7Baggers

Teladoc Health, Inc
(NYSE:TDOC) 

TDOC stock logo

Teladoc Health, Inc. provides virtual healthcare services on a business-to-business basis in the United States and internationally. It covers various clinical conditions, including non-critical, episodic care, chronic, and complicated cases like cancer and congestive heart failure, as well as offers...

Founded: 2002
IPO Price: $19 (Jul 01, 2015)
Full Time Employees: 5,100 (Dec 2021)
Founder: Brooks Michael Gorton 
CEO: Jason Gorevic  
Sector: Healthcare
Industry: Health Information Services
Telehealth
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At a glance:
  • Demand Normalizing After Pandemic Surge: Teladoc continues to face tougher year-over-year comparisons as utilization trends normalize, making growth more dependent on sustained engagement rather than one-time pandemic-driven adoption.
  • Better Execution Needed to Restore Profitability: Investors remain focused on Teladoc’s ability to improve operating leverage through cost controls and efficiency initiatives, with a clear path to consistent profitability a key driver of sentiment.
  • Chronic Care and Integrated Offerings Are Central to the Thesis: The company’s longer-term opportunity is tied to cross-selling and retaining members across primary care, mental health, and chronic condition programs to increase lifetime value and reduce churn.
  • Competitive Pressure and Pricing Remain Key Risks: Teladoc operates in a crowded virtual care market that includes large insurers, provider systems, and point-solution startups, which can pressure pricing and make member acquisition and retention more challenging.
  • Balance Sheet and Cash Flow Discipline in Focus: Market attention is on cash generation and capital allocation, with ongoing emphasis on maintaining liquidity, reducing cash burn (where applicable), and demonstrating sustainable cash flow over time.
Bull Thesis:
  • Market Leadership & Comprehensive Virtual Care Platform: Teladoc maintains a leading position in the telehealth market, offering a broad suite of services from urgent care to chronic condition management and mental health, positioning it as a holistic virtual care provider.
  • Increasing Adoption of Virtual Healthcare: The long-term trend towards virtual healthcare adoption continues, driven by convenience, cost-effectiveness, and provider shortages, creating a sustained demand for Teladoc's services.
  • Robust Payer and Employer Partnerships: Teladoc benefits from strong, established relationships with major health plans and large employers, providing a stable and recurring revenue base through contracted services and member access.
  • International Expansion Opportunities: Beyond its core U.S. market, Teladoc has significant potential for international growth as virtual care models gain traction globally, opening new revenue streams.
Bear Thesis:
  • Persistent Profitability Challenges & Negative Free Cash Flow: Despite revenue growth, Teladoc has struggled to achieve consistent GAAP profitability and generate positive free cash flow, raising concerns about its long-term financial sustainability without further capital raises.
  • Intensifying Competitive Landscape: The telehealth market is becoming increasingly crowded with new entrants from tech giants, traditional healthcare providers, and specialized startups, putting pressure on pricing and market share.
  • Integration & Synergy Realization Hurdles: The integration of Livongo has proven complex, leading to significant goodwill impairments and slower-than-anticipated cross-selling synergies, impacting overall financial performance and investor confidence.
  • High Marketing Spend & Reliance on BetterHelp: A substantial portion of Teladoc's revenue and growth is driven by BetterHelp, a B2C mental health service that requires high marketing expenditures and faces potential churn, impacting overall margins.
Main Competitors:
  • Amwell (American Well) ($AMWL) (Telehealth platform and services), A direct competitor offering a comprehensive telehealth platform to health systems, health plans, and employers. Amwell provides virtual urgent care, specialty care, and chronic condition management, directly vying for similar enterprise contracts and patient volumes as Teladoc.
  • MDLive (Evernorth/Cigna) (Virtual primary care, urgent care, mental health), Now part of Cigna's Evernorth health services division, MDLive offers a broad range of virtual care services including urgent care, primary care, and mental health. Its integration with a major insurer like Cigna provides a strong distribution channel and competitive advantage in securing employer and health plan contracts.
  • Omada Health (Digital chronic care management (diabetes, hypertension, weight management)), Specializes in digital-first chronic condition management programs, focusing on areas like diabetes prevention, hypertension, and weight management. Omada Health directly competes with Teladoc's Livongo segment for employer and health plan contracts aimed at preventing and managing chronic diseases.
  • Talkspace ($TALK) (Online therapy and psychiatry), A leading virtual mental health provider, offering therapy and psychiatry services through its platform. Talkspace directly competes with Teladoc's robust mental health offerings, including its BetterHelp subsidiary, for individual consumers and employer/health plan partnerships.
  • Large Integrated Health Systems (e.g., Mayo Clinic, Cleveland Clinic) (In-house telehealth services), Many major hospital systems and academic medical centers have developed their own sophisticated telehealth platforms and virtual care programs. They compete by leveraging their established brand trust, existing patient relationships, and extensive provider networks to offer virtual consultations, specialist care, and post-discharge follow-ups.
Moat:
Teladoc Health maintains a competitive moat primarily through its **scale, comprehensive service offering, and integrated platform**. As one of the largest and most recognized virtual care providers, it offers a broad spectrum of services, from general medical and mental health (BetterHelp) to chronic condition management (Livongo), enabling a 'whole-person' approach to care. Its extensive network of providers and deep integration with a vast client base (employers, health plans) create significant switching costs and network effects. The company also leverages data and AI to personalize care and improve outcomes. However, the competitive landscape is **intensely dynamic and fragmented**. Teladoc faces direct competition from other pure-play telehealth providers like Amwell and MDLive, which vie for similar enterprise contracts. Specialized digital health companies, such as Omada Health (chronic care) and Talkspace (mental health), challenge Teladoc in specific high-growth segments. Furthermore, traditional healthcare systems are increasingly developing their own robust in-house virtual care capabilities, leveraging their existing brand trust and patient relationships. The potential entry and expansion of large tech companies like Amazon into healthcare also represent a long-term competitive threat, pushing Teladoc to continuously innovate and demonstrate value.
Income Statements:
Quarterly
Annual
    Unit: USD2026-03-31 2025-12-31 2025-09-30 2025-06-30 2025-03-31 2024-12-31 2024-09-30 2024-06-30 2024-03-31 2023-12-31 2023-09-30 2023-06-30 2023-03-31 2022-12-31 2022-09-30 2022-06-30 2022-03-31 2021-12-31 2021-09-30 2021-06-30 2021-03-31 2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 2018-03-31 2017-12-31 2017-09-30 2017-06-30 2017-03-31 2016-12-31 2016-09-30 2016-06-30 2016-03-31 2015-12-31 2015-09-30 2015-06-30 
                                                
      revenue
    		613,845,000 642,269,000 626,439,000 631,900,000 629,369,000 640,491,000 640,508,000 642,444,000 646,131,000 660,527,000 660,238,000 652,406,000 629,244,000 637,709,000 611,402,000 592,379,000 565,350,000 554,235,000 521,658,000 503,139,000 453,675,000 383,321,000 288,812,000 241,030,000 180,799,000 156,489,000 137,969,000 130,276,000 128,573,000 122,741,000 110,962,000 94,560,000 89,644,000 77,140,000 68,650,000 44,591,000 42,898,000 37,400,000 32,381,000 26,488,000 26,888,000 22,639,000 19,973,000 18,283,000 
      yoy
    		-2.47% 0.28% -2.20% -1.64% -2.59% -3.03% -2.99% -1.53% 2.68% 3.58% 7.99% 10.13% 11.30% 15.06% 17.20% 17.74% 24.62% 44.59% 80.62% 108.75% 150.93% 144.95% 109.33% 85.01% 40.62% 27.50% 24.34% 37.77% 43.43% 59.11% 61.63% 112.06% 108.97% 106.26% 112.01% 68.34% 59.54% 65.20% 62.12% 44.88%     
      qoq
    		-4.43% 2.53% -0.86% 0.40% -1.74% -0.00% -0.30% -0.57% -2.18% 0.04% 1.20% 3.68% -1.33% 4.30% 3.21% 4.78% 2.01% 6.24% 3.68% 10.90% 18.35% 32.72% 19.82% 33.31% 15.53% 13.42% 5.91% 1.32% 4.75% 10.62% 17.35% 5.48% 16.21% 12.37% 53.95% 3.95% 14.70% 15.50% 22.25% -1.49% 18.77% 13.35% 9.24%  
      costs and expenses:
    		                                            
