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Income Taxes - Significant Components of Deferred Income Tax Assets and Liabilities (Detail) - USD ($)
$ in Thousands
Dec. 31, 2019
Dec. 31, 2018
Income Tax Disclosure [Abstract]    
Allowance for uncollectible accounts $ 202,464 $ 194,299
Reserves and accruals 72,132 56,583
Stock-based compensation 11,393 9,201
Loss carryforwards 36,017 24,864
Property and equipment 388 0
Other 631 1,197
Deferred tax assets before valuation allowance 323,025 286,144
Less: Valuation allowance (24,139) (2,628)
Deferred tax assets, net of valuation allowance 298,886 283,516
Gross deferred tax liabilities:    
Amortization (119,481) (247,239)
Accounting method changes (74,684) (109,418)
Accrual to cash adjustment   (39)
Other (331) (491)
Total deferred tax liabilities (194,496) (357,187)
Net deferred tax assets $ 104,390  
Net deferred tax liabilities   $ (73,671)