| Mar'20 | Dec'19 | Sep'19 | Jun'19 | Mar'19 | Dec'18 | Sep'18 | Jun'18 | Mar'18 | Dec'17 | Sep'17 | Jun'17 | Mar'17 | Dec'16 | Sep'16 | Jun'16 | Mar'16 | Dec'15 | Sep'15 | Jun'15 | Mar'15 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Cash flows from operating activities: | ||||||||||||||||||||
Net income (loss) | ||||||||||||||||||||
-202,811 | -161,916 | -150,195 | -128,889 | -138,353 | -198,234 | -204,337 | -179,005 | -183,639 | -112,357 | -176,426 | -154,324 | -367,715 | -345,197 | -254,324 | -251,947 | -5,776 | 4,735 | 0 | 0 | 0 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||||||||||||||||||
Depreciation and amortization | ||||||||||||||||||||
55,192 | 57,613 | 60,146 | 61,730 | 64,372 | 67,994 | 70,729 | 74,852 | 78,296 | 82,155 | 89,875 | 97,374 | 108,251 | 117,288 | 123,528 | 126,782 | 127,460 | 128,001 | 0 | 0 | 0 |
Non-cash interest expense, net | ||||||||||||||||||||
10,322 | 9,880 | 8,964 | 8,518 | 8,861 | 8,733 | 8,941 | 8,874 | 6,851 | 5,770 | 3,733 | 3,197 | 3,226 | 2,496 | 1,986 | 729 | 0 | - | 0 | 0 | - |
Provision for (benefit from) deferred income taxes | ||||||||||||||||||||
772 | 825 | 16 | -1,184 | -1,726 | -1,280 | -22,854 | -22,367 | -22,202 | -22,137 | -5,194 | -8,633 | -55,738 | -56,339 | -51,532 | -47,451 | 0 | - | 0 | 0 | - |
Stock-based compensation expense | ||||||||||||||||||||
4,618 | 5,325 | 7,385 | 8,407 | 9,969 | 10,663 | 10,236 | 9,844 | 9,619 | 9,952 | 10,465 | 10,872 | 10,238 | 7,441 | 4,678 | 1,897 | 0 | - | 0 | 0 | - |
Impairment of long-lived assets and goodwill | ||||||||||||||||||||
45,960 | 42,820 | 47,760 | 72,188 | 46,238 | 77,138 | 98,018 | 70,841 | 83,741 | 47,281 | 62,931 | 57,670 | 295,170 | 291,870 | 250,400 | 250,400 | 0 | - | 0 | 0 | - |
Loss (gain) on sale of hospitals, net | ||||||||||||||||||||
-5,509 | -3,088 | -2,424 | -2,023 | -1,190 | -9,005 | -8,796 | -8,070 | -3,442 | 5,243 | 2,962 | 3,041 | -1,280 | -2,150 | 0 | 0 | 0 | - | - | - | - |
Non-cash portion of loss (gain) on hospital closures | ||||||||||||||||||||
13,724 | 12,683 | 1,574 | 13,355 | 12,266 | 6,394 | -6,394 | -6,394 | -5,305 | 0 | 0 | 0 | 0 | - | - | - | - | - | - | - | - |
Changes in reserves for self-insurance claims, net of payments | ||||||||||||||||||||
-30,708 | -25,953 | -21,247 | -16,505 | 17,813 | 19,678 | 21,269 | 21,645 | 24,332 | 22,519 | 16,148 | 22,357 | 24,216 | 27,994 | 28,099 | 16,891 | 0 | - | 0 | 0 | - |
Changes in reserves for legal, professional and settlement costs, net of payments | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | -3,651 | -4,642 | -4,642 | 0 | 3,651 | 4,642 | 0 | 0 | - | 0 | - | - |
Other non-cash expense (income), net | ||||||||||||||||||||
-2,806 | -1,247 | -2,553 | 304 | 364 | -959 | -339 | -192 | -183 | -190 | -196 | -17 | 63 | 575 | -650 | -1,301 | -197 | -380 | 0 | 0 | 0 |
Changes in operating assets and liabilities, net of acquisitions and divestitures: | ||||||||||||||||||||
Patient accounts receivable | ||||||||||||||||||||
-43,796 | -23,751 | -22,643 | -23,683 | -20,562 | -25,977 | -80,564 | -80,514 | -47,683 | -29,091 | -5,809 | 12,933 | -5,164 | -10,205 | 15,006 | 29,059 | 16,328 | 16,639 | 0 | 0 | 0 |
Due from and due to third-party payors, net | ||||||||||||||||||||
-5,137 | -2,932 | -10,442 | -8,666 | -26,268 | -31,906 | -41,292 | -29,772 | -14,377 | -24,201 | -20,963 | -16,611 | -5,707 | -7,005 | 16,092 | 0 | 0 | - | 0 | - | - |
Due to and due from third-party payors, net | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 0 | - |
Inventories, prepaid expenses and other current assets | ||||||||||||||||||||
