v3.26.1
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2026
Jun. 30, 2025
Cash flows from operating activities:    
Net (loss) income $ (147,592) $ 9,749
Adjustments to reconcile net (loss) income to net cash provided by operating activities:    
Depreciation and amortization, including patient equipment depreciation 226,766 186,705
Goodwill impairment 144,236 0
Equity-based compensation 12,089 11,427
Reduction in the carrying amount of operating lease right-of-use assets 21,299 15,300
Reduction in the carrying amount of finance lease right-of-use assets 10,081 7,096
Deferred income tax (benefit) expense (21,147) 12,643
Loss on extinguishment of debt 1,322 0
Amortization of deferred financing costs 2,326 3,105
Write-off of fixed assets 1,178 0
Gain on sale of businesses (note 4) (6,269) (32,225)
Other (787) 0
Changes in operating assets and liabilities, net of effects from acquisitions:    
Accounts receivable (19,491) 8,868
Inventory 12,066 (9,713)
Prepaid and other assets 10,045 (4,578)
Operating lease obligations (20,351) (15,812)
Operating liabilities 13,253 64,956
Net cash provided by operating activities 239,024 257,521
Cash flows from investing activities:    
Purchases of equipment and other fixed assets (287,456) (184,250)
Payments for business acquisitions, net of cash acquired (127,422) (18,561)
Proceeds from the sale of businesses, net of cash disposed 6,269 115,674
Proceeds from the sale of assets 1,439 0
Receipt of contingent consideration from the sale of assets 0 1,156
Net cash used in investing activities (407,170) (85,981)
Cash flows from financing activities:    
Proceeds from borrowings on long-term debt and lines of credit 575,000 0
Repayments on long-term debt and lines of credit (425,000) (175,000)
Repayments of finance lease obligations (8,118) (8,346)
Proceeds received in connection with employee stock purchase plan 951 564
Payments relating to the Tax Receivable Agreement (26,846) (25,012)
Payments of debt financing costs (5,038) 0
Distributions to noncontrolling interests (2,349) (2,573)
Payments for tax withholdings from vesting of restricted stock units and stock option exercises (3,090) (2,079)
Payments of deferred purchase price from acquisitions (211) (211)
Net cash provided by (used in) financing activities 105,299 (212,657)
Net decrease in cash (62,847) (41,117)
Cash at beginning of period 106,136 109,747
Cash at end of period 43,289 68,630
Supplemental disclosures:    
Cash paid for interest 49,535 52,942
Cash (refunded) paid for income taxes (11,886) 21,709
Noncash investing and financing activities:    
Unpaid equipment and other fixed asset purchases at end of period 81,667 59,170
Assets subject to operating lease obligations 33,380 8,611
Operating lease obligations (33,380) (8,611)
Write-off of assets subject to operating lease obligations (543) (3,327)
Write-off of operating lease obligations 543 3,327
Assets subject to finance lease obligations 3,286 11,441
Finance lease obligations (3,286) (11,441)
Write-off of assets subject to finance lease obligations (704) (1,329)
Write-off of finance lease obligations $ 704 $ 1,329