      cost of revenue
    		197,526,000 197,048,000 187,179,000 190,537,000 196,829,000 188,928,000 179,745,000 188,059,000 194,538,000 193,424,000 185,960,000 190,540,000 190,107,000 188,873,000 185,619,000 182,470,000 187,025,000 174,985,000 169,041,000 160,273,000 145,959,000 122,942,000 104,725,000 90,780,000 72,382,000 55,355,000 42,799,000 41,634,000 44,677,000 40,028,000 34,167,000 27,684,000 26,856,000 22,716,000 16,742,000 10,026,000 12,139,000 10,025,000 7,112,000 6,891,000 7,943,000 6,478,000 4,488,000 4,793,000 
      advertising and marketing
    		151,527,000 149,655,000 167,985,000 167,547,000 168,185,000 174,726,000 177,462,000 170,270,000 183,329,000 147,156,000 186,152,000 178,756,000 176,790,000 146,442,000 178,920,000 164,574,000 133,600,000 112,988,000 111,078,000 103,221,000 89,439,000 93,751,000 52,302,000 47,578,000 32,515,000 25,356,000 31,321,000 26,616,000 26,404,000 23,555,000 21,668,000 19,561,000 20,325,000 18,441,000 14,328,000 12,278,000 12,616,000 9,820,000 9,046,000 7,804,000 8,050,000 5,880,000 5,284,000 4,730,000 
      sales
    		51,276,000 47,665,000 48,209,000 49,951,000 48,693,000 52,726,000 47,465,000 50,438,000 54,364,000 53,451,000 52,309,000 53,530,000 54,490,000 56,279,000 54,634,000 57,930,000 58,329,000 59,330,000 62,602,000 63,856,000 64,793,000 93,942,000 23,483,000 18,687,000 17,940,000 16,751,000 16,120,000 15,832,000 16,212,000 14,509,000 16,303,000 14,559,000 13,783,000 11,279,000 11,393,000 7,324,000 7,988,000 7,451,000 7,662,000 5,860,000 5,270,000 4,786,000 5,111,000 4,397,000 
      technology and development
    		67,865,000 71,608,000 67,572,000 68,784,000 69,958,000 76,752,000 72,383,000 76,751,000 81,388,000 89,938,000 84,289,000 87,309,000 86,985,000 77,576,000 87,815,000 80,826,000 87,412,000 72,867,000 80,250,000 80,759,000 78,008,000 92,697,000 29,958,000 23,029,000 19,257,000 16,246,000 15,746,000 16,665,000 15,987,000 13,544,000 13,577,000 14,348,000 12,904,000 10,446,000 9,964,000 7,537,000 6,512,000 5,894,000 5,867,000 4,829,000 5,225,000 4,160,000 3,941,000 3,203,000 
      general and administrative
    		102,093,000 108,422,000 102,581,000 108,114,000 112,774,000 99,996,000 114,245,000 109,552,000 111,697,000 108,957,000 115,716,000 125,841,000 114,145,000 121,522,000 112,542,000 110,868,000 104,923,000 118,603,000 103,016,000 111,216,000 105,172,000 341,375,000 56,930,000 54,383,000 45,120,000 44,482,000 38,681,000 38,549,000 35,982,000 36,461,000 30,314,000 26,140,000 24,001,000 27,482,000 21,938,000 15,873,000 14,488,000 13,353,000 12,298,000 11,570,000 13,607,000 14,135,000 12,253,000 16,488,000 
      goodwill impairment
    		    59,138,000   790,000,000      3,772,812,000  3,030,000,000 6,600,000,000                            
      acquisition, integration, and transformation costs
    		1,064,000 2,233,000 1,931,000 2,658,000 2,188,000 456,000 457,000 457,000 373,000 4,262,000 5,824,000 5,080,000 5,944,000 6,627,000 1,594,000 2,892,000 4,507,000                            
      restructuring costs
    		11,975,000 6,796,000 1,950,000 5,692,000 4,347,000 5,602,000 3,580,000 1,500,000 9,673,000 899,000 411,000 7,530,000 8,102,000                                
      amortization of intangible assets
    		89,826,000 92,039,000 85,757,000 88,664,000 84,304,000 86,540,000 86,906,000 94,862,000 95,057,000                                    
      depreciation of property and equipment
    		2,461,000 2,800,000 2,612,000 4,338,000 3,564,000 2,980,000 2,666,000 1,703,000 2,834,000                                    
      total costs and expenses
    		675,613,000 678,266,000 678,401,000 686,285,000 749,980,000 688,706,000 684,909,000 1,483,592,000                                     
      income from operations
    		-61,768,000 -35,997,000 -51,962,000 -54,385,000 -120,611,000 -48,215,000 -44,401,000 -841,148,000 -87,122,000 -35,081,000 -64,725,000 -71,645,000 -77,102,000 -3,815,553,000 -71,730,000 -3,096,552,000 -6,669,379,000 -41,429,000 -60,576,000 -78,948,000 -84,678,000 -458,506,000 -19,725,000 -7,179,000 -21,011,000 -15,588,000 -19,944,000 -22,023,000 -22,887,000 -17,837,000 -15,778,000 -18,147,000 -19,092,000 -24,559,000 -21,541,000 -14,492,000 -14,802,000 -13,230,000 -20,257,000 -14,462,000 -14,715,000 -14,346,000 -12,595,000  
      yoy
    		-48.79% -25.34% 17.03% -93.53% 38.44% 37.44% -31.40% 1074.05% 13.00% -99.08% -9.77% -97.69% -98.84% 9109.86% 18.41% 3822.27% 7776.17% -90.96% 207.10% 999.71% 303.02% 2841.40% -1.10% -67.40% -8.20% -12.61% 26.40% 21.36% 19.88% -27.37% -26.75% 25.22% 28.98% 85.63% 6.34% 0.21% 0.59% -7.78% 60.83%      
      qoq
    		71.59% -30.72% -4.46% -54.91% 150.15% 8.59% -94.72% 865.48% 148.35% -45.80% -9.66% -7.08% -97.98% 5219.33% -97.68% -53.57% 15998.33% -31.61% -23.27% -6.77% -81.53% 2224.49% 174.76% -65.83% 34.79% -21.84% -9.44% -3.78% 28.31% 13.05% -13.05% -4.95% -22.26% 14.01% 48.64% -2.09% 11.88% -34.69% 40.07% -1.72% 2.57% 13.90%   
      operating margin %
    		-10.06% -5.60% -8.29% -8.61% -19.16% -7.53% -6.93% -130.93% -13.48% -5.31% -9.80% -10.98% -12.25% -598.32% -11.73% -522.73% -1179.69% -7.47% -11.61% -15.69% -18.66% -119.61% -6.83% -2.98% -11.62% -9.96% -14.46% -16.90% -17.80% -14.53% -14.22% -19.19% -21.30% -31.84% -31.38% -32.50% -34.51% -35.37% -62.56% -54.60% -54.73% -63.37% -63.06% 0% 
      interest income
    		-6,490,000 -6,951,000 -7,081,000 -10,064,000 -12,674,000 -14,231,000 -15,326,000 -13,572,000 -13,942,000 -13,707,000 -12,606,000 -11,558,000                            -407,000 -427,000    
      interest expense
    		5,368,000 4,950,000 4,526,000 4,473,000 5,765,000 6,846,000 5,660,000 5,648,000 5,649,000 5,538,000 5,646,000 5,835,000 -3,648,000 -1,893,000 1,346,000 4,337,000 5,480,000 18,872,000 18,895,000 20,473,000 22,125,000 20,819,000 17,222,000 13,151,000 9,303,000 7,581,000 7,700,000 7,211,000 6,521,000 6,663,000 7,666,000 6,910,000 4,873,000 7,813,000 8,202,000 774,000 702,000 881,000 873,000      
      other expense
    		196,000 -378,000 815,000 -8,371,000 -2,435,000 7,341,000 -2,239,000 563,000 370,000 -1,537,000 1,792,000 207,000  -1,748,000 1,571,000 1,760,000  405,000 376,000 -217,000 -5,652,000                        
      income before provision for income taxes
    		-60,842,000 -33,618,000 -50,222,000 -40,423,000 -111,267,000 -48,171,000 -32,496,000 -833,787,000 -79,199,000 -25,375,000 -59,557,000 -66,129,000 -68,547,000                                
      provision for income taxes
    		2,995,000 -8,475,000 -715,000 -7,763,000 -18,255,000 238,000 780,000 3,884,000 2,690,000 3,515,000 -2,484,000 -952,000 681,000 -1,841,000 -1,171,000 -1,188,000                             
      net income
    		-63,837,000 -25,143,000 -49,507,000 -32,660,000 -93,012,000 -48,409,000 -33,276,000 -837,671,000 -81,889,000 -28,890,000 -57,073,000 -65,177,000 -69,228,000 -3,810,071,000 -73,476,000 -3,101,461,000 -6,674,523,000 -10,985,000 -84,340,000 -133,819,000 -199,649,000 -393,967,000 -35,884,000 -25,682,000 -29,603,000 -19,044,000 -20,346,000 -29,324,000 -30,150,000 -24,879,000 -23,264,000 -25,079,000 -23,862,000 -44,383,000 -31,330,000 -15,415,000 -15,654,000 -14,261,000 -29,772,000 -14,879,000 -15,304,000 -15,007,000 -13,246,000  
      yoy
    		-31.37% -48.06% 48.78% -96.10% 13.58% 67.56% -41.70% 1185.22% 18.29% -99.24% -22.32% -97.90% -98.96% 34584.31% -12.88% 2217.65% 3243.13% -97.21% 135.04% 421.06% 574.42% 1968.72% 76.37% -12.42% -1.81% -23.45% -12.54% 16.93% 26.35% -43.94% -25.75% 62.69% 52.43% 211.22% 5.23% 3.60% 2.29% -4.97% 124.76%      
      qoq
    		153.90% -49.21% 51.58% -64.89% 92.14% 45.48% -96.03% 922.93% 183.45% -49.38% -12.43% -5.85% -98.18% 5085.46% -97.63% -53.53% 60660.34% -86.98% -36.97% -32.97% -49.32% 997.89% 39.72% -13.25% 55.45% -6.40% -30.62% -2.74% 21.19% 6.94% -7.24% 5.10% -46.24% 41.66% 103.24% -1.53% 9.77% -52.10% 100.09% -2.78% 1.98% 13.29%   
      net income margin %
    		-10.40% -3.91% -7.90% -5.17% -14.78% -7.56% -5.20% -130.39% -12.67% -4.37% -8.64% -9.99% -11.00% -597.46% -12.02% -523.56% -1180.60% -1.98% -16.17% -26.60% -44.01% -102.78% -12.42% -10.66% -16.37% -12.17% -14.75% -22.51% -23.45% -20.27% -20.97% -26.52% -26.62% -57.54% -45.64% -34.57% -36.49% -38.13% -91.94% -56.17% -56.92% -66.29% -66.32% 0% 
      other comprehensive income, net of tax:
    		                                            
