v3.26.1
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2026
Mar. 31, 2025
Cash flows from operating activities:    
Net loss $ (14,873) $ (6,079)
Adjustments to reconcile net loss to net cash provided by operating activities:    
Depreciation and amortization, including patient equipment depreciation 106,469 94,345
Equity-based compensation 6,532 5,296
Reduction in the carrying amount of operating lease right-of-use assets 10,659 7,490
Reduction in the carrying amount of finance lease right-of-use assets 5,046 3,374
Deferred income tax benefit (5,600) (776)
Amortization of deferred financing costs 1,186 1,283
Writeoff of fixed assets 691 0
Other (786) 0
Changes in operating assets and liabilities, net of effects from acquisitions:    
Accounts receivable (21,069) (15,429)
Inventory (7,751) 9,159
Prepaid and other assets 11,913 194
Operating lease obligations (10,298) (7,861)
Operating liabilities 11,603 4,531
Net cash provided by operating activities 93,722 95,527
Cash flows from investing activities:    
Purchases of equipment and other fixed assets (121,212) (95,585)
Payments for business acquisitions (84,683) 0
Proceeds from the sale of assets 1,439 0
Net cash used in investing activities (204,456) (95,585)
Cash flows from financing activities:    
Proceeds from borrowings on lines of credit 100,000 0
Repayments on long-term debt and lines of credit (14,063) (25,000)
Repayments of finance lease obligations (3,104) (3,221)
Proceeds received in connection with employee stock purchase plan 464 564
Payments relating to the Tax Receivable Agreement (26,846) (25,012)
Distributions to noncontrolling interests (1,522) (2,046)
Payments for tax withholdings from vesting of restricted stock units (2,367) (1,324)
Net cash provided by (used in) financing activities 52,562 (56,039)
Net decrease in cash (58,172) (56,097)
Cash at beginning of period 106,136 109,747
Cash at end of period 47,964 53,650
Supplemental disclosures:    
Cash paid for interest 43,080 45,969
Cash (refunded) paid for income taxes (12,287) 42
Noncash investing and financing activities:    
Unpaid equipment and other fixed asset purchases at end of period 102,503 58,250
Assets subject to operating lease obligations 19,441 3,483
Operating lease obligations (19,441) (3,483)
Write-off of assets subject to operating lease obligations (450) (2,232)
Write-off of operating lease obligations 450 2,232
Assets subject to finance lease obligations 3,157 7,388
Finance lease obligations (3,157) (7,388)
Write-off of assets subject to finance lease obligations (492) (678)
Write-off of finance lease obligations $ 492 $ 678