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Income Taxes
 12 Months Ended
Dec. 31, 2025
Income Tax Disclosure [Abstract]  
Income Taxes Income Taxes
Significant components of the Company’s net deferred tax assets (liabilities) are as follows (in thousands):
 
 Years Ended December 31,
 20252024
Deferred tax assets:
Patient accounts receivable, net$8,702 $19,430 
Accrued liabilities976 5,253 
Deferred compensation20,196 17,751 
Self-insurance reserves35,137 31,252 
Financing costs10,521 16,082 
Lease liability283,704 278,369 
Other4,699 4,697 
Federal tax credits163 89 
Federal net operating loss carryforward3,150 2,369 
State net operating loss carryforward8,380 8,560 
Change in value of derivatives
1,274 — 
Total deferred tax assets376,902 383,852 
Deferred tax liabilities:
Prepaid expenses(6,856)(7,971)
Right of use assets(283,704)(278,369)
Depreciation and amortization(73,371)(61,423)
Partnership basis differences(33,061)(13,897)
Change in value of derivatives— (3,440)
Total deferred tax liabilities(396,992)(365,100)
Valuation allowance for deferred tax assets(6,468)(6,431)
Net deferred tax (liabilities) assets$(26,558)$12,321 

At December 31, 2025 and 2024, the Company had federal net operating loss carryforwards for income tax purposes totaling $15.0 million and $11.3 million, respectively. Federal net operating losses totaling $5.1 million expire between 2034 and 2037. Federal net operating losses totaling $9.9 million generated in years beginning after December 31, 2017 may be carried forward indefinitely. Certain amounts of the federal net operating losses are subject to limitations on use. The Company expects $5.0 million of the carryforwards to expire unused and has recorded a valuation allowance for those amounts. At December 31, 2025 and 2024, the Company had no capital loss carryforwards. At December 31, 2025 and 2024, the Company had state net operating loss carryforwards of $204.4 million and $210.1 million, respectively. State net operating losses of $111.5 million expire between 2037 and 2045, and state net operating losses of $92.9 million may be carried forward indefinitely.

In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers the positive and negative evidence from all sources, including net operating loss carryback opportunities, historical operating results, prudent and feasible tax planning strategies and projections of future taxable income. Based on the analysis of positive and negative evidence, the Company recorded a valuation allowance of $6.5 million and $6.4 million at December 31, 2025 and 2024, respectively, for the uncertainty regarding the ability to utilize certain deferred tax assets.

With respect to the change in valuation allowances, the Company recognized no federal tax expense or benefits during the years ended December 31, 2025 and 2024, and the Company recognized state tax expense of $0.1 million during each of the years ended December 31, 2025 and 2024.

On July 4, 2025, the One Big Beautiful Bill Act (“OBBBA”) was enacted into federal law. The Company evaluated the income tax effects of OBBBA in accordance with ASC 740 and recorded the impact in the period of enactment. The provisions of OBBBA expected to have the most significance to the Company relate to amendments to the limitation of the deductibility of business interest under Internal Revenue Code §163(j) and modifications to bonus depreciation rules.

The OBBBA modifies §163(j) by changing the formula to calculate adjusted taxable income (“ATI”) to add back tax depreciation and amortization expense. As a result of this change, the Company expects an increase in the amount of deductible business interest expense beginning in 2025.
The OBBBA modifies the bonus depreciation rules by reinstating 100% bonus depreciation for qualified property placed in service after January 19, 2025 and making changes to eligible asset classes. As a result of this change, the Company expects an increase in the amount of tax depreciation expense beginning in 2025.

The Company's effective tax rate is not impacted by the OBBBA changes. The Company's inventory of deferred tax assets and liabilities has been adjusted to reflect the impact of the OBBBA on future tax years.

The Company has considered the impact of the OBBBA on the realizability of deferred tax assets and determined that no valuation allowance was required as of December 31, 2025. The OBBBA did not have a material impact on the Company's unrecognized tax benefits.

Significant components of the provision for income taxes are as follows (in thousands):
 
 Years Ended December 31,
 202520242023
Current:
Federal
$6,097 $30,560 $11,190 
State
6,532 9,511 6,693 
Total current
12,629 40,071 17,883 
Deferred:
Federal
36,735 21,965 5,814 
State
6,859 1,316 (1,060)
Total deferred
43,594 23,281 4,754 
Total provision$56,223 $63,352 $22,637 

The Company’s consolidated effective tax rate from continuing operations differed from the amounts computed using the federal statutory rate as set forth below (dollar amounts in thousands):
 
Years Ended December 31,
 
2025
2024
2023
 AmountPercentAmountPercentAmountPercent
Tax at federal statutory rate$60,135 21.0 %$76,243 21.0 %$31,839 21.0 %
State taxes, net of federal benefits (a)
12,191 4.3 9,758 2.7 4,217 2.8 
Non-taxable or non-deductible items
Permanent differences899 0.3 1,621 0.4 1,707 1.1 
Executive and equity-based compensation limitations4,676 1.6 3,545 1.0 190 0.1 
Noncontrolling interests(19,761)(6.9)(18,099)(5.0)(15,171)(10.0)
Change in valuation allowance— — — — — — 
Change in unrecognized tax benefit— — (9,210)(2.5)664 0.5 
Tax credits(382)(0.1)(464)(0.1)(1,001)(0.7)
Other, net(1,535)(0.5)(42)— 192 0.1 
$56,223 19.7 %$63,352 17.5 %$22,637 14.9 %
(a)
State taxes in Oklahoma and Texas for 2025, Texas and New Mexico for 2024 and Texas for 2023 made up the majority (greater than 50%) of the tax effect in this category.
The Company paid the following income taxes (net of refunds) during the periods presented, which are disaggregated by federal and significant state jurisdictions (in thousands):

Years Ended December 31,
202520242023
Federal $23,999 $32,600 $14,000 
State
Texas5,481 4,605 4,900 
New Mexico3,030 2,130 — 
New Jersey2,080 — — 
Other1,920 2,268 533 
Total$36,510 $41,603 $19,433 

The Company follows the provisions of ASC 740, Income Taxes, regarding unrecognized tax benefits. At December 31, 2025, the Company had no liability for unrecognized tax benefits and no accrued interest expense. During the year ended December 31, 2024, the Company released its liability for unrecognized tax benefits, as well as the accrued interest expense related to the unrecognized tax benefits, due to the expiration of its statute of limitations.
As of December 31, 2025, the Company has no ongoing or pending federal examinations for prior years and has an ongoing examination by the State of Idaho for the 2023 tax year. Based on available information as of the reporting date, management does not expect the resolution of this examination to have a material impact on the Company's consolidated financial statements. The Company has outstanding federal income tax refund claims for the 2016 and 2018 tax years. Since the total amount of the refund claims is equal to $10.0 million, which was classified within other current assets on the Company's consolidated balance sheet at December 31, 2025 and 2024, the refund claims are subject to ongoing Joint Committee on Taxation reviews. As of December 31, 2025 and 2024, the Company has accrued $2.1 million and $0.8 million of interest income related to the refund claim respectively, which has been included as part of the Company's income tax expense. The Company's tax years from 2022 through 2025 remain open to examination by federal and state taxing authorities.