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Income Taxes
 12 Months Ended
Dec. 31, 2022
Income Tax Disclosure [Abstract]  
Income Taxes Income Taxes
The Company accounts for income taxes using the asset and liability method. Under the asset and liability method, deferred taxes are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax laws that will be in effect when the differences are expected to reverse.
 Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2022 and 2021 were as follows (amounts in thousands):
20222021
Deferred tax assets:
Allowance for uncollectible accounts$6,400 $8,394 
Accrued employee benefits7,372 7,533 
Stock compensation2,828 2,735 
Accrued self-insurance7,810 6,626 
Acquisition costs4,244 2,631 
Net operating loss carry forward31,097 5,245 
Intangible asset impairment6 6 
Interest Expense7,820 — 
Lease payable22,591 23,220 
Government stimulus advance— 21,591 
Payroll tax— 5,895 
Other1,630 312 
Gross deferred tax assets91,798 84,188 
Less: valuation allowance(3,590)(3,121)
Net deferred tax assets$88,208 $81,067 
Deferred tax liabilities:
Amortization of intangible assets(120,303)(100,339)
Tax depreciation in excess of book depreciation(17,386)(17,584)
Prepaid expenses(2,063)(1,733)
Non-accrual experience accounting method(666)(829)
Right of use asset(22,105)(22,781)
Other(12,015)(7,827)
Deferred tax liabilities(174,538)(151,093)
Net deferred tax liability$(86,330)$(70,026)
Based on the Company’s historical pattern of taxable income, the Company believes it will produce sufficient income in the future to realize its deferred income tax assets. Management provides a valuation allowance for any net deferred tax assets when it is more likely than not that a portion of such net deferred tax assets will not be recovered.
The components of the Company’s income tax expense from continuing operations, less noncontrolling interest, for the twelve months ended December 31, were as follows (amounts in thousands):
202220212020
Current:
Federal$(883)$10,746 $37,253 
State1,931 4,220 12,232 
1,048 14,966 49,485 
Deferred:
Federal14,677 17,699 (10,800)
State1,236 5,022 (2,642)
15,913 22,721 (13,442)
Total income tax expense $16,961 $37,687 $36,043 

A reconciliation of the difference between the federal statutory tax rate and the Company's effective tax rate for income taxes for each of the twelve months ended December 31, were as follows:
202220212020
Federal statutory tax rate21.0 %21.0 %21.0 %
State income taxes, net of federal benefit8.1 4.8 5.2 
Nondeductible expenses5.4 1.4 1.9 
Uncertain tax position(0.1)0.1 1.5 
Cares Act Enactment— — (2.9)
Excess tax benefit(1.8)(1.5)(1.7)
Credits and other(2.7)(1.2)(0.6)
Effective tax rate29.9 %24.6 %24.4 %

The Company is subject to both federal tax and state income tax for jurisdictions within which it operates. Within these jurisdictions, the Company is open to examination for tax years ended after December 31, 2012.
As of December 31, 2022, the Company has gross U.S. operating loss carry forwards of $102.5 million that are available to reduce future taxable income. If not used to offset taxable income, a portion of these losses will expire between 2032 and 2034. Losses generated in years ending after December 31, 2017 have an unlimited carryforward under the Tax Cut and Jobs Act ("2017 Tax Act"). Due to U.S. limitations on acquired operating losses, a valuation allowance has been established on $1.6 million of these losses.
Gross state operating loss carryforwards totaling $189.4 million at December 31, 2022 are being carried forward in jurisdictions where the Company is permitted to use tax losses from prior periods to reduce future taxable income. If not used to offset future taxable income, these losses will expire between 2023 and 2042. Due to uncertainty regarding the Company's ability to use some of the carryforwards, a valuation allowance has been established on $56.2 million of state net operating loss carryforwards. Based on the Company's historical record of producing taxable income and expectations for the
future, the Company has concluded that future operating income will be sufficient to give rise to taxable income sufficient to utilize the remaining state net operating loss carryforwards.
The effective tax rate for the twelve months ended December 31, 2022 benefited from $1.0 million of excess tax benefits associated with stock-based compensation arrangements. For the twelve months ended December 31, 2021, the effective tax rate benefited from $2.4 million of excess tax benefits associated with stock-based compensation arrangements.
In response to the COVID-19 pandemic, the CARES Act was signed into law in March 2020. The CARES Act lifts certain deduction limitations originally imposed by the 2017 Tax Act. Corporate taxpayers may carryback net operating losses ("NOLs") originating during 2018 through 2020 for up to five years, which was not previously allowed under the 2017 Tax Act. The CARES Act also eliminates the 80% of taxable income limitations by allowing corporate entities to fully utilize NOL carryforwards to offset taxable income in 2018, 2019, or 2020. Taxpayers may generally deduct interest up to the sum of 50% of adjusted taxable income plus business interest income (30% limit under the 2017 Tax Act) for tax years beginning January 1, 2019 and 2020. The CARES Act allows taxpayers with alternative minimum tax credits to claim a refund in 2020 for the entire amount of the credits instead of recovering the credits through refunds over a period of years, as originally enacted by the 2017 Tax Act. In addition, the CARES Act raises the corporate charitable deduction limit to 25% of taxable income and makes qualified improvement property generally eligible for 15-year cost-recovery and 100% bonus depreciation. The effective tax rate for the twelve months ended December 31, 2020 benefited from a $4.3 million impact from the enactment of the CARES Act. The benefit was primarily driven by NOL carryback provisions and rate differential between the affected years. There was no material impact to our net deferred tax assets as of December 31, 2020.
US GAAP prescribes a recognition threshold and measurement attribute for the accounting and financial statement disclosure of tax positions taken or expected to be taken in a tax return. The evaluation of a tax position is a two-step process. The first step requires the Company to determine whether it is more likely than not that a tax position will be sustained upon examination based on the technical merits of the position. The second step requires the Company to recognize in the financial statements each tax position that meets the more likely than not criteria, measured at the amount of benefit that has a greater than 50% likelihood of being realized. The Company's unrecognized tax benefits would affect the tax rate, if recognized. The Company includes the full amount of unrecognized tax benefits in noncurrent income taxes payable in the consolidated balance sheets. The Company anticipates it is reasonably possible an increase or decrease in the amount of unrecognized tax benefits could be made in the next twelve months; however, the Company does not presently anticipate that any increase or decrease in unrecognized tax benefits will be material to the consolidated financial statements. The impact of the CARES Act increased unrecognized tax benefits by $2.1 million, which also had an impact on the Company's effective tax rate for the twelve months ended December 31, 2020. The impact was primarily driven by the NOL carryback mentioned above to previously closed years. As of December 31, 2022 and 2021, the Company recognized $7.2 million and $7.3 million, respectively, in unrecognized tax benefits.
A reconciliation of the total amounts of unrecognized tax benefits follows:
Unrecognized tax benefits
As of January 1, 2021$6,203 
Acquired unrecognized tax position— 
Increased (decreased) in unrecognized tax benefits as a result of:
Tax positions taken in the current year1,244 
Lapse of statute of limitations(127)
As of December 31, 2021$7,320 
Increased (decreased) in unrecognized tax benefits as a result of:
Tax positions taken in the current year304 
Lapse of statute of limitations(405)
As of December 31, 2022$7,219