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INCOME TAXES
 12 Months Ended
Dec. 31, 2025
Income Tax Disclosure [Abstract]  
INCOME TAXES INCOME TAXES
  
For the years ended December 31, 2025, 2024 and 2023, we have the following income (loss) before income taxes (in thousands):
 December 31,
 202520242023
US Domestic$50,367 $60,704 $60,374 
Foreign(18,458)(15,842)(21,564)
Income before income taxes$31,909 $44,862 $38,810 

For the years ended December 31, 2025, 2024 and 2023, we recognized income tax expense comprised of the following (in thousands):
 
 December 31,
 202520242023
Federal current tax$— $— $— 
State current tax4,039 2,375 3,442 
Foreign current tax1,022 1,302 638 
Other current tax— — — 
Total current expenses5,061 3,677 4,080 
Federal deferred tax9,526 3,269 8,960 
State deferred tax1,990 (246)(2,724)
Foreign deferred tax(1,715)(674)(1,843)
Total deferred expenses9,801 2,349 4,393 
Income tax expense14,862 6,026 8,473 
 
A reconciliation of the statutory U.S. federal rate and effective rates is as follows:
Years Ended December 31,
202520242023
AmountPercentAmountPercentAmountPercent
U.S. Federal Statutory Tax Rate$6,701 21.00 %$9,416 20.99 %$8,150 21.00 %
State and Local Income Taxes, Net of Federal Income Tax Effect1
4,663 14.61 %1,957 4.36 %1,451 3.74 %
Foreign Tax Effects
Netherlands
Statutory tax rate difference between Netherlands and U.S.(891)(2.79)%(866)(1.93)%(1,116)(2.88)%
Change in valuation allowance4,071 12.76 %4,181 9.32 %4,064 10.47 %
Other222 0.70 %— — %(23)(0.06)%
Other foreign jurisdictions(220)(0.69)%637 1.42 %398 1.03 %
Changes in Valuation Allowances30 0.09 %15 0.03 %— — %
Nontaxable or Nondeductible Items
(Income)/loss attributable to noncontrolling interests(7,497)(23.49)%(7,569)(16.87)%(5,752)(14.82)%
Stock-based compensation1,508 4.73 %(1,694)(3.78)%62 0.16 %
Nondeductible executive compensation2,449 7.67 %870 1.94 %1,199 3.09 %
Adjustments to fair market value— — %418 0.93 %(563)(1.45)%
Nondeductible split dollar insurance(351)(1.10)%(320)(0.71)%(248)(0.64)%
Meals and Entertainment427 1.34 %416 0.93 %636 1.64 %
Nondeductible transaction costs1,472 4.61 %— — %— — %
Other353 1.11 %267 0.60 %309 0.80 %
Changes in Unrecognized Tax Benefits72 0.23 %(274)(0.61)%(884)(2.28)%
Other Adjustments
Other basis adjustments to joint ventures741 2.32 %268 0.60 %(226)(0.58)%
Other basis adjustments to other assets1,112 3.48 %(1,696)(3.78)%1,016 2.62 %
Other
Effective Tax Rate14,862 46.58 %6,026 13.44 %8,473 21.84 %
(1) State tax expense comprising the majority (greater than 50 percent) of the tax effect in this category for the years ended December 31, 2025, 2024 and 2023 is Maryland and New York, Maryland, and Maryland, respectively.
A summary of income taxes paid, net of refunds received, for the years ended December 31, 2025, 2024 and 2023 is as follows:
Years Ended December 31,
202520242023
Federal income taxes paid, net of refunds received
State income taxes paid, net of refunds received
California$145$317$127
Delaware— — 181 
Florida510 329 186 
Maryland2,301 1,150 1,000 
New Jersey81 284 1 
New York337 10 38 
Other State Jurisdictions299 80 55 
3,673 2,170 1,588 
Foreign income taxes paid, net of refunds received
United Kingdom845 1,885 — 
Other Foreign Jurisdictions43 113 — 
888 1,998 — 
Total income taxes paid, net of refunds received4,561 4,168 1,588 

Deferred income taxes reflect the net tax effects of temporary differences between carrying amounts of assets and liabilities for financial and income tax reporting purposes and operating loss carryforwards.
 
