| Dec'19 | Dec'18 | Dec'17 | Dec'16 | Dec'15 | Dec'14 | |
|---|---|---|---|---|---|---|
Cash flows from operating activities: | ||||||
Net income (loss) | ||||||
-161,916 | -198,234 | -112,357 | -345,197 | 4,735 | 7,353 | |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||||
Depreciation and amortization | ||||||
57,613 | 67,994 | 82,155 | 117,288 | 128,001 | 127,593 | |
Non-cash interest expense, net | ||||||
9,880 | 8,733 | 5,770 | 2,496 | 0 | 0 | |
Provision for (benefit from) deferred income taxes | ||||||
825 | -1,280 | -22,137 | -56,339 | 2,542 | 5,007 | |
Stock-based compensation expense | ||||||
5,325 | 10,663 | 9,952 | 7,441 | 0 | 0 | |
Impairment of long-lived assets and goodwill | ||||||
42,820 | 77,138 | 47,281 | 291,870 | 13,000 | 1,000 | |
Loss (gain) on sale of hospitals, net | ||||||
-3,088 | -9,005 | 5,243 | -2,150 | 0 | 0 | |
Non-cash portion of loss (gain) on hospital closures | ||||||
12,683 | 6,394 | 0 | 0 | - | - | |
Changes in reserves for self-insurance claims, net of payments | ||||||
-25,953 | 19,678 | 22,519 | 27,994 | 0 | 0 | |
Changes in reserves for legal, professional and settlement costs, net of payments | ||||||
0 | 0 | -3,651 | 3,651 | 0 | 0 | |
Other non-cash expense (income), net | ||||||
-1,247 | -959 | -190 | 575 | -380 | -495 | |
Changes in operating assets and liabilities, net of acquisitions and divestitures: | ||||||
Patient accounts receivable | ||||||
-23,751 | -25,977 | -29,091 | -10,205 | 16,639 | 38,744 | |
Due from and due to third-party payors, net | ||||||
-2,932 | -31,906 | -24,201 | -7,005 | 18,198 | 47,626 | |
Inventories, prepaid expenses and other current assets | ||||||
-12,040 | -15,156 | -673 | -1,457 | -8,000 | 7,194 | |
Accounts payable and accrued liabilities | ||||||
328 | -33,860 | -14,743 | 20,760 | -78,944 | 3,422 | |
Long-term assets and liabilities, net | ||||||
17,533 | 725 | -3,269 | 9,120 | -12 | 8,262 | |
Net cash provided by (used in) operating activities | ||||||
-32,870 | 39,504 | 66,970 | 81,086 | 42,889 | 43,044 | |
Cash flows from investing activities: | ||||||
Capital expenditures for property and equipment | ||||||
39,428 | 45,882 | 61,530 | 79,920 | 59,455 | 69,066 | |
Capital expenditures for software | ||||||
8,206 | 2,662 | 6,898 | 7,269 | 8,845 | 61,054 | |
Acquisitions, net of cash acquired | ||||||
565 | 121 | 1,920 | 785 | 8,019 | 141,994 | |
Proceeds from the sale of hospitals | ||||||
52,734 | 40,848 | 32,081 | 13,746 | 0 | 0 | |
Proceeds from asset sales | ||||||
- | - | - | - | 3,114 | 258 | |
Other investing activities, net | ||||||
-3,574 | 489 | 0 | -1,082 | 5,387 | 242 | |
Net cash provided by (used in) investing activities | ||||||
8,109 | -8,306 | -38,267 | -73,146 | -78,592 | -272,098 | |
Cash flows from financing activities: | ||||||
Borrowings under revolving credit facilities | ||||||
640,000 | 490,000 | 508,000 | 50,000 | 0 | - | |
Repayments under revolving credit facilities | ||||||
557,000 | 476,000 | 508,000 | 50,000 | 0 | - | |
Borrowings of long-term debt | ||||||
280 | 105 | 376 | 1,256,281 | 372 | 110 | |
Repayments of long-term debt | ||||||
54,270 | 41,918 | 39,195 | 15,222 | 1,563 | 1,631 | |
Increase in Due to Parent, net | ||||||
- | - | - | 24,796 | 262,775 | 111,686 | |
Increase (decrease) in receivables facility, net | ||||||
- | - | - | - | -224,774 | 122,064 | |
Payments of debt issuance costs | ||||||
0 | 2,268 | 3,119 | 29,146 | 0 | 0 | |
Payments on purchase contracts | ||||||
962 | 0 | 0 | - | - | - | |
Cancellation of restricted stock awards for payroll tax withholdings on vested shares | ||||||
590 | 1,996 | 1,508 | - | - | - | |
Cash paid to Parent related to the Spin-off | ||||||
- | - | - | 1,217,336 | 0 | 0 | |
Cancellation of restricted stock awards for payroll tax withholdings on vested shares | ||||||
- | - | - | 13 | 0 | 0 | |
Cash distributions to noncontrolling investors | ||||||
2,755 | 1,535 | 3,851 | 2,850 | 1,623 | 1,489 | |
Purchases of shares from noncontrolling investors | ||||||
0 | 0 | 1,244 | 101 | 937 | 0 | |
Net cash provided by (used in) financing activities | ||||||
24,703 | -33,612 | -48,541 | 16,409 | 34,250 | 230,740 | |
Net change in cash, cash equivalents and restricted cash | ||||||
-58 | -2,414 | -19,838 | 24,349 | -1,453 | 1,686 | |
Supplemental cash flow information: | ||||||
Interest payments, net | ||||||
111,437 | 120,025 | 125,725 | 90,909 | 98,290 | 92,926 | |
Income tax payments, net | ||||||
392 | 600 | 196 | 0 | 0 | 0 | |
Non-cash purchases of property and equipment under finance lease obligations | ||||||
271 | 0 | 54 | 6,579 | 15,448 | 2,407 | |