as compared to $1.1 million and $5.1 million, respectively, for the three and nine months ended September 30, 2023 and were primarily related to severance costs for all periods. The restructuring charges for the three and nine months ended September 30, 2023 are net of $0.2 million related to facility closures costs that were reversed in the third quarter of 2023.


	Severance Pay and Benefits		Retention and Facility Closure Costs		Total
Accrued balance, January 1, 2024	$	2,811	$	757	$	3,568

Charges incurred	5,065		295		5,360
Payments	(2,760)		(184)		(2,944)
Other(1)	(41)		—		(41)
Currency translation	(13)		(7)		(20)
Accrued balance, March 31, 2024	$	5,062	$	861	$	5,923
Charges incurred	7,712		—		7,712
Payments	(3,678)		—		(3,678)
Currency translation	(33)		—		(33)

Accrued balance, June 30, 2024	$	9,063	$	861	$	9,924
Charges incurred	3,385		187		3,572
Payments	(2,119)		(658)		(2,777)
Other(2)	(134)		—		(134)
Currency translation	136		42		178
Accrued balance, September 30, 2024	$	10,331	$	432	$	10,763

__________________________

(1) Relates to prior year accrued restructuring charges for estimated severances costs that will not be utilized and were reversed during the three months ended March 31, 2024.

(2) Relates to prior year accrued restructuring charges for estimated severances costs that will not be utilized and were reversed during the three months ended September 30, 2024.

Strategic Transaction and Integration Expenses

We incurred and expensed $13.2 million and $33.5 million in strategic transaction and integration expenses during the three and nine months ended September 30, 2024, respectively, as compared to $6.1 million and $25.4 million in strategic transaction and integration expenses during the three and nine months ended September 30, 2023, respectively, which are included in restructuring, strategic transaction and integration expenses in our condensed consolidated statements of operations. The strategic transaction and integration expenses during the three and nine months ended September 30, 2024 and 2023 were primarily related to consulting expenses and employee costs incurred to integrate our Smiths Medical business acquired in 2022.

Related-party Transition Services Expenses

Smiths Group plc ("Smiths") became a related party to us when we issued 2.5 million shares of our common stock as partial consideration to Smiths for the acquisition of Smiths Medical 2020 Limited ("Smiths Medical"). Additionally, we entered into a transition services agreement ("TSA") with certain Smiths legal entities. The TSA included certain information technology, human resource and tax support services for an initial term of twelve months with the option to extend up to 24 months. During the three and nine months ended September 30, 2023, we expensed $0.3 million and $8.3 million, respectively, for services provided by Smiths under the TSA. Since December 31, 2023, there were no services being provided under the TSA and we had no remaining related-party open payables as of December 31, 2023.

Equity Accumulated Other Comprehensive Income (Loss) (Details) - USD ($)
$ in Thousands

3 Months Ended

9 Months Ended

Sep. 30, 2024

Jun. 30, 2024

Mar. 31, 2024

Sep. 30, 2023

Jun. 30, 2023

Mar. 31, 2023

Sep. 30, 2024

Sep. 30, 2023

Dec. 31, 2023

Dec. 31, 2022

Accumulated Other Comprehensive Income (Loss) [Line Items]

Other Comprehensive Income (Loss), before Reclassifications, Net of Tax

$ (62,436)

$ (91,785)

$ (69,538)

$ (84,727)

$ (48,794)

$ (61,603)

$ (62,436)

$ (84,727)

$ (53,081)

^[1]

$ (80,978)

34,606

(15,429)

(8,909)

(26,768)

20,710

24,839

Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax

(5,257)

(6,818)

(7,548)

(9,165)

(7,901)

(5,464)

Accumulated Foreign Currency Adjustment Attributable to Parent [Member]

29,349

(22,247)

(16,457)

(35,933)

12,809

19,375

(9,355)

(3,749)

Accumulated Other Comprehensive Income (Loss) [Line Items]

Other Comprehensive Income (Loss), before Reclassifications, Net of Tax

(65,885)

(115,466)

(99,601)

(127,978)

(90,421)

(97,990)

(65,885)

(127,978)

(76,784)

(122,973)

49,581

(15,865)

(22,817)

(37,557)

7,569

24,983

Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax

Accumulated Net Gain (Loss) from Cash Flow Hedges Attributable to Parent [Member]

49,581

(15,865)

(22,817)

(37,557)

7,569

24,983

Accumulated Other Comprehensive Income (Loss) [Line Items]

Other Comprehensive Income (Loss), before Reclassifications, Net of Tax

1,630

21,862

28,244

42,135

40,476

35,202

1,630

42,135

21,884

40,779

(14,975)

436

13,908

10,824

13,175

(113)

Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax

(5,257)

(6,818)

(7,548)

(9,165)

(7,901)

(5,464)

Accumulated Defined Benefit Plans Adjustment Attributable to Parent [Member]

(20,232)

(6,382)

6,360

1,659

5,274

(5,577)

Accumulated Other Comprehensive Income (Loss) [Line Items]

Other Comprehensive Income (Loss), before Reclassifications, Net of Tax

1,819

1,116

1,151

1,185

$ 1,819

$ 1,116

$ 1,819

$ 1,216

(35)

(34)

(31)

Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax

Other Comprehensive (Income) Loss, Defined Benefit Plan, after Tax and Reclassification Adjustment, Attributable to Parent

$ 0

$ (35)

$ (34)

$ (31)

$ 0

[1]	December 31, 2023 balances were derived from audited consolidated financial statements.

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.

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

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

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

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