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Long-Term Debt (Tables)
 12 Months Ended
Dec. 31, 2024
Debt Disclosure [Abstract]  
Long-term Debt
Long-term debt comprised the following: 
 December 31,As of December 31, 2024
 20242023Maturity dateInterest rate
Estimated fair value(1)
Senior Secured Credit Facilities:  
Term Loan A-1$2,259,295 $1,234,375 4/28/2028
Base +1.75%(2)
$2,256,471 
Term Loan B-1— 2,603,786 $— 
Extended Term Loan B-11,636,150 5/9/2031SOFR + 2.00%$1,638,195 
Revolving line of credit— — 4/28/2028
Base +1.75%(2)
$— 
Senior Notes:
4.625% Senior Notes2,750,000 2,750,000 6/1/20304.625 %$2,533,438 
3.75% Senior Notes1,500,000 1,500,000 2/15/20313.75 %$1,301,250 
6.875% Senior Notes1,000,000 9/1/20326.875 %$1,007,500 
Acquisition obligations and other notes payable(3)
56,483 102,328 2025-20385.58 %$56,483 
Financing lease obligations(4)
216,401 255,491 2025-20394.58 %
CHC temporary funding assistance(5)
92,777 — %$92,777 
Total debt principal outstanding9,511,106 8,445,980 
Discount, premium and deferred financing costs(6)
(64,336)(54,347)
 9,446,770 8,391,633 
Less current portion(270,867)(123,299)
 $9,175,903 $8,268,334 
(1)For the Company's senior secured credit facilities, fair value estimates are based on bid and ask quotes, a level 2 input. For the Company's senior notes, fair value estimates are based on market level 1 inputs. For acquisition obligations and other notes payable, the carrying values presented here approximate their estimated fair values, based on estimates of their present values typically using level 2 interest rate inputs. For the CHC temporary funding assistance, the carrying value presented here approximates the estimated fair value based on the short-term nature of settlement.
(2)The Company's senior secured credit facilities bear interest at Term SOFR, plus an interest rate margin, with certain portions also subject to a credit spread adjustment (CSA). Term SOFR plus CSA is referred to as "Base" in the table above. The Term Loan A-1 and revolving line of credit bear a CSA of 0.10%.
(3)The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of December 31, 2024.
(4)Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding.
(5)The Change Healthcare (CHC) temporary funding assistance, as described below, is interest-free and amounts provided under this program are subject to repayment at a future date to be mutually agreed to by the parties. The balance is included in the Company's current portion of long-term debt as of December 31, 2024.
(6)As of December 31, 2024, the carrying amount of the Company's senior secured credit facilities has been reduced by a discount of $8,084 and deferred financing costs of $28,879, and the carrying amount of the Company's senior notes has been reduced by deferred financing costs of $37,612 and increased by a debt premium of $10,239. As of December 31, 2023, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $2,487 and deferred financing costs of $32,498, and the carrying amounts of the Company's senior notes was reduced by deferred financing costs of $31,491 and increased by a debt premium of $12,129.
Scheduled Maturities of Long-term Debt
Scheduled maturities of long-term debt at December 31, 2024 were as follows: 
2025$270,867 
2026$174,693 
2027$202,674 
2028$1,922,275 
2029$39,993 
Thereafter$6,900,604 
Derivative Instruments
The following table summarizes the Company’s interest rate cap agreements outstanding as of December 31, 2024:
Notional amount effective
through December 31 unless noted
Year cap agreements executedInitial notional amountSOFR maximum rateApproximate effective dateMaturity date
2024202520262027
2023$1,000,000 3.75%6/30/202412/31/2025$1,000,000$500,000
2023$1,000,000 
4.00%(1)
6/30/202412/31/2025$1,000,000$750,000
2023$1,000,000 
4.75%(2)
6/30/202412/31/2025$1,000,000$750,000
2023$500,000 
5.00%(3)
6/30/202412/31/2026$500,000$500,000$500,000
2023$250,000 4.50%12/31/202412/31/2025$250,000
2023$750,000 4.00%12/31/202412/31/2026$750,000$500,000
2024$1,750,000 
4.50%(4)
12/31/202512/31/2027$1,750,000$1,000,000
2024$750,000 
4.00%(5)
12/31/202512/31/2027$750,000$500,000
Total notional coverage$3,500,000$3,500,000$3,500,000$1,500,000
Weighted average strike rate4.29 %4.02 %4.32 %4.58 %
(1)Effective January 1, 2025, the maximum rate of 4.00% decreased to 3.75% for these interest rate caps.
(2)Effective January 1, 2025, the maximum rate of 4.75% decreased to 4.00% for these interest rate caps.
(3)Effective January 1, 2025, the maximum rate of 5.00% decreased to 4.50% for these interest rate caps.
(4)Effective December 31, 2026, the maximum rate of 4.50% increases to 4.75% for these interest rate caps.
(5)Effective December 31, 2026, the maximum rate of 4.00% increases to 4.25% for these interest rate caps.
Effects of Interest Rate Swap and Cap Agreements
The following table summarizes the effects of the Company’s interest rate cap agreements for the years ended December 31, 2024, 2023 and 2022: 
 Amount of unrealized gains (losses) in OCI on interest rate cap agreementsLocation in Consolidated Statements of IncomeReclassification from accumulated other comprehensive income into net income
 Year ended December 31,Year ended December 31,
Derivatives designated as cash flow hedges202420232022202420232022
Interest rate cap agreements$9,662 $9,186 $144,793 Debt expense$(58,175)$(103,567)$(11,732)
Related income tax(2,412)(2,291)(36,124)Related income tax14,515 25,840 2,926 
Total$7,250 $6,895 $108,669  $(43,660)$(77,727)$(8,806)