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Long-term debt
 3 Months Ended
Mar. 31, 2025
Debt Disclosure [Abstract]  
Long-term debt Long-term debt
Long-term debt comprised the following:
As of March 31, 2025
March 31,
2025		December 31, 2024Maturity dateInterest rate
Estimated fair value(1)
Senior Secured Credit Facilities:  
Term Loan A-1(2)
$2,229,567 $2,259,295 4/28/2028Base +1.75%$2,226,780 
Term Loan B-11,632,050 1,636,150 5/9/2031SOFR + 2.00%$1,630,010 
Revolving line of credit(2)
425,000 — 4/28/2028Base +1.75%$425,000 
Senior Notes:
4.625% Senior Notes2,750,000 2,750,000 6/1/20304.625 %$2,536,875 
3.75% Senior Notes1,500,000 1,500,000 2/15/20313.75 %$1,304,535 
6.875% Senior Notes1,000,000 1,000,000 9/1/20326.875 %$1,005,000 
Acquisition obligations and other notes payable(3)
53,990 56,483 2025-20385.55 %$53,990 
Financing lease obligations(4)
208,825 216,401 2026-20394.56 %
CHC temporary funding assistance— 92,777 $— 
Total debt principal outstanding9,799,432 9,511,106 
Discount, premium and deferred financing costs(5)
(61,039)(64,336)
 9,738,393 9,446,770 
Less current portion(178,648)(270,867)
 $9,559,745 $9,175,903 
(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.
(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 March 31, 2025.
(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)As of March 31, 2025, the carrying amount of the Company's senior secured credit facilities has been reduced by a discount of $7,759 and deferred financing costs of $26,965, and the carrying amount of the Company's senior notes has been reduced by deferred financing costs of $36,081 and increased by a debt premium of $9,766. As of December 31, 2024, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $8,084 and deferred financing costs of $28,879, and the carrying amount of the Company's senior notes was reduced by deferred financing costs of $37,612 and increased by a debt premium of $10,239.
During the first three months of 2025, the Company made regularly scheduled principal payments under its senior secured credit facilities totaling $29,728 on Term Loan A-1 and $4,100 on Term Loan B-1.
On March 1, 2024, Change Healthcare (CHC), a subsidiary of UnitedHealth Group, launched a temporary assistance funding program (CHC Funding) to help bridge the gap in short-term cash flow needs for providers impacted by the disruption of CHC's services. Under the program, CHC provided funding to providers for amounts that would otherwise have been received (with certain limitations), but for the disruption in processing electronic claims as a result of the outage. During the first quarter of 2025, the Company repaid all remaining balances outstanding under the CHC Funding program.
As of March 31, 2025, the effective portion of the Company's 2023 interest rate cap agreements have the economic effect of capping the Company's maximum exposure to SOFR variable interest rate changes on equivalent amounts of the Company's floating rate debt, including all of Term Loan B-1 and a portion of Term Loan A-1. The remaining $361,617 outstanding principal balance of Term Loan A-1 and $425,000 balance outstanding on the revolving line of credit are subject to SOFR-based interest rate volatility. These cap agreements are designated as cash flow hedges and, as a result, changes in their fair
values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features.
During the first quarter of 2025 the Company entered into several forward interest rate cap agreements, described below, that have the economic effect of capping the Company's exposure to SOFR variable interest rate changes on specific portions of the Company's floating rate debt (2025 cap agreements). These 2025 cap agreements are designated as cash flow hedges and, as a result, changes in their fair values will be reported in other comprehensive income. These 2025 cap agreements do not contain credit-risk contingent features and become effective and expire as described in the table below.
The following table summarizes the Company’s interest rate cap agreements outstanding as of March 31, 2025: 
Year cap agreements executedInitial notional amountSOFR maximum rateApproximate effective dateMaturity dateNotional amount effective
through December 31
2025202620272028
2023$2,000,000 3.75%6/30/202412/31/2025$1,250,000 
2023$1,000,000 4.00%6/30/202412/31/2025$750,000 
2023$500,000 4.50%6/30/202412/31/2026$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%(1)
12/31/202512/31/2027$1,750,000 $1,000,000 
2024$750,000 
4.00%(2)
12/31/202512/31/2027$750,000 $500,000 
2025$1,000,000 
4.50%(3)
12/31/202612/31/2028$1,000,000 $750,000 
Total notional coverage$3,500,000 $3,500,000 $2,500,000 $750,000 
Weighted average strike rate4.02%4.32%4.55%4.75%
(1)Effective December 31, 2026, the maximum rate of 4.50% increases to 4.75% for these interest rate caps.
(2)Effective December 31, 2026, the maximum rate of 4.00% increases to 4.25% for these interest rate caps.
(3)Effective December 31, 2027, the maximum rate of 4.50% increases to 4.75% for these interest rate caps.
The fair value of the Company's interest rate cap agreements, which are classified in other long-term assets on its consolidated balance sheet, was $21,894 and $30,062 as of March 31, 2025 and December 31, 2024, respectively.
See Note 9 for further details on amounts reclassified from accumulated other comprehensive loss and recorded as debt expense (offset) related to the Company’s interest rate cap agreements for the three months ended March 31, 2025 and 2024.
As a result of the variable rate cap from the Company's 2023 interest rate cap agreements, the Company’s weighted average effective interest rate on its senior secured credit facilities at the end of the first quarter of 2025 was 6.62%, based on the current margins in effect for its senior secured credit facilities as of March 31, 2025, as detailed in the table above.
The Company’s weighted average effective interest rate on all debt, including the effect of interest rate caps and amortization of debt discount, for the three months ended March 31, 2025 was 5.60% and as of March 31, 2025 was 5.65%.
As of March 31, 2025, the Company’s interest rates were fixed and economically fixed on approximately 56% and 92% of its total debt, respectively.
As of March 31, 2025, the Company had $1,075,000 available and $425,000 drawn on its $1,500,000 revolving line of credit under its senior secured credit facilities. Credit available under this revolving line of credit is reduced by the amount of any letters of credit outstanding under the facility, of which there were none as of March 31, 2025. The Company also had letters of credit of approximately $172,716 outstanding under a separate bilateral secured letter of credit facility as of March 31, 2025.