      currency translation adjustment
    		-694,000 -121,000 791,000 1,847,000 1,143,000 -1,282,000 1,860,000 -337,000 -1,639,000                                    
      comprehensive loss
    		-64,531,000 -25,264,000 -48,716,000 -30,813,000 -91,869,000 -49,691,000 -31,416,000 -838,008,000 -83,528,000 -24,360,000 -59,813,000 -62,960,000 -67,449,000 -3,803,581,000 -92,878,000 -3,119,901,000 -6,679,662,000 -16,138,000 -97,763,000 -126,554,000 -213,141,000                        
      net income per share
    		-0.36 -0.14 -0.28 -0.19 -0.53 -0.26 -0.19 -4.92 -0.49 -0.17 -0.35 -0.4 -0.42 -23.51 -0.45 -19.22 -41.58 -0.05 -0.53 -0.86 -1.31 -4.19 -0.43 -0.34 -0.4 -0.27 -0.28 -0.41 -0.43 -0.35 -0.34 -0.4 -0.39 -0.78 -0.55 -0.28 -0.3 -0.29 -0.65 -0.38 -0.4 0.24 -0.37 -7.2 
      weighted-average shares used for eps calculation
    		179,122,268 176,221,530 176,934,781 175,917,380 174,154,128 170,564,088 171,496,282 170,229,583 167,730,746 164,578,219 165,119,379 164,171,372 162,922,691 161,457,123 161,727,962 161,377,695 160,532,301 156,939,349 159,435,165 156,055,090 152,167,606 90,509,229 83,607,902 76,512,870 73,278,857 71,844,535 72,151,094 71,721,246 70,919,496 65,844,908 68,247,655 62,975,535 61,797,762 55,427,460 56,493,054 54,572,862 52,192,859 42,330,908 45,860,269 38,717,186 38,584,345 19,917,348 36,099,556 2,370,113 
      goodwill impairments
    		  12,625,000                                          
      other comprehensive loss, net of tax:
    		                                            
      expenses:
    		                                            
      operating expenses:
    		                                            
      total expenses
    		        733,253,000 695,608,000 724,963,000 724,051,000 706,346,000 4,453,262,000 683,132,000 3,688,931,000 7,234,729,000 595,664,000 582,234,000 582,087,000 538,353,000 841,827,000 308,537,000 248,209,000 201,810,000 172,077,000 157,913,000 152,299,000                 
      depreciation and amortization
    		         59,887,500 94,302,000 75,465,000 69,783,000 75,715,000 62,008,000 59,371,000 58,933,000 52,332,000 51,907,000 51,341,000 48,659,000 36,960,000 12,932,000 9,893,000 9,710,000 9,887,000 9,617,000 9,848,000 9,600,000 9,557,000 9,746,000 8,046,000 8,253,000 7,402,000 6,418,000 2,668,000 2,607,000 2,597,000 2,607,000 1,558,000 1,508,000 1,546,000 1,491,000 923,000 
      currency translation adjustment and other
    		         4,530,000 -2,740,000 2,217,000 1,779,000 6,490,000 -19,402,000 -18,440,000 -5,139,000                            
      other income
    		            -4,907,000    -724,000                            
      loss on extinguishment of debt
    		                 20,000 850,000 31,419,000 11,459,000 99,000 1,227,000 7,751,000                     
      net loss before provision for income taxes
    		             -2,462,857,750 -74,647,000 -3,102,649,000                             
      net loss before taxes
    		                -6,674,135,000 -60,726,000 -80,697,000 -130,623,000 -112,610,000 -479,424,000 -38,174,000 -28,081,000 -30,314,000 -23,169,000 -27,644,000 -29,234,000 -29,408,000 -24,500,000 -23,444,000 -25,057,000 -23,965,000 -45,037,000 -31,200,000 -15,266,000 -15,504,000 -14,111,000 -29,584,000      
      income tax expense
    		                388,000 -49,741,000 3,643,000 3,196,000 87,039,000 -85,457,000 -2,290,000 -2,399,000 -711,000                    
      acquisition, integration and transformation costs
    		                 5,521,000 4,340,000 11,421,000 6,323,000                        
      other comprehensive gain, net of tax:
    		                                            
      cumulative translation adjustment
    		                 -4,912,500 -13,423,000 7,265,000 -13,492,000                        
      legal and regulatory
    		                     2,610,000 2,812,000 2,232,000 1,222,000 1,523,000 1,634,000 2,019,000                 
      acquisition and integration related costs
    		                     57,550,000 25,395,000 1,627,000 3,664,000 2,477,000 1,995,000 1,136,000 1,012,000 1,434,000 1,588,000 5,800,000 1,569,000 2,557,000 8,526,000          
      gain on sale
    		                              -1,430,000 -4,070,000             
      income tax benefit
    		                         -4,125,000 -7,298,000           -90,000 -188,000 -10,000 -162,000 -31,250 162,000 171,000 
      income tax provision
    		                           90,000 742,000 379,000 -180,000 22,000 -103,000 -654,000 130,000 149,000 150,000        
      gross profit
    		                            83,896,000 82,713,000 76,795,000 66,876,000 62,788,000 54,424,000 51,908,000 34,565,000 30,759,000 27,375,000 25,269,000 19,597,000 18,945,000 16,161,000 15,485,000 13,490,000 
      yoy
    		                            33.62% 51.98% 47.94% 93.48% 104.13% 98.81% 105.42% 76.38% 62.36% 69.39% 63.18% 45.27%     
      qoq
    		                            1.43% 7.71% 14.83% 6.51% 15.37% 4.85% 50.18% 12.37% 12.36% 8.33% 28.94% 3.44% 17.23% 4.37% 14.79%  
      gross margin %
    		0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 65.25% 67.39% 69.21% 70.72% 70.04% 70.55% 75.61% 77.52% 71.70% 73.20% 78.04% 73.98% 70.46% 71.39% 77.53% 73.78% 
      legal
    		                            1,097,000 1,023,000 254,000 108,000 481,000 760,000 105,000 277,000 343,000 769,000 1,033,000 1,666,000     
      regulatory
    		                            489,000 467,000 553,000 531,000 564,000 616,000 777,000 987,000 1,007,000 721,000 817,000 772,000     
      amortization of warrants and loss on extinguishment of debt
    		                                 12,665,000 1,457,000    8,454,000      
      acquisition related costs
    		                                   2,113,000   6,196,000      
      net income before taxes
    		                                       -14,869,000 -15,142,000 -14,846,000 -13,084,000  
      interest (expense)
    		                                         -424,750 -489,000  
      preferred stock dividend
    		                                            
      accretion of preferred stock
    		                                            
      net income available to common stockholders
    		                                         -10,753,250 -13,246,000 -17,064,000 
      pro forma net income per share, basic and diluted
    		                                         -0.39 -0.35  
      pro forma net loss per share, basic and diluted
    		                                           -0.46 
    Balance Sheets:
    Quarterly
    Annual
      Unit: USD2026-03-31 2025-12-31 2025-09-30 2025-06-30 2025-03-31 2024-12-31 2024-09-30 2024-06-30 2024-03-31 2023-12-31 2023-09-30 2023-06-30 2023-03-31 2022-12-31 2022-09-30 2022-06-30 2022-03-31 2021-12-31 2021-09-30 2021-06-30 2021-03-31 2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 2018-03-31 2017-12-31 2017-09-30 2017-06-30 2017-03-31 2016-12-31 2016-09-30 2016-06-30 2016-03-31 2015-12-31 2015-09-30 2015-06-30 
                                                  
        assets
      		                                            
        current assets:
      		                                            
