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Long-term debt | 6 Months Ended
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Jun. 30, 2025
Debt Disclosure [Abstract] |
Long-term debt | Long-term debt Long-term debt comprised the following:
|  |  |  |  |  |  | As of June 30, 2025
| June 30, 2025 |  | December 31, 2024 |  | Maturity date |  | Interest rate |  | Estimated fair value(1)
Senior Secured Credit Facilities: |  |  |  |  |  |  |  |  |
Term Loan A-1(2) | $ | 2,199,840 |  |  | $ | 2,259,295 |  |  | 4/28/2028 |  | Base +1.75% |  | $ | 2,202,590 |
Term Loan B-1 | 1,627,949 |  |  | 1,636,150 |  |  | 5/9/2031 |  | SOFR + 2.00% |  | $ | 1,636,089 |
Revolving line of credit(2) | — |  |  | — |  |  | 4/28/2028 |  | Base +1.75% |  | $ | — |
Senior Notes: |  |  |  |  |  |  |  |  |
4.625% Senior Notes | 2,750,000 |  |  | 2,750,000 |  |  | 6/1/2030 |  | 4.625 | % |  | $ | 2,633,125 |
3.75% Senior Notes | 1,500,000 |  |  | 1,500,000 |  |  | 2/15/2031 |  | 3.75 | % |  | $ | 1,362,225 |
6.875% Senior Notes | 1,000,000 |  |  | 1,000,000 |  |  | 9/1/2032 |  | 6.875 | % |  | $ | 1,035,000 |
6.75% Senior Notes | 1,000,000 |  |  |  |  | 7/15/2033 |  | 6.75 | % |  | $ | 1,032,500 |
Acquisition obligations and other notes payable(3) | 51,276 |  |  | 56,483 |  |  | 2025-2038 |  | 5.41 | % |  | $ | 51,276 |
Financing lease obligations(4) | 201,413 |  |  | 216,401 |  |  | 2026-2039 |  | 4.54 | % |  |
CHC temporary funding assistance | — |  |  | 92,777 |  |  |  |  |  |  | $ | — |
Total debt principal outstanding | 10,330,478 |  |  | 9,511,106 |  |  |  |  |  |  |
Discount, premium and deferred financing costs(5) | (69,231) |  |  | (64,336) |  |  |  |  |  |  |
| 10,261,247 |  |  | 9,446,770 |  |  |  |  |  |  |
Less current portion | (182,442) |  |  | (270,867) |  |  |  |  |  |  |
| $ | 10,078,805 |  |  | $ | 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 June 30, 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 June 30, 2025, the carrying amount of the Company's senior secured credit facilities has been reduced by a discount of $7,435 and deferred financing costs of $24,978, and the carrying amount of the Company's senior notes has been reduced by deferred financing costs of $46,111 and increased by a debt premium of $9,293. 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. On May 23, 2025, the Company issued $1,000,000 aggregate principal amount of 6.75% senior notes due 2033 (the 6.75% Senior Notes) in a private offering pursuant to Rule 144A and Regulation S under the Securities Act of 1933, as amended. The 6.75% Senior Notes pay interest on January 15 and July 15 of each year beginning January 15, 2026 and mature on July 15, 2033. The 6.75% Senior Notes are unsecured senior obligations and rank equally in right of payment with the Company's existing and future unsecured senior indebtedness. The 6.75% Senior Notes are guaranteed by each of the Company’s domestic subsidiaries that guarantee its senior secured credit facilities. The Company may redeem up to 40% of the aggregate principal amount of the 6.75% Senior Notes at any time prior to July 15, 2028 at 106.75% of the aggregate principal amount from the net cash proceeds of one or more equity offerings, plus accrued and unpaid interest. On and after July 15, 2028, the Company may at its option redeem the 6.75% Senior Notes, in whole or from time to time in part, at certain redemption prices specified in the indenture governing the 6.75% Senior Notes, plus accrued and unpaid interest. If the Company experiences certain change of control events, the Company must offer to repurchase all of the 6.75% Senior Notes (unless otherwise redeemed) at a price equal to 101% of the principal amount thereof, plus accrued and unpaid interest. The 6.75% Senior Notes contain restrictive covenants that limit the ability of the Company and the subsidiary guarantors of the 6.75% Senior Notes to, among other things and subject to certain exceptions and qualifications, create certain liens, enter into certain sale/leaseback transactions, or merge with