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Long-term debt (Tables)
 9 Months Ended
Sep. 30, 2024
Debt Disclosure [Abstract]  
Long-term Debt
Long-term debt comprised the following:
As of September 30, 2024
September 30,
2024		December 31, 2023Maturity dateInterest rate
Estimated fair value(1)
Senior Secured Credit Facilities:  
Term Loan A-1$2,289,022 $1,234,375 4/28/2028
Base +1.75%(2)
$2,277,577 
Term Loan B-1— 2,603,786 8/12/2026$— 
Extended Term Loan B-11,640,251 5/9/2031SOFR + 2.00%$1,638,201 
Revolving line of credit— — 4/28/2028
Base +1.75%(2)
$— 
Senior Notes:
4.625% Senior Notes2,750,000 2,750,000 6/1/20304.625 %$2,622,813 
3.75% Senior Notes1,500,000 1,500,000 2/15/20313.75 %$1,350,000 
6.875% Senior Notes1,000,000 — 9/1/20326.875 %$1,035,000 
Acquisition obligations and other notes payable(3)
87,945 102,328 2024-20366.55 %$87,945 
Financing lease obligations(4)
236,722 255,491 2025-20404.62 %
CHC temporary funding assistance(5)
119,814 — %$119,814 
Total debt principal outstanding9,623,754 8,445,980 
Discount, premium and deferred financing costs(6)
(67,168)(54,347)
 9,556,586 8,391,633 
Less current portion(296,255)(123,299)
 $9,260,331 $8,268,334 
(1)For the Company's senior secured credit facilities, fair value estimates are based on bid and ask quotes, a level 2 input. For the Company's senior notes, fair value estimates are based on market level 1 inputs. For acquisition obligations and other notes payable, the carrying values presented here approximate their estimated fair values, based on estimates of their present values typically using level 2 interest rate inputs. For the CHC temporary funding assistance, the carrying value presented here approximates the estimated fair value based on the short-term nature of settlement.
(2)The Company's senior secured credit facilities bear interest at Term SOFR, plus an interest rate margin, with certain portions also subject to a credit spread adjustment (CSA). Term SOFR plus CSA is referred to as "Base" in the table above. The Term Loan A-1 and revolving line of credit bear a CSA of 0.10%.
(3)The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of September 30, 2024.
(4)Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding.
(5)The Change Healthcare (CHC) temporary funding assistance, as described below, is interest-free and amounts provided under this program are subject to repayment within 45 business days from a future date to be mutually agreed to by the parties. The balance is included in the Company's current portion of long-term debt as of September 30, 2024.
(6)As of September 30, 2024, the carrying amount of the Company's senior secured credit facilities has been reduced by a discount of $8,410 and deferred financing costs of $30,740, and the carrying amount of the Company's senior notes has been reduced by deferred financing costs of $38,729 and increased by a debt premium of $10,711. As of December 31, 2023, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $2,487 and deferred financing costs of $32,498, and the carrying amount of the Company's senior notes was reduced by deferred financing costs of $31,491 and increased by a debt premium of $12,129.
Schedule of Derivative Instruments
The following table summarizes the Company’s interest rate cap agreements outstanding during the nine months ended September 30, 2024: 
Year cap agreements executedNotional amountSOFR maximum rateApproximate effective dateNotional reduction or contractual maturity date
At December 31 unless noted
2024(1)
202520262027
2019$3,500,000 2.00%6/30/2020$3,500,000 
2023$1,000,000 3.75%6/30/2024$500,000 $500,000 
2023$1,000,000 
4.00%(2)
6/30/2024$250,000 $750,000 
2023$1,000,000 
4.75%(3)
6/30/2024$250,000 $750,000 
2023$500,000 
5.00%(4)
6/30/2024$500,000 
2023$250,000 4.50%12/31/2024$250,000 
2023$750,000 4.00%12/31/2024$250,000 $500,000 
2024$1,000,000 
4.50%(5)
12/31/2025$500,000 $500,000 
2024$750,000 
4.00%(6)
12/31/2025$250,000 $500,000 
(1)The Company's 2019 cap agreements matured on June 30, 2024.
(2)Effective January 1, 2025, the maximum rate of 4.00% decreases to 3.75% for these interest rate caps.
(3)Effective January 1, 2025, the maximum rate of 4.75% decreases to 4.00% for these interest rate caps.
(4)Effective January 1, 2025, the maximum rate of 5.00% decreases to 4.50% for these interest rate caps.
(5)Effective December 31, 2026, the maximum rate of 4.50% increases to 4.75% for these interest rate caps.
(6)Effective December 31, 2026, the maximum rate of 4.00% increases to 4.25% for these interest rate caps.