        cash and cash equivalents
      		750,738,000 781,084,000 726,249,000 679,621,000 1,193,332,000 1,298,327,000 1,243,866,000 1,162,383,000 1,097,935,000 1,123,675,000 1,030,527,000 958,695,000 888,579,000 918,182,000 899,631,000 881,161,000 836,444,000 893,480,000 823,828,000 783,724,000 720,104,000 733,324,000 1,187,299,000 1,308,843,000 507,956,000 514,353,000 475,242,000 440,443,000 433,958,000 423,989,000 457,554,000 105,804,000 65,179,000 42,817,000 83,119,000 409,224,000 139,948,000 50,015,000 44,032,000 55,781,000 50,193,000 55,066,000 54,064,000 15,423,000 
        accounts receivable
      		213,627,000 192,826,000 210,757,000 225,431,000 232,971,000 214,146,000 212,039,000 218,420,000 214,293,000 217,423,000 205,866,000 215,181,000 215,981,000 210,554,000 201,701,000 205,434,000   178,072,000 179,436,000 178,341,000 169,281,000 85,803,000 76,902,000 70,721,000 56,948,000 53,669,000 49,778,000 50,583,000 43,571,000 39,965,000 38,100,000 30,701,000 27,094,000 26,995,000 14,229,000 15,309,000 13,806,000 12,904,000 13,209,000 13,819,000 12,134,000 9,370,000 8,954,000 
        inventories
      		31,557,000 38,203,000 39,904,000 38,159,000 38,012,000 38,138,000 36,993,000 34,896,000 32,268,000 29,513,000 35,916,000 34,054,000 45,801,000 56,342,000 59,344,000 60,260,000 70,654,000 73,079,000 56,937,000 56,990,000 58,290,000 56,498,000 11,578,000                      
        prepaid expenses and other current assets
      		136,417,000 107,016,000 115,849,000 130,059,000 137,514,000 113,296,000 115,738,000 130,956,000 141,769,000 118,437,000 114,782,000 113,034,000 136,346,000 130,310,000 126,912,000 107,875,000 106,875,000 87,387,000 95,941,000 82,149,000 73,065,000 47,259,000 22,293,000 14,433,000 14,932,000 13,990,000 13,416,000 10,227,000 10,503,000 10,631,000 10,760,000 8,396,000 6,497,000 6,839,000 7,484,000 2,468,000 3,564,000 3,103,000 3,380,000 1,661,000 2,639,000 2,096,000 2,547,000 5,604,000 
        total current assets
      		1,132,339,000 1,119,129,000 1,092,759,000 1,073,270,000 1,601,829,000 1,663,907,000 1,608,636,000 1,546,655,000 1,486,265,000 1,489,048,000 1,387,091,000 1,320,964,000 1,286,707,000 1,315,388,000 1,287,588,000 1,257,269,000 1,208,045,000 1,225,439,000 1,157,316,000 1,104,837,000 1,032,330,000 1,059,607,000 1,310,043,000 1,403,110,000 596,428,000 588,002,000 557,960,000 532,609,000 540,789,000 532,736,000 523,253,000 178,859,000 156,932,000 156,239,000 207,356,000 456,991,000 194,826,000 82,717,000 91,232,000 127,349,000 136,173,000 151,578,000 163,948,000 30,059,000 
        property and equipment
      		26,278,000 26,972,000 26,916,000 27,667,000 30,640,000 29,487,000 28,030,000 29,330,000 29,550,000 32,032,000 32,887,000 30,392,000 29,791,000 29,641,000 27,270,000 27,403,000 28,419,000 27,234,000 27,027,000 28,184,000 28,436,000 28,551,000 20,364,000 9,606,000 10,092,000 10,296,000 10,021,000 9,722,000 9,841,000 10,148,000 9,717,000 10,034,000 7,995,000 8,963,000 9,627,000 7,424,000 7,441,000 7,479,000 7,124,000 6,100,000 6,087,000 6,259,000 5,852,000 4,154,000 
        goodwill
      		283,190,000 283,190,000 283,190,000 283,190,000 283,190,000 283,190,000 283,190,000 283,190,000 1,073,190,000 1,073,190,000 1,073,190,000 1,073,190,000 1,073,190,000 1,073,190,000 4,846,001,000 4,858,196,000 7,899,795,000 14,504,174,000 14,470,399,000 14,454,712,000 14,451,975,000 14,581,255,000 1,691,355,000 742,314,000 734,386,000 746,079,000 737,647,000 748,073,000 734,459,000 737,197,000 744,062,000 745,280,000 498,277,000 498,520,000 498,549,000 188,184,000 188,184,000 188,184,000 188,136,000 56,342,000 56,342,000 56,342,000 56,342,000 56,260,000 
        intangible assets
      		1,235,185,000 1,297,087,000 1,336,653,000 1,383,306,000 1,393,381,000 1,431,360,000 1,496,698,000 1,547,498,000 1,614,238,000 1,677,781,000 1,728,302,000 1,784,105,000 1,815,948,000 1,836,765,000 1,854,263,000 1,872,172,000 1,883,897,000 1,910,278,000 1,932,012,000 1,963,172,000 1,997,214,000 2,020,864,000 386,573,000 213,474,000 214,666,000 225,453,000 228,838,000 239,344,000 238,314,000 247,394,000 256,834,000 264,677,000 153,493,000 159,811,000 164,570,000 21,239,000 23,078,000 24,875,000 26,386,000 13,794,000 14,588,000 15,265,000 16,854,000 16,203,000 
        operating lease—right-of-use assets
      		24,233,000 26,119,000 32,365,000 25,501,000 26,589,000 27,092,000 34,115,000 35,538,000                                     
        other assets
      		106,036,000 105,803,000 106,664,000 101,070,000 108,816,000 81,488,000 77,912,000 81,427,000 80,007,000 80,258,000 74,452,000 72,930,000 63,993,000 48,540,000 43,656,000 37,940,000 26,629,000 20,703,000 17,890,000 18,334,000 28,002,000 18,357,000 7,117,000 19,884,000 15,330,000 6,545,000 6,367,000 6,376,000 1,372,000 1,401,000 1,316,000 1,059,000 827,000 858,000 822,000 308,000 424,000 415,000 390,000 305,000 293,000 293,000 284,000 265,000 
        total assets
      		2,807,261,000 2,858,300,000 2,878,547,000 2,894,004,000 3,444,445,000 3,516,524,000 3,528,581,000 3,523,638,000 4,320,756,000 4,392,369,000 4,327,973,000 4,316,405,000 4,309,147,000 4,345,355,000 8,103,965,000 8,102,775,000 11,092,337,000 17,734,608,000 17,652,579,000 17,611,119,000 17,582,358,000 17,755,281,000 3,449,385,000 2,418,828,000 1,603,077,000 1,602,827,000 1,568,429,000 1,565,344,000 1,551,625,000 1,528,876,000 1,535,182,000 1,199,909,000 817,524,000 824,391,000 880,924,000 674,146,000 413,953,000 303,670,000 313,268,000 203,890,000 213,483,000 229,737,000 243,280,000 106,941,000 
        liabilities and stockholders’ equity
      		                                            
        current liabilities:
      		                                            
