Leases

12 Months Ended

Dec. 31, 2024

We have entered into hospital property, office and equipment rental agreements with various lessors including related parties. The following tables disclose information about our leases of property and equipment:


	Year ended December 31,
	2024		2023		2022

Operating lease cost	$	2,070,442	$	2,656,800	$	2,969,789

Finance lease cost:
Amortization of right-of-use assets	10,866,869		10,052,616		7,120,266
Interest on lease liabilities	16,686,052		12,100,495		9,952,783
Total finance lease cost	27,552,921		22,153,111		17,073,049

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	2,341,214		2,479,120		2,778,767
Operating cash flows from finance leases	16,202,689		12,131,011		9,952,783
Financing cash flows from finance leases	4,973,458		3,495,222		1,721,224
Net cash paid for amounts included in the measurement of lease liabilities	23,517,361		18,105,353		14,452,774

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	16,727,826		51,435		—
Finance leases	53,228,790		25,449,227		23,603,317
Total right-of-use assets obtained in exchange for lease obligations	$	69,956,616	$	25,500,662	$	23,603,317

Weighted average remaining lease term (years):
Operating leases	17		9		10
Finance leases	22		21		13


Weighted average discount rate:
Operating leases	10	%	5	%	4	%
Finance leases	10	%	8	%	3	%

For the year ended December 31, 2024, the Company opened four facilities throughout the year. For three facilities, the Company recognized financing right-of-use (ROU) assets of $53.2 million related to the hospital property and equipment leases entered into as a result of the openings. For one facility, we recognized operating ROU assets of $16.7 million related to the hospital property lease entered into as a result of the facility opening. The recognized operating ROU asset also increased the weighted average discount rate.

Due to the closures of two facilities in January 2023 and two facilities in January 2024, we remeasured the one lease associated with a facility, recording a reduction to financing lease liabilities and financing right-of-use assets of $11.4 million as of December 31, 2023. After remeasurement, we recognized an impairment loss of $24.6 million for the year ended December 31, 2023 for the remaining carrying value of the right-of-use assets associated with the four facilities.

The following table shows minimum lease payments for the next five years:


	Operating leases				Finance leases
	Third-parties		Related parties		Third-parties		Related parties

2025	$	2,043,228	$	1,930,814	$	6,478,205	$	19,645,210
2026	1,942,910		2,208,399		5,434,573		20,289,300
2027	1,925,245		2,265,426		3,686,277		20,645,216
2028	1,972,126		2,323,933		3,478,965		21,008,747
2029	1,716,970		2,383,958		3,393,147		21,379,909
Thereafter	4,951,959		56,867,884		37,815,772		536,567,772
Total minimum lease payments	14,552,438		67,980,414		60,286,939		639,536,154
Less interest	(2,515,927)		(47,319,586)		(18,210,342)		(414,428,782)
Total lease liabilities	$	12,036,511	$	20,660,828	$	42,076,597	$	225,107,372