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Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Deferred tax assets    
Implicit discounts and adjustments $ 4,166 $ 6,169
Compensation and benefit-related accruals 46,459 44,651
Professional malpractice liability insurance 14,724 14,081
Federal and state net operating loss and state tax credit carryforwards 26,506 22,611
Interest limitation carryforward 46,187 47,905
Stock awards 995 2,314
Equity investments 1,442 1,235
Operating lease liabilities 192,152 174,165
Derivatives 1,548 0
Research and experimental expenditures 9,914 20,478
Excess capital loss 1,131 4,941
Other 399 384
Deferred tax assets 345,623 338,934
Valuation allowance (16,644) (15,230)
Deferred tax assets, net of valuation allowance 328,979 323,704
Deferred tax liabilities    
Investment in unconsolidated affiliates (22,502) (20,228)
Investment in consolidated affiliates (3,613) (3,511)
Depreciation and amortization (205,334) (190,355)
Deferred financing costs (420) (494)
Operating lease right-of-use assets (178,359) (162,171)
Other (1,813) (1,378)
Deferred tax liabilities (412,041) (378,137)
Deferred tax liabilities, net of deferred tax assets $ (83,062) $ (54,433)