Fair Value Measurement
Fair value represents the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. When determining fair value, the Company considers the principal or most advantageous market in which the Company would conduct a transaction, in addition to the assumptions that market participants would use when pricing the related assets or liabilities, including non-performance risk.
A three-level hierarchy prioritizes the inputs to valuation techniques used to measure fair value and requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. The three levels of the fair value hierarchy are as follows:
Level 1—Quoted prices in active markets for identical assets or liabilities.
Level 2—Observable inputs other than Level 1 prices such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.
Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.
There were no transfers between the three levels of the fair value hierarchy during the years ended December 31, 2025, 2024 and 2023.
Assets and Liabilities Measured on a Recurring Basis
From time to time, the Company invests a portion of its cash and cash equivalents in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.
The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, which are Level 1 inputs. The deferred compensation plan is more fully described in Note (10), “Retirement Plans.”
The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company include commercial paper and corporate bonds. The commercial paper is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. The corporate bonds are measured using readily available pricing sources that utilize observable market data, including the current interest rate for comparable instruments, which are Level 2 inputs. The following table presents the fair value of commercial paper and corporate bonds issued and outstanding:
| | | | | | | | | | | |
| | As of December 31, 2025 | | As of December 31, 2024 |
| Commercial paper | $ | 12,985 | | | $ | 64,580 | |
| | | |
| Total classified as restricted cash equivalents | $ | 12,985 | | | $ | 64,580 | |
| Commercial paper | $ | 1,449 | | | $ | 1,399 | |
| Corporate bonds | 32,586 | | | 6,769 | |
| Total classified as restricted investments | $ | 34,035 | | | $ | 8,168 | |
The fair value of our available-for-sale securities as of December 31, 2025, by remaining contractual maturities, are presented in the following table:
| | | | | |
| | Fair Value |
| Due in one year or less | $ | 3,807 | |
| Due after one year through five years | 30,228 | |
| $ | 34,035 | |
Expected maturities may differ from stated due dates because borrowers may have the ability to call or prepay obligations with or without call or prepayment penalties.
The Company’s contingent consideration liabilities are measured at fair value using probability-weighted discounted cash flow analysis or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the consolidated statements of comprehensive income (loss). There were no assets or liabilities measured on a recurring basis with level 3 inputs outstanding as of December 31, 2025 and 2024.
The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value:
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| | Fair Value Measurements as of December 31, 2025 | | Fair Value Measurements as of December 31, 2024 |
| Assets (Liabilities) | Level 1 | | Level 2 | | | | Total | | Level 1 | | Level 2 | | | | Total |
| | | | | | | | | | | | | | | |
| Deferred compensation | $ | (205,390) | | | $ | — | | | | | $ | (205,390) | | | $ | (191,006) | | | $ | — | | | | | $ | (191,006) | |
| Corporate bonds | — | | | 32,586 | | | | | 32,586 | | | — | | | 6,769 | | | | | 6,769 | |
| Commercial paper | — | | | 14,434 | | | | | 14,434 | | | — | | | 65,979 | | | | | 65,979 | |
| | | | | | | | | | | | | | | |
Assets Measured on a Non-Recurring Basis
The Company applies fair value techniques on a non-recurring basis associated with valuing identifiable intangible assets acquired through acquisitions and potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments.
The fair value of identifiable intangible assets are determined using either the income approach (the relief-from-royalty method, multi-period excess earnings method or with-and-without method) or the cost approach (replacement cost method).
These valuation approaches use a combination of assumptions, including Level 3 inputs, such as (i) forecasted revenue, growth rates and customer attrition rates, (ii) forecasted operating expenses and profit margins, and (iii) royalty rates and discount rates used to present value the forecasted cash flows.
The Company assesses long-lived assets (including definite-lived intangible assets, fixed assets, and right-of-use assets) for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of long-lived assets to be held and used is measured by a comparison of the carrying amount of an asset group to the future undiscounted net cash flows that are expected to be generated by the asset group. If such asset group is considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the asset group exceeds its fair value. The Company determines the fair value of its asset groups based on a combination of inputs, including Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. In connection with the impairment loss on the customer relationships intangible assets recognized during the three months ended June 30, 2025, the following unobservable inputs were used in discounted cash flow method (within the income approach) to measure the fair value of the revenue cycle solutions asset group:
| | | | | | | | | | | | | | |
| | Range | | Average |
Revenue growth rates | | (2.1)% - 6.1% | | 3.3% |
Long-term growth rate | | 3.5% | | N/A |
Weighted-average cost of capital | | 14.0% | | N/A |
The Company maintains goodwill on its balance sheet, which represents the excess of the total purchase price of acquisitions over the fair value of the net assets and intangible assets acquired. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever events or changes in circumstances indicate that it is more likely than not that an impairment exists. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs. Refer to Note (5) “Goodwill and Identifiable Intangible Assets” for additional details. The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. When the Company identifies price changes in orderly transactions for identical or similar investments of the same issuer, the investment is measured at fair value. To determine whether a security of the same issuer is similar to the Company’s equity investment, the Company considers other information available such as the rights and obligations of the securities. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the consolidated statements of comprehensive income (loss). As of December 31, 2025, the Company has recognized cumulative upward adjustments and cumulative downward adjustments (including impairments) of $14,033 and $19,860, respectively. The balance of the equity investment was $2,773 as of December 31, 2025 and 2024.
Fair Value of Financial Instruments
The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. The fair value of the Company’s 4.625% senior notes due 2027 (the “2027 Notes”), 4.000% senior notes due 2029 (the “2029 Notes”), and 6.500% senior notes due 2031 (the “2031 Notes”), was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2027 Notes, the 2029 Notes, and the 2031 Notes which are more fully described in Note (9), “Notes Payable and Credit Agreement,” are presented in the following table: | | | | | | | | | | | | | | | | | | | | | | | |
| As of December 31, 2025 | | As of December 31, 2024 |
| Carrying Amount | | Estimated Fair Value | | Carrying Amount | | Estimated Fair Value |
| 2027 Notes | $ | — | | | $ | — | | | $ | 500,000 | | | $ | 473,750 | |
| 2029 Notes | 350,000 | | | 331,188 | | | 350,000 | | | 312,375 | |
2031 Notes | 400,000 | | | 398,500 | | | — | | | — | |
The Company initially recognized the 2027 Note Receivable at its estimated fair value of $9,899 in connection with the sale of its Smart Square healthcare scheduling software on July 1, 2025. The fair value was determined using Level 2 inputs, including observable market interest rates and pricing for similar credit facilities. The fair value of the 2027 Note Receivable was not re-measured as of December 31, 2025 as there were no material changes in contractual terms, counterparty credit risk, or other relevant factors. The carrying amount of $9,931 as of December 31, 2025 approximates its fair value and is classified as a noncurrent asset in the consolidated balance sheet. See Note (3), “Sale of Disposal Group” for additional information. The fair value of the Company’s long-term self-insurance accruals cannot be estimated as the Company cannot reasonably determine the timing of future payments.