        accounts payable
      		45,196,000 47,967,000 52,198,000 54,434,000 52,054,000 33,130,000 37,801,000 56,111,000 37,674,000 43,637,000 25,998,000 16,071,000 38,625,000 47,690,000 70,783,000 94,371,000 47,412,000 47,257,000 34,655,000 42,077,000 34,377,000 46,030,000 21,408,000 10,816,000 8,142,000 9,075,000 6,068,000 6,079,000 7,738,000 7,769,000 4,821,000 5,545,000 3,290,000 3,884,000 1,852,000 1,150,000 1,949,000 2,236,000 785,000 506,000 1,078,000 2,213,000 2,056,000 6,962,000 
        accrued expenses and other current liabilities
      		233,292,000 198,208,000 205,898,000 202,304,000 218,971,000 202,157,000 188,095,000 173,804,000 199,418,000 178,634,000 192,553,000 192,937,000 184,642,000 168,693,000 177,111,000 127,187,000 116,689,000 102,933,000 106,252,000 91,609,000 82,397,000 83,657,000 65,130,000 75,153,000 71,927,000 49,848,000 53,822,000 46,201,000 45,733,000 26,801,000 32,586,000 27,936,000 21,498,000 19,357,000 24,137,000 9,684,000 8,947,000 7,981,000 9,733,000 6,608,000 9,485,000 8,197,000 8,045,000 12,791,000 
        accrued compensation
      		60,668,000 96,258,000 76,848,000 70,332,000 56,741,000 76,229,000 66,437,000 54,656,000 50,523,000 102,686,000 84,897,000 67,001,000 50,900,000 81,554,000 63,211,000 51,594,000 46,075,000 91,941,000 75,891,000 59,629,000 59,439,000 94,593,000 53,957,000 37,579,000 17,095,000 31,258,000 25,312,000 18,141,000 18,231,000 27,869,000 20,786,000 23,538,000 13,024,000 17,089,000 14,854,000 8,853,000 7,242,000 8,856,000 7,781,000 4,631,000 3,135,000 6,326,000 5,956,000 5,088,000 
        deferred revenue, current
      		65,714,000                                            
        total current liabilities
      		404,870,000 404,738,000 405,090,000 401,767,000 952,423,000 941,535,000 931,381,000 930,727,000 388,844,000 420,616,000 402,640,000 383,394,000 381,344,000 399,769,000 411,401,000 371,479,000 306,687,000 331,013,000 302,105,000 276,227,000 260,364,000 332,649,000 200,825,000 123,548,000 97,164,000 90,181,000 85,202,000 70,421,000 71,702,000 62,439,000 58,193,000 57,019,000 37,812,000 40,330,000 40,843,000 19,687,000 18,138,000 21,073,000 20,299,000 15,995,000 14,948,000 17,986,000 17,307,000 26,091,000 
        operating lease liabilities, net of current portion
      		31,738,000 34,204,000 37,799,000 32,047,000 33,798,000 32,135,000 36,896,000 37,716,000 39,971,000 42,837,000 34,353,000 36,809,000 35,927,000 38,042,000 41,080,000 44,274,000 40,163,000 41,773,000 42,729,000 36,493,000 40,140,000 43,142,000 30,326,000 27,940,000 29,430,000 24,994,000 25,853,000 26,386,000 22,936,000                
        deferred revenue, net of current portion
      		10,365,000 9,139,000 11,204,000 10,694,000 10,246,000 9,786,000 10,469,000 11,743,000 15,002,000 13,623,000 13,152,000 14,240,000 4,117,000 3,872,000 3,146,000 3,373,000 2,884,000 3,834,000 4,075,000 3,501,000 2,716,000 2,449,000 4,884,000                      
        deferred taxes
      		27,610,000 28,945,000 34,058,000 29,947,000 24,336,000 49,851,000 50,846,000 50,673,000 47,472,000 49,452,000 44,252,000 48,097,000 50,613,000 50,939,000 51,742,000 55,926,000 57,516,000 75,777,000 93,824,000 81,882,000 84,876,000 102,103,000 17,896,000 18,976,000 18,848,000 21,678,000 22,720,000 31,710,000 29,748,000 32,444,000 34,964,000 35,175,000 12,258,000 12,906,000 14,416,000 1,994,000 1,844,000 1,694,000 1,545,000 1,357,000 1,347,000 1,185,000 33,000 78,000 
        convertible senior notes
      		995,811,000        1,539,546,000 1,538,688,000 1,537,833,000 1,536,981,000 1,536,134,000 1,535,288,000 1,534,448,000 1,533,609,000 1,532,780,000 1,225,671,000 1,211,375,000 1,201,039,000 1,352,977,000 1,379,592,000 953,484,000 948,178,000 447,221,000 440,410,000 433,760,000 427,197,000 420,893,000 414,683,000 408,653,000 402,755,000 210,432,000 207,370,000 204,393,000 201,395,000         
        other liabilities
      		551,000 643,000 4,237,000 4,245,000 4,322,000 720,000 736,000 1,007,000 1,023,000 1,080,000 1,693,000 1,740,000 1,749,000 1,618,000 1,632,000 1,609,000 1,445,000 1,492,000 1,328,000 1,346,000 1,383,000 1,616,000 1,033,000 5,257,000 10,237,000 11,539,000 7,156,000 6,990,000 4,788,000 6,191,000 5,601,000 5,579,000 6,154,000 4,882,000 7,555,000 9,254,000 8,104,000 7,609,000 6,655,000 7,441,000 7,128,000 6,775,000 6,517,000 6,625,000 
        total liabilities
      		1,470,945,000 1,472,594,000 1,486,432,000 1,471,865,000 2,017,415,000 2,025,445,000 2,020,879,000 2,021,552,000                                     
        commitments and contingencies
      		                                            
        stockholders’ equity:
      		                                            
        common stock, 0.001 par value...
      		180,000 178,000 177,000 177,000 175,000 173,000 172,000 171,000 169,000 167,000 166,000 165,000 164,000 163,000 162,000 162,000 161,000 160,000 160,000 159,000 154,000 150,000 84,000 79,000 74,000 73,000 72,000 72,000 71,000 70,000 70,000 64,000 62,000 61,000 57,000 55,000 54,000 46,000 46,000 39,000 39,000 38,000 38,000 3,000 
        additional paid-in capital
      		17,865,617,000 17,850,478,000 17,831,624,000 17,812,932,000 17,787,012,000 17,759,194,000 17,726,127,000 17,689,096,000 17,637,902,000 17,591,551,000 17,535,169,000 17,476,451,000 17,409,574,000 17,358,645,000 17,299,981,000 17,239,092,000 17,177,152,000 17,473,336,000 17,399,023,000 17,314,749,000 17,016,628,000 16,857,797,000 2,835,274,000 1,879,573,000 1,572,024,000 1,538,716,000 1,510,205,000 1,483,245,000 1,457,156,000 1,434,780,000 1,415,840,000 1,062,362,000 882,804,000 866,330,000 710,010,000 635,186,000 563,832,000 435,551,000 432,711,000 312,589,000 310,861,000 309,078,000 307,998,000 23,366,000 
        accumulated deficit
      		-16,494,059,000 -16,430,222,000 -16,405,079,000 -16,355,572,000 -16,322,912,000 -16,229,900,000 -16,181,491,000 -16,148,215,000 -15,310,544,000 -15,228,655,000 -15,199,765,000 -15,142,692,000 -15,077,515,000 -15,008,287,000 -11,198,216,000 -11,124,740,000 -8,023,279,000 -1,421,454,000 -1,410,469,000 -1,326,129,000 -1,192,310,000 -992,661,000 -598,694,000 -562,810,000 -537,128,000 -507,525,000 -488,481,000 -468,135,000 -438,811,000 -408,661,000 -383,782,000 -360,517,000 -335,439,000 -311,577,000 -267,194,000 -235,864,000 -220,449,000 -204,726,000 -190,465,000 -160,693,000 -145,814,000 -130,510,000 -115,503,000  
        accumulated other comprehensive loss
      		-35,422,000 -34,728,000 -34,607,000 -35,398,000 -37,245,000 -38,388,000 -37,106,000 -38,966,000 -38,629,000 -36,990,000 -41,520,000 -38,780,000 -40,997,000 -42,776,000 -49,266,000 -29,864,000 -11,424,000     18,518,000 -5,628,000 -21,913,000 -34,793,000 -17,239,000 -28,058,000               -42,000   
        total stockholders’ equity
      		1,336,316,000 1,385,706,000 1,392,115,000 1,422,139,000 1,427,030,000 1,491,079,000 1,507,702,000 1,502,086,000 2,288,898,000 2,326,073,000 2,294,050,000 2,295,144,000 2,291,226,000 2,307,745,000 6,052,661,000 6,084,650,000 9,142,610,000 16,045,757,000 15,987,582,000 16,001,070,000 15,829,498,000 15,883,804,000 2,231,036,000 1,294,929,000 1,000,177,000 1,014,025,000 993,738,000 1,002,640,000 1,001,558,000 1,013,119,000 1,027,771,000 699,381,000 550,868,000 558,903,000 446,779,000 399,376,000 343,433,000 230,870,000 242,300,000 151,960,000 165,103,000 178,564,000 192,537,000  
        total liabilities and stockholders’ equity
      		2,807,261,000 2,858,300,000 2,878,547,000 2,894,004,000 3,444,445,000 3,516,524,000 3,528,581,000 3,523,638,000 4,320,756,000 4,392,369,000 4,327,973,000 4,316,405,000 4,309,147,000 4,345,355,000 8,103,965,000 8,102,775,000 11,092,337,000 17,734,608,000 17,652,579,000 17,611,119,000 17,582,358,000 17,755,281,000 3,449,385,000 2,418,828,000 1,603,077,000 1,602,827,000 1,568,429,000 1,565,344,000 1,551,625,000 1,528,876,000 1,535,182,000 1,199,909,000 817,524,000 824,391,000 880,924,000 674,146,000 413,953,000 303,670,000 313,268,000 203,890,000 213,483,000    
        deferred revenue—current
      		 62,305,000 70,146,000 74,697,000 73,933,000 79,296,000 88,325,000 95,434,000                                     
        convertible senior notes, net—current
      		    550,724,000 550,723,000 550,723,000 550,722,000                                     
        convertible senior notes, net—non-current
      		 994,925,000 994,044,000 993,165,000 992,290,000 991,418,000 990,551,000 989,686,000                                     
        operating lease - right-of-use assets
      		        37,506,000 40,060,000 32,051,000 34,824,000 39,518,000 41,831,000 45,187,000 49,795,000 45,552,000 46,780,000 47,935,000 41,880,000 44,401,000 46,647,000 33,933,000 30,440,000 32,175,000 26,452,000 27,596,000 29,220,000 26,850,000                
        deferred revenue-current
      		        101,229,000 95,659,000 99,192,000 107,385,000 95,930,000 90,457,000 90,210,000 86,254,000 83,847,000 75,569,000 72,865,000 69,293,000 70,458,000 52,356,000 46,721,000                      
        advances from financing companies
      		            11,247,000 11,375,000 10,086,000 12,073,000 12,664,000 13,313,000 12,442,000 13,619,000 13,693,000 13,453,000 13,609,000                      
        advances from financing companies, net of current portion
      		            8,037,000 8,082,000 7,855,000 7,855,000 8,252,000 9,291,000 9,561,000 9,561,000 10,404,000 9,926,000 9,901,000                      
        short-term investments
      		               2,539,000 2,544,000 2,537,000 2,538,000 2,538,000 2,530,000 53,245,000 3,070,000 2,932,000 2,819,000 2,711,000 15,633,000 32,161,000 45,745,000 54,545,000 14,974,000 26,559,000 54,555,000 79,489,000    15,793,000 30,916,000 56,698,000 69,522,000 82,282,000 97,934,000  
        accounts receivable, net of provision of 13,056 and 12,384, respectively
      		                191,528,000                            
        accounts receivable, net of provision of 12,384 and 6,412, respectively
      		                 168,956,000                           
        current portion of long-term debt
      		                     42,560,000                       
        accumulated other comprehensive gain
      		                 -6,285,000 -1,132,000 12,291,000 5,026,000                        
        accumulated other comprehensive income
      		                           -12,542,000 -16,858,000 -13,070,000 -4,357,000 -2,528,000 3,441,000 4,089,000 3,906,000    8,000 25,000 17,000  4,000  
        other debt - current portion
      		                                            