or into, or convey, transfer or lease all or substantially all of their assets. The 6.75% Senior Notes and related subsidiary guarantees do not have any registration or similar rights and are not expected to be registered or listed on any securities exchange. As of June 30, 2025, the Company incurred $11,799 in fees and other professional expenses associated with this transaction that were capitalized and will amortize over the term of the 6.75% Senior Notes. During the first six months of 2025, the Company made regularly scheduled principal payments under its senior secured credit facilities totaling $59,455 on Term Loan A-1 and $8,201 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 following a cybersecurity incident. 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 June 30, 2025, the effective portion of the Company's interest rate cap agreements, as detailed in the table below, 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 $327,789 outstanding principal balance of Term Loan A-1 is 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 2025 the Company entered into several forward interest rate cap agreements, detailed in the table 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 June 30, 2025:
Year cap agreements executed | Initial notional amount |  | SOFR maximum rate |  | Approximate effective date |  | Maturity date |  | Notional amount effective through December 31
|  |  |  | 2025 |  | 2026 |  | 2027 |  | 2028
2023 | $ | 2,000,000 |  |  | 3.75% |  | 6/30/2024 |  | 12/31/2025 |  | $ | 1,250,000 |  |  |  |  |  |  |
2023 | $ | 1,000,000 |  |  | 4.00% |  | 6/30/2024 |  | 12/31/2025 |  | $ | 750,000 |  |  |  |  |  |  |
2023 | $ | 500,000 |  |  | 4.50% |  | 6/30/2024 |  | 12/31/2026 |  | $ | 500,000 |  |  | $ | 500,000 |  |  |  |  |
2023 | $ | 250,000 |  |  | 4.50% |  | 12/31/2024 |  | 12/31/2025 |  | $ | 250,000 |  |  |  |  |  |  |
2023 | $ | 750,000 |  |  | 4.00% |  | 12/31/2024 |  | 12/31/2026 |  | $ | 750,000 |  |  | $ | 500,000 |  |  |  |  |
2024 | $ | 1,750,000 |  |  | 4.50%(1) |  | 12/31/2025 |  | 12/31/2027 |  |  |  | $ | 1,750,000 |  |  | $ | 1,000,000 |  |  |
2024 | $ | 750,000 |  |  | 4.00%(2) |  | 12/31/2025 |  | 12/31/2027 |  |  |  | $ | 750,000 |  |  | $ | 500,000 |  |  |
2025 | $ | 1,000,000 |  |  | 4.50%(3) |  | 12/31/2026 |  | 12/31/2028 |  |  |  |  |  | $ | 1,000,000 |  |  | $ | 750,000 |
2025 | $ | 1,000,000 |  |  | 4.25%(4) |  | 12/31/2026 |  | 12/31/2028 |  |  |  |  |  | $ | 1,000,000 |  |  | $ | 1,000,000 |
Total notional coverage |  | $ | 3,500,000 |  |  | $ | 3,500,000 |  |  | $ | 3,500,000 |  |  | $ | 1,750,000 |
Weighted average strike rate |  | 4.02% |  | 4.32% |  | 4.46% |  | 4.61%
(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. (4)Effective December 31, 2027, the maximum rate of 4.25% increases to 4.50% 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 $17,187 and $30,062 as of June 30, 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 and six months ended June 30, 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 second quarter of 2025 was 6.60%, based on the current margins in effect for its senior secured credit facilities as of June 30, 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, premium and deferred financing costs, for the three and six months ended June 30, 2025 was 5.71% and 5.66%, respectively, and as of June 30, 2025 was 5.73%. As of June 30, 2025, the Company’s interest rates were fixed and economically fixed on approximately 63% and 97% of its total debt, respectively. As of June 30, 2025, the Company had an undrawn revolving line of credit under its senior secured credit facilities of $1,500,000. 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 June 30, 2025. The Company also had letters of credit of approximately $159,115 outstanding under a separate bilateral secured letter of credit facility as of June 30, 2025. Subsequent to June 30, 2025, the Company amended its senior secured credit facilities. For additional information see Note 14

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