Our deferred tax assets and liabilities comprise the following (in thousands):
 December 31,
Deferred tax assets:20252024
Net operating losses$89,606 $46,868 
Accrued expenses3,720 5,087 
Operating lease liability152,768 138,842 
Amortization of research and experimental expenditures9,481 9,977 
Equity compensation5,796 3,813 
Allowance for doubtful accounts2,267 2,411 
Limitation of business interest9,075 16,083 
Other2,815 1,182 
Valuation allowance(26,562)(13,797)
Total deferred tax assets$248,966 $210,466 
Deferred tax liabilities:
Property and equipment(17,977)(20,383)
Goodwill(51,576)(45,794)
Intangibles(30,746)(13,206)
Operating lease right-of-use asset(136,831)(124,427)
Outside basis difference(33,271)(27,066)
Other(468)(1,820)
Total deferred tax liabilities$(270,869)$(232,696)
Net deferred tax liability$(21,903)$(22,230)
 
As of December 31, 2025, we had federal net operating loss carryforwards of approximately $240.1 million, which is comprised of definite and indefinite net operating losses. We had federal net operating loss carryforwards of approximately $92.6 million, which expire at various intervals from the years 2026 to 2037, and had carryforwards of $147.4 million of net operating losses which do not expire. Federal net operating losses generated in tax years following December 31, 2017 carryover indefinitely and may be used to offset up to 80% of future taxable net income. We also had state net operating loss carryforwards of approximately $417.2 million, which expire at various intervals from the years 2026 through 2044. As of December 31, 2025, $196.6 million of our federal net operating loss carryforwards acquired in connection with the 2011 acquisition of Raven Holdings U.S., Inc., 2019 acquisition of Nulogix Health, Inc., and the 2025 acquisition of iCAD, Inc. are subject to limitations related to their utilization under Section 382 of the Internal Revenue Code. We also had foreign net operating loss carryforwards of approximately $106.0 million, which do not expire and are carried over indefinitely.
   
We considered all evidence available when determining whether deferred tax assets are more likely-than-not to be realized, including projected future taxable income, scheduled reversals of deferred tax liabilities, prudent tax planning strategies, and recent financial operations. The evaluation of this evidence requires significant judgment about the forecasts of future taxable income, based on the plans and estimates we are using to manage the underlying businesses. In evaluating the objective evidence that historical results provide, we consider three years of cumulative operating income. As of December 31, 2025, we have determined that deferred tax assets of $249.0 million are more likely-than-not to be realized. We have also determined deferred tax liabilities of $10.3 million are related to book basis in goodwill that has an indefinite life.
 
We file consolidated income tax returns in the U.S. federal jurisdiction and various states and foreign jurisdictions. We continue to reinvest earnings of the non-US entities for the foreseeable future and therefore have not recognized any U.S. tax expense on these earnings. With limited exceptions, we are no longer subject to U.S. federal, state and local, or non-U.S. income tax examinations by tax authorities for years before 2019. We do not anticipate the results of any open examinations would result in a material change to our financial position.
  
A reconciliation of the total gross amounts of unrecognized tax benefits for the years ended are as follows (in thousands):
 December 31,
 20252024
Balance at beginning of year$3,024 $3,082 
Increases related to prior year tax positions443 276 
Increases related to current year tax positions— 45 
Increases related to acquisitions4,079 — 
Expiration of the statute of limitations for the assessment of taxes(367)(381)
Increase related to change in rate(7)2 
Balance at end of year$7,172 $3,024 

At December 31, 2025, we had unrecognized tax benefits of $7.2 million of which $6.6 million will affect the effective tax rate if recognized.
 
We recognize accrued interest and penalties related to unrecognized tax benefits in income tax expense. During the year ended December 31, 2025 the Company accrued approximately $14 thousand of interest and penalties. As of December 31, 2025, accrued interest and penalties amounted to approximately $0.4 million. We do not anticipate the uncertain tax position to change materially within the next 12 months.

The Organization for Economic Co-operation and Development issued Pillar Two model rules for a global minimum tax of 15% effective January 1, 2024. While it is uncertain whether the United States will enact legislation to adopt Pillar Two, certain countries in which we operate have adopted legislation, and other countries are in the process of introducing legislation to implement Pillar Two. Pillar Two had no impact on our 2024 ETR, and we do not currently expect Pillar Two to significantly impact our ETR going forward.

On July 4, 2025, the U.S. President signed into law H.R.1, the legislation commonly known as the One Big Beautiful Bill Act (OBBBA). This legislation extended, modified, or made permanent many of the tax provisions which were initially enacted as part of the Tax Cuts and Jobs Act (TCJA) of 2017. The OBBBA contains a number of tax provisions including, but not limited to, immediate expensing of domestic research and experimental expenditures, modifications to the limitation on
business interest, bonus depreciation modifications, as well as international tax provision modifications. These tax provisions apply to either tax years beginning after December 31, 2024 or December 31, 2025.

The Company is still in the process of analyzing some of the tax elections available under the OBBBA. However, we do not expect these elections to have an impact on our effective rate for 2025.