        long term bank and other debt
      		                                  166,938,000 42,440,000 42,434,000 42,424,000 42,469,000 27,137,000 24,957,000 25,227,000 25,863,000 31,408,000 
        short-term marketable securities
      		                                  89,758,000 31,070,000 36,005,000        
        long term bank and other debt - current portion
      		                                            
        subordinated promissory note
      		                                            
        long-term bank and other debt-current portion
      		                                     2,000,000 2,000,000 4,250,000 1,250,000 1,250,000 1,250,000 1,250,000 
        due from officer
      		                                            
        liabilities, convertible preferred stock and stockholders’ equity
      		                                            
        convertible preferred stock, 0.001 par value...
      		                                           117,914,000 
        redeemable common stock, 0.001 par value...
      		                                           2,852,000 
        stockholders’ equity
      		                                            
        total liabilities, convertible preferred stock and stockholders’ equity
      		                                         229,737,000 243,280,000  
        liabilities, convertible preferred stock and stockholders’ (deficit) equity
      		                                            
        stockholders’ (deficit) equity:
      		                                            
        total stockholders’ (deficit) equity
      		                                            
        total liabilities, convertible preferred stock and stockholders’ (deficit) equity
      		                                           106,941,000 
      Cashflow Statements:
      Quarterly
      Annual
        Unit: USD2026-03-31 2025-12-31 2025-09-30 2025-06-30 2025-03-31 2024-12-31 2024-09-30 2024-06-30 2024-03-31 2023-12-31 2023-09-30 2023-06-30 2023-03-31 2022-12-31 2022-09-30 2022-06-30 2022-03-31 2021-12-31 2021-09-30 2021-06-30 2021-03-31 2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 2018-03-31 2017-12-31 2017-09-30 2017-06-30 2017-03-31 2016-12-31 2016-09-30 2016-06-30 2016-03-31 2015-12-31 2015-09-30 
                                                   
          cash flows from operating activities:
        		                                           
          net loss
        		-63,837,000 -25,143,000 -49,507,000 -32,660,000 -93,012,000 -48,409,000 -33,276,000 -837,671,000 -81,889,000 -28,890,000 -57,073,000 -65,177,000 -69,228,000 -3,810,071,000 -73,476,000 -3,101,461,000 -6,674,523,000 -10,985,000 -84,340,000 -133,819,000 -199,649,000 -393,967,000 -35,884,000 -25,682,000 -29,603,000 -19,044,000 -20,346,000 -29,324,000 -30,150,000 -24,879,000 -23,264,000 -25,079,000 -23,862,000 -44,383,000 -31,330,000 -15,415,000 -15,654,000       
          adjustments to reconcile net loss to net cash flows from operating activities:
        		                                           
          goodwill impairment
        		   0 59,138,000 0 0       3,772,812,000 0 3,030,000,000 6,600,000,000                           
          amortization of intangible assets
        		89,826,000 92,039,000 85,757,000 88,664,000 84,304,000 86,540,000 86,906,000 94,862,000 95,057,000                                   
          stock-based compensation
        		14,611,000 15,911,000 16,996,000 22,344,000 25,163,000 27,472,000 34,047,000 42,107,000 42,325,000 46,823,000 52,964,000 55,725,000 46,038,000 50,754,000 55,662,000 51,000,000 60,436,000 61,615,000 71,701,000 82,970,000 86,300,000 414,380,000 20,908,000 21,928,000 18,315,000 18,457,000 17,354,000 17,368,000 13,523,000 12,683,000 12,195,000 11,059,000 7,832,000 16,969,000 5,966,000 4,565,000 3,097,000   1,634,000 1,288,000 979,000 718,000 
          depreciation of property and equipment
        		2,461,000 2,800,000 2,612,000 4,338,000 3,564,000 2,980,000 2,666,000 1,703,000 2,834,000                                   
          amortization of right-of-use assets
        		1,898,000 4,383,000 3,783,000 1,885,000 2,305,000 2,151,000 2,242,000 2,288,000 2,614,000 3,325,000 2,547,000 2,722,000 3,056,000 2,491,000 2,726,000 3,367,000 3,173,000 3,864,000   2,948,000                       
          provision for allowances for doubtful accounts
        		-79,000 482,000 -858,000 318,000 59,000 1,596,000 1,389,000 724,000 86,000                                   
          deferred income taxes
        		-1,060,000 -9,958,000 2,623,000 -7,207,000 -26,865,000 -1,756,000 -757,000 2,968,000 -1,600,000 4,755,000 -3,101,000 -3,202,000 -355,000 -1,898,000 -3,414,000 -209,000 -2,319,000 -49,614,000 7,591,000 -3,181,000 87,004,000 -86,062,000 -639,000 -637,000 -2,820,000 -580,000 -8,816,000 1,200,000 -2,672,000 -340,000 -649,000 -673,000 -585,000 -531,000 -74,000 149,000 150,000 150,000 188,000 10,000 162,000 161,000  
          other
        		1,329,000 3,127,000 1,223,000 296,000 1,753,000 4,584,000 2,517,000 1,292,000 1,403,000 -5,561,000 681,000 8,092,000 -3,522,000 3,907,000 413,000 0 3,264,000 -3,883,000 0 0 38,000                       
          changes in operating assets and liabilities:
        		                                           
          accounts receivable
        		-20,996,000 17,462,000 16,161,000 6,773,000 -15,270,000 -4,050,000 6,646,000 -5,104,000 2,133,000 -9,556,000 6,336,000 7,014,000 -14,046,000 -16,374,000 -1,319,000 -16,106,000 -27,842,000 1,897,000 -2,834,000 -4,856,000 -11,717,000 -4,641,000 8,323,000 -7,554,000 -17,219,000 -3,498,000 -5,149,000 1,014,000 -8,251,000 -3,396,000 -3,508,000 711,000 -4,738,000 -473,000 -2,000,000 623,000 -1,809,000 -1,385,000 989,000 -42,000 -2,462,000 -3,380,000  
          prepaid expenses and other current assets
        		-29,446,000 8,014,000 15,108,000 7,352,000 -23,786,000 2,339,000 15,866,000 10,674,000 -23,691,000 -1,609,000 -2,555,000 22,790,000 -6,165,000 -1,904,000 -18,982,000 -1,202,000 -18,993,000 3,476,000 -7,808,000 -13,959,000 -12,799,000 -6,659,000 -7,501,000 1,494,000 101,000 -466,000 -3,470,000 901,000 350,000 -956,000 -1,116,000 -1,139,000 599,000 714,000 -3,417,000 1,130,000 -430,000 290,000 -1,551,000 978,000 -543,000 363,000  
          inventory
        		6,315,000 1,438,000 -1,900,000 -654,000 1,515,000 -1,421,000 -2,296,000 -2,941,000 -3,091,000 5,849,000 -2,367,000 10,613,000 10,000,000 1,091,000 1,735,000 9,951,000 2,023,000 -16,833,000 -427,000 643,000 -2,877,000 -22,340,000                      
          other assets
        		336,000 1,606,000 -1,225,000 7,204,000 412,000 -2,696,000 763,000 -333,000 1,009,000 -4,690,000 -899,000 -7,524,000 -9,939,000 -4,913,000 -5,401,000 -11,406,000 -6,047,000 -115,000 -5,351,000 675,000 1,244,000 -8,275,000 104,000 -101,000 137,000 -178,000 -1,000 44,000 30,000 -87,000 -254,000 -104,000 31,000 187,000 -196,000   -24,000 -6,000   -8,000 -19,000 
          accounts payable
        		-2,108,000 -4,802,000 -3,022,000 1,922,000 17,356,000 -4,514,000 -18,465,000 18,484,000 -5,870,000 17,485,000 10,118,000 -22,656,000 -9,132,000 -22,191,000 -23,350,000 46,925,000 492,000 12,303,000 -6,374,000 7,248,000 -11,989,000 -94,579,000 4,740,000 2,346,000 -502,000 2,881,000 -2,350,000 402,000 -28,000 -34,000 -1,728,000 1,904,000 -533,000 2,316,000 303,000 -798,000 -287,000 1,452,000 -558,000 -572,000 -1,135,000 157,000 -4,517,000 
          accrued expenses and other current liabilities
        		39,114,000 -20,737,000 2,902,000 -17,717,000 12,568,000 16,198,000 13,826,000 -25,031,000 25,185,000 -8,006,000 -3,667,000 5,290,000 15,452,000 -8,829,000 49,334,000 9,006,000 11,706,000 2,295,000 10,500,000 7,269,000 -1,889,000 2,856,000 -7,939,000 3,643,000 21,565,000 -6,171,000 10,654,000 -4,172,000 14,530,000 -3,568,000 7,848,000 -2,123,000 1,836,000 -5,140,000 7,729,000 737,000 966,000 -1,759,000 1,127,000 -2,877,000 1,288,000 2,857,000 -3,466,000 
          accrued compensation
        		-31,529,000 18,091,000 4,750,000 11,918,000 -21,463,000 15,444,000 9,859,000 6,171,000 -51,973,000 18,747,000 15,965,000 16,733,000 -32,265,000 19,738,000 6,300,000 10,491,000 -48,819,000 12,677,000 18,254,000 8,018,000 -43,624,000 25,490,000 11,147,000 11,980,000 -13,798,000 6,359,000 7,320,000 2,604,000 -11,737,000 6,489,000 5,803,000 4,105,000 -7,917,000 2,801,000 1,231,000 1,657,000 -1,921,000 1,074,000 2,309,000 1,496,000 -3,191,000 371,000 868,000 
          deferred revenue
        		5,060,000 -9,985,000 -3,693,000 -542,000 -5,542,000 -7,790,000 -8,818,000 -8,935,000 7,297,000 -3,639,000 -8,807,000 1,898,000 5,648,000 2,929,000 1,488,000 3,344,000 7,479,000 552,000 2,797,000 119,000 17,086,000 2,403,000                      
          operating lease liabilities
        		-2,297,000 -3,379,000 -5,079,000 -2,688,000 -2,482,000 -2,804,000 -2,664,000 -2,563,000 -2,861,000 -3,091,000 -2,187,000 -2,088,000 -2,858,000 -3,414,000 -845,000 -3,640,000 -3,626,000 -8,330,000 -2,369,000 -2,757,000 -3,076,000 -1,940,000 -1,572,000 -1,501,000 -1,287,000 -936,000 -687,000 -315,000 -479,000               
          other liabilities
        		-82,000 -3,607,000 8,000 -114,000 -3,798,000 38,000 -276,000 -12,000 -48,000 -624,000 -36,000 -18,000 129,000 -2,348,000 2,332,000 223,000 -7,000 1,105,000 1,235,000 286,000 -19,000 449,000 -1,962,000 -304,000 -543,000 3,242,000 -214,000 -971,000 -1,414,000 405,000 295,000 -1,002,000 1,047,000   1,150,000 495,000 621,000 -596,000 263,000 353,000 -2,476,000 2,598,000 
          net cash from operating activities
        		9,516,000 87,742,000 99,264,000 91,432,000 15,919,000 85,902,000 110,175,000 88,683,000 8,920,000 130,082,000 105,601,000 101,182,000 13,156,000 65,549,000 63,021,000 92,469,000 -31,747,000 83,208,000 76,591,000 52,217,000 -18,026,000 -114,936,000   -6,320,000 18,122,000 13,490,000 6,149,000 -7,892,000 2,476,000 10,181,000 -3,646,000 -13,871,000 -7,275,000 -11,745,000 -2,914,000 -12,507,000 -8,045,000 -14,875,000 -11,745,000 -17,130,000 -12,804,000  
          cash flows from investing activities:
        		                                           
