There was no change in the carrying amount of goodwill for the three and nine months ended September 30, 2026.

Changes in the carrying amount of goodwill consist of the following for the three and nine months ended September 30, 2025 (in thousands):


	Amount
Balance at December 31, 2024	$	1,540,246
Acquisitions	65,684
Balance at March 31, 2025	$	1,605,930
Purchase accounting adjustments	(75)
Balance at June 30, 2025	$	1,605,855
Purchase accounting adjustments	$	791
Balance at September 30, 2025	$	1,606,646

The carrying amount and accumulated amortization of intangible assets consist of the following as of September 30, 2026 and December 31, 2025 (in thousands):


	September 30, 2026		December 31, 2025
Gross intangible assets:
Referral sources	$	551,188	$	551,188
Trademarks/names	46,808		46,808
Other amortizable intangible assets	985		985
Total gross intangible assets	598,981		598,981

Accumulated amortization:
Referral sources	(289,213)		(263,907)
Trademarks/names	(27,526)		(25,170)
Other amortizable intangible assets	(873)		(726)
Total accumulated amortization	(317,612)		(289,803)
Total intangible assets, net	$	281,369	$	309,178

Amortization expense for intangible assets was $9.3 million and $27.8 million for the three and nine months ended September 30, 2026, respectively. Amortization expense for intangible assets was $9.3 million and $27.7 million for the three and nine months ended September 30, 2025, respectively.