          capital expenditures
        		-1,660,000 -2,619,000 -2,280,000 -1,268,000 -2,726,000 -6,132,000 -1,597,000 -1,912,000 -1,149,000 -1,404,000 -5,793,000 -1,904,000 -2,363,000 -6,195,000 -3,830,000 -2,542,000 -3,913,000 -2,923,000 -1,206,000 -2,290,000 -2,115,000 0   -962,000 -663,000 -1,599,000 -677,000 -571,000 -1,279,000 -717,000 -1,458,000 -557,000 -590,000 -744,000 -679,000 -620,000 -990,000 -340,000 -503,000 -275,000 -794,000  
          free cash flows
        		7,856,000 85,123,000 96,984,000 90,164,000 13,193,000 79,770,000 108,578,000 86,771,000 7,771,000 128,678,000 99,808,000 99,278,000 10,793,000 59,354,000 59,191,000 89,927,000 -35,660,000 80,285,000 75,385,000 49,927,000 -20,141,000 -114,936,000   -7,282,000 17,459,000 11,891,000 5,472,000 -8,463,000 1,197,000 9,464,000 -5,104,000 -14,428,000 -7,865,000 -12,489,000 -3,593,000 -13,127,000 -9,035,000 -15,215,000 -12,248,000 -17,405,000 -13,598,000  
          capitalized software development costs
        		-34,162,000 -31,700,000 -29,038,000 -28,965,000 -28,859,000 -23,512,000 -29,551,000 -25,836,000 -34,363,000          -13,894,000 -10,364,000 -11,144,000                       
          acquisitions accounted for as business combinations, net of cash acquired
        		 0                                          
          payments for investments
        		-700,000 0 -800,000 0 -27,075,000                                       
          net cash from investing activities
        		-36,522,000 -34,319,000 -48,720,000 -59,696,000 -123,268,000 -29,644,000 -31,148,000 -27,748,000 -35,512,000 -36,506,000 -37,647,000 -36,570,000 -45,624,000 -53,891,000 -41,448,000 -44,837,000 -27,567,000 -20,075,000 -34,708,000 -2,168,000 -16,030,000 -413,925,000 -155,460,000 -9,662,000 -11,928,000 9,547,000 13,194,000 -5,064,000 7,336,000 -42,348,000 461,000 -239,581,000 23,972,000 8,342,000 -439,860,000 4,128,000 -20,989,000 13,712,000 -11,691,000 12,051,000 12,074,000 14,266,000  
          cash flows from financing activities:
        		                                           
          proceeds from the exercise of stock options
        		 4,000 0 1,000 80,000                                       
          proceeds from employee stock purchase plan
        		399,000 1,099,000 517,000 695,000 689,000 1,027,000 923,000 1,282,000 1,516,000 1,054,000 3,162,000 2,704,000 2,731,000 3,115,000 1,414,000 -1,708,000 3,680,000 2,814,000 2,965,000 2,383,000 8,648,000 2,249,000 0   1,505,000 0   1,141,000 0   888,000 0         
          net cash from financing activities
        		-2,449,000 1,104,000 -3,592,000 -549,933,000 769,000 2,058,000 698,000 3,805,000 1,751,000 -1,775,000 5,068,000 4,208,000 3,353,000 4,381,000 634,000 -1,334,000 2,816,000 6,625,000 784,000 11,363,000 22,175,000 70,436,000 422,000 773,225,000 15,053,000 10,041,000 9,153,000 5,198,000 10,702,000 7,449,000 341,349,000 284,616,000 12,198,000 -41,463,000 125,403,000 268,062,000 123,429,000 316,000 14,817,000 5,282,000 183,000 -460,000  
          net decrease in cash and cash equivalents
        		-29,455,000    -106,580,000    -24,841,000    -29,115,000    -56,498,000    -11,881,000                    -4,873,000   
          effect of foreign currency exchange rate changes
        		-891,000 308,000 -324,000 4,486,000 1,585,000 -3,855,000 1,758,000 -292,000 -899,000 1,347,000                                  
          cash and cash equivalents at beginning of the period
        		781,084,000 0 0 0 1,298,327,000 0 0 0 1,123,675,000 0 0 0 918,182,000 0 0 0 893,480,000 0 0 0 733,324,000 0 0 0 514,353,000 0 0 0 423,989,000 0 0 0 42,817,000 0 0 0 50,015,000 0 0 0 55,066,000   
          cash and cash equivalents at end of the period
        		750,738,000 54,835,000 46,628,000 -513,711,000 1,193,332,000 54,461,000 81,483,000 64,448,000 1,097,935,000 93,148,000 71,832,000 70,116,000 888,579,000 18,551,000 18,470,000 44,717,000 836,444,000 69,652,000 40,104,000 63,620,000 720,104,000 -453,975,000 -121,544,000 800,887,000 507,956,000 39,111,000 34,799,000 6,485,000 433,958,000 -33,565,000 351,750,000 40,625,000 65,179,000 -40,302,000 -326,105,000 269,276,000 139,948,000 5,983,000 -11,749,000 5,588,000 50,193,000   
          cash paid for income taxes
        		-42,000 2,980,000 104,000 5,333,000 328,000 1,712,000 2,621,000                                     
          supplemental disclosure of non-cash investing activities
        		                                           
          accruals related to intangible assets, net and property and equipment
        		4,823,000                                           
          goodwill impairments
        		 0                                          
          proceeds from the sale of investment
        		 0 0               0 0                         
          asset acquisition resulting in net intangible assets
        		 0 0                                         
          repayment of convertible senior notes
        		 0 0                                         
          payment of credit facility issuance costs
        		 1,000                                          
          net increase in cash and cash equivalents
        		 54,527,000 46,952,000   58,316,000 79,725,000   91,801,000 73,022,000   16,039,000 22,207,000   69,758,000 42,667,000   -458,425,000 -122,843,000 799,113,000 -3,195,000 37,710,000 35,837,000 6,283,000 10,146,000 -32,423,000 351,991,000 41,389,000 22,299,000 -40,396,000 -326,202,000 269,276,000 89,933,000 5,983,000 -11,749,000     
          interest paid
        		 6,344,000 3,000   8,660,000 0   8,735,000 11,000 8,482,000 194,000 8,673,000 15,000 8,666,000 7,000 8,457,000 1,000 7,969,000 3,000 9,278,000 3,000   6,112,000 10,000   6,178,000 0 4,123,000 2,000 4,723,000 2,880,000 853,000 994,000 653,000 684,000 446,000 604,000   
          accruals related to property and equipment, net and intangible assets
        		  2,015,000 1,410,000 4,271,000 645,000 607,000 -574,000 3,673,000                                   
          acquisition accounted for as a business combination, net of cash acquired
        		                                           
          acquisition of business, net of cash acquired
        		    -64,608,000                     17,000 3,000   45,000 -8,952,000   -1,000    0    0  
          proceeds from marketable securities
        		             0    0 0 0 50,000,000     12,935,000 16,470,000 13,695,000 9,000,000 4,700,000 11,500,000 42,970,000 25,000,000 39,933,000 26,143,000 4,937,000 14,740,000       
          net proceeds from the exercise of stock options
        		      34,000 2,546,000 131,000 58,000 746,000 381,000 296,000 238,000 666,000 1,395,000 3,585,000 2,825,000 5,175,000 5,873,000 11,908,000 13,687,000 7,114,000 18,624,000 14,889,000 8,463,000 9,119,000 6,847,000 8,854,000 5,124,000 10,433,000 7,122,000 8,643,000 3,841,000 2,680,000 3,121,000 1,195,000 315,000 1,619,000 94,000 496,000   
          cash received for withholding taxes on stock-based compensation
        		      -259,000 -23,000 106,000 -2,887,000 1,159,000 954,000 496,000 -470,000 540,000 -49,000 103,000 313,000 -2,050,000 3,941,000 1,218,000 -27,029,000 -4,166,000 4,328,000 164,000 73,000 244,000                 
          income taxes (refunded) paid
        		        -245,000                                   
          depreciation
        		                                           
          amortization
        		                                           
          depreciation of rental equipment
        		         637,000 641,000 643,000 681,000 674,000 699,000 716,000 770,000 833,000   824,000                       
          provision for allowances
        		           -5,986,000 9,034,000 6,531,000 3,010,000                             
          accretion of interest
        		         855,000 852,000 848,000 845,000 849,000 837,000 833,000 826,000 14,410,000 14,277,000 15,737,000 16,829,000 15,837,000 12,883,000 9,717,000 6,859,000 6,016,000 7,075,000 6,287,000 6,060,000 5,894,000 5,966,000 4,609,000 3,018,000 3,120,000 3,234,000 46,000 -18,000 233,000 -146,000 46,000 129,000 219,000 160,000 
          loss on extinguishment of debt
        		                 21,000 849,000 28,323,000 11,459,000 99,000 1,227,000                     
          gain on sale of investment
        		                 0 0                         
          capitalized software
        		         -35,103,000 -31,854,000 -34,666,000 -43,261,000 -47,696,000 -39,375,000 -42,295,000 -26,918,000                           
          acquisitions of businesses, net of cash acquired
        		                                           
          income taxes paid
        		         921,000 5,532,000 439,000 346,000 1,611,000 337,000 303,000 261,000 860,000 3,062,000 0 52,000 538,000 727,000   464,000 537,000 286,000 23,000 203,000 179,000 7,000 52,000           
          depreciation and amortization
        		          94,302,000 75,465,000 69,783,000 75,715,000 62,008,000 59,371,000 58,933,000 52,332,000 51,907,000 51,341,000 48,659,000 31,466,000 15,374,000 11,427,000 11,228,000 11,092,000 11,417,000 10,880,000 11,563,000 9,557,000 9,746,000 8,046,000 8,253,000 7,402,000 6,418,000 2,668,000 2,607,000 2,597,000 2,607,000 1,558,000 1,508,000 1,546,000 1,491,000 
          foreign exchange difference
        		           1,296,000 -488,000 2,512,000 -3,737,000 -1,581,000 -538,000 -106,000 -2,563,000 2,208,000 -1,339,000 4,450,000 1,299,000 1,774,000 -3,202,000 1,401,000 -1,038,000 202,000 -177,000 -1,142,000 -241,000 -764,000 63,000 94,000          
          proceeds from advances from financing companies
        		            3,375,000 5,066,000 1,694,000 2,881,000 2,232,000 4,598,000 2,753,000 3,108,000 4,816,000 4,078,000                      
          payment against advances from financing companies
        		            -3,548,000 -3,550,000 -3,681,000 -3,868,000 -3,921,000 -3,997,000                          
          proceeds from issuance of 2027 notes
        		                     0 0                     
          payment of issuance costs of 2027 notes
        		                                           
          repurchase of 2022 notes
        		                 0 -2,000 -7,000 -130,000 0 -23,000                     
          proceeds from the sale of capped call related to the livongo notes
        		                                           
          payment of assumed indebtedness
        		                                           
          operating activities:
        		                                           
          adjustments to reconcile net loss to net cash from operating activities:
        		                                           
          investing activities:
        		                                           
          financing activities:
        		                                           
          provision for doubtful accounts
        		                4,591,000                           
          acquisitions of business, net of cash acquired
        		                 -2,719,000 -19,608,000 -415,000 -55,921,000                       
          purchase of software
        		                                           
          allowance for doubtful accounts
        		                  3,819,000 4,460,000 3,074,000 2,964,000 30,000 1,043,000 1,247,000 948,000 703,000 231,000 783,000 708,000 277,000 110,000 1,148,000 388,000 579,000 458,000 306,000 442,000 541,000 652,000 777,000 616,000 460,000 
          amortization of right-of-use assets and depreciation of rental equipment
        		                                           
          payment from customers against advances from financing companies
        		                   -4,024,000 -4,098,000 -4,208,000                      
          unrealized gain on investment
        		                    -5,852,000                       
          change in fair value of contingent consideration
        		                                           
          gain on sale
        		                             0 -1,430,000             
          purchase of marketable securities
        		                             -44,206,000 0   -29,591,000 -84,716,000 3,000 -34,957,000 41,000 1,000 -7,066,000 -37,122,000 -2,474,000  
          sale of assets
        		                          3,000 1,000 6,000 30,000 0             
          investment in securities
        		                         0 0                 
          proceeds from issuance of 2025 notes
        		                                           
          proceeds from borrowing under bank and other debt
        		                                 0    5,500,000 23,990,000   0 0 
          proceeds from issuance of common stock
        		                             -13,000    134,626,000 0 0 123,928,000 0      
          purchase of property and equipment
        		                      -1,231,000 -679,000 -962,000 -663,000 -1,599,000 -677,000 -571,000 -1,279,000 -717,000 -1,458,000 -557,000 -590,000 -744,000 -679,000 -620,000 -990,000 -340,000 -503,000 -275,000 -794,000  
          purchase of internally-developed software
        		                                           
          issuance costs of 2027 notes
        		                      0                     
          net cash from (used) in operating activities
        		                                           
          purchase of internal-use software
        		                       -4,483,000 -1,966,000 -2,732,000 -1,683,000 -1,876,000 -1,099,000 -1,638,000 -1,370,000 -917,000 -471,000 -1,409,000 -1,188,000 -133,000 -152,000       
          pre-funding associated with the pending acquisition
        		                       -4,500,000 -9,000,000                   
          contingent consideration fair value adjustment
        		                                           
          amortization of warrants and loss on extinguishment of debt
        		                                 12,665,000          
          proceeds from issuance of convertible notes
        		                             5,000 21,000   0 0         
          repayment of debt
        		                                           
          proceeds from cash received for withholding taxes on stock-based compensation
        		                            1,848,000 1,182,000 39,000 -3,055,000 3,555,000           
          impairment of long-lived assets
        		                                           
          repayment of bank borrowings and other debt
        		                                           
          cash for withholding taxes on stock-based awards
        		                                 -569,000 235,000 -46,000 306,000       
          repayment of bank loan and other debt
        		                                  -44,191,000 0 -2,000,000 -5,499,000      
          amortization of warrants
        		                                     0      
          purchase of internal software
        		                                     -452,000 -194,000 -273,000 -385,000 -368,000  
          proceeds from the liquidation/maturity of marketable securities
        		                                     15,113,000 25,855,000 19,893,000 49,856,000 17,902,000  
          proceeds from issuance of convertible preferred stock
        		                                           
          proceeds from issuance of common stock under ipo
        		                                         0  
          repurchase of stock
        		                                           
          cash flows used in operating activities:
        		                                           
          net income
        		                                      -29,772,000 -14,879,000 -15,304,000 -15,007,000 -13,246,000 
          adjustments to reconcile net income to net cash from operating activities:
        		                                           
          stock-based compensation, including employee stock purchase plan
        		                                           
          payment of deferred offering costs
        		                                           
          repayment of bank loan
        		                                       -312,000 -313,000   
          due from officer
        		                                         0 0 
          proceeds from the exercise of stock options and warrants
        		                                         102,000 65,000 
          repayment of bank and other debt
        		                                         -562,000  
          cash and cash equivalents at beginning of year
        		                                         0 0 
          cash and cash equivalents at end of year
        		                                         1,002,000 38,641,000 
          interest paid:
        		                                         627,000 448,000 
          cash flows used in investing activities:
        		                                           
          repayment of term loan
        		                                           
          net cash provided by financing activities