-7,641 | -12,040 | -28,232 | -15,153 | -18,777 | -15,156 | 8,933 | -8,176 | -18,637 | -673 | -15,656 | 8,789 | 12,628 | -1,457 | 14,029 | -13,454 | -12,478 | -8,000 | 0 | 0 | 0 |
Accounts payable and accrued liabilities | ||||||||||||||||||||
9,954 | 328 | -245 | -32,930 | -23,301 | -33,860 | -1,639 | -25,749 | -43,221 | -14,743 | -15,891 | -6,394 | 66,451 | 20,760 | 38,245 | 20,210 | -31,935 | -78,944 | 0 | 0 | 0 |
Long-term assets and liabilities, net | ||||||||||||||||||||
19,515 | 17,533 | 10,683 | -2,598 | 653 | 725 | -301 | 1,527 | -2,447 | -3,269 | -448 | -1,596 | 8,344 | 9,120 | 11,881 | 12,390 | 2,833 | -12 | 0 | 0 | 0 |
Net cash provided by (used in) operating activities | ||||||||||||||||||||
-49,685 | -32,870 | 19,409 | 22,587 | 50,175 | 39,504 | 109,116 | 90,526 | 45,851 | 66,970 | 21,109 | 10,938 | 75,215 | 81,086 | 98,220 | 81,386 | 100,936 | 42,889 | 0 | 0 | 0 |
Cash flows from investing activities: | ||||||||||||||||||||
Capital expenditures for property and equipment | ||||||||||||||||||||
41,442 | 39,428 | 36,818 | 38,674 | 39,646 | 45,882 | 45,758 | 47,707 | 52,841 | 61,530 | 74,139 | 85,855 | 90,297 | 79,920 | 82,142 | 72,252 | 62,356 | 59,455 | 0 | 0 | 0 |
Capital expenditures for software | ||||||||||||||||||||
8,698 | 8,206 | 6,495 | 5,135 | 3,340 | 2,662 | 2,251 | 4,773 | 5,905 | 6,898 | 8,185 | 6,634 | 6,249 | 7,269 | 8,060 | 8,270 | 0 | - | 0 | 0 | - |
Proceeds from other asset sales | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 0 | - | - | - | - |
Acquisitions, net of cash acquired | ||||||||||||||||||||
110 | 565 | 531 | 518 | 544 | 121 | 121 | 91 | 1,952 | 1,920 | 1,946 | 1,913 | 0 | - | 0 | 0 | - | - | 0 | 0 | - |
Proceeds from the sale of hospitals | ||||||||||||||||||||
53,724 | 52,734 | 54,411 | 13,419 | 2,185 | 40,848 | 42,011 | 51,095 | 66,462 | 32,081 | 42,986 | 33,902 | 18,028 | 13,746 | 0 | 0 | 0 | - | - | - | - |
Purchases of and costs to develop information technology | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 0 |
Proceeds from sale of property and equipment | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 0 | 0 | 0 |
Other investing activities, net | ||||||||||||||||||||
-2,179 | -3,574 | -2,512 | 1,121 | -1,043 | 489 | -259 | -249 | -197 | 0 | -884 | -538 | -1,030 | -1,082 | 1,827 | 1,551 | 3,910 | 5,387 | 0 | 0 | 0 |
Net cash provided by (used in) investing activities | ||||||||||||||||||||
5,653 | 8,109 | 13,079 | -32,029 | -40,302 | -8,306 | -5,860 | -1,227 | 5,961 | -38,267 | -41,991 | -61,579 | -79,131 | -73,146 | -92,833 | -88,843 | -80,787 | -78,592 | 0 | 0 | 0 |
Cash flows from financing activities: | ||||||||||||||||||||
Borrowings under revolving credit facilities | ||||||||||||||||||||
617,000 | 640,000 | 587,000 | 570,000 | 510,000 | 490,000 | 443,000 | 453,000 | 468,000 | 508,000 | 0 | 0 | 0 | - | - | - | - | - | - | - | - |
Repayments under revolving credit facilities | ||||||||||||||||||||
487,000 | 557,000 | 562,000 | 542,000 | 512,000 | 476,000 | 488,000 | 489,000 | 528,000 | 508,000 | 0 | 0 | 0 | - | - | - | - | - | - | - | - |
Borrowings (repayments) of revolving credit facilities, net | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | - | - | - | - | 0 | 0 | 0 | - | - | - | - |
Borrowings of long-term debt | ||||||||||||||||||||
130 | 280 | 134 | 224 | 254 | 105 | 286 | 371 | 388 | 376 | 972 | 833 | 1,256,261 | 1,256,281 | 1,255,643 | 1,255,757 | 332 | 372 | 0 | 0 | 0 |
Repayments of long-term debt | ||||||||||||||||||||
52,952 | 54,270 | 24,525 | 24,434 | 43,124 | 41,918 | 54,479 | 58,795 | 32,713 | 39,195 | 24,297 | 22,792 | 21,242 | 15,222 | 8,010 | 5,104 | 2,256 | 1,563 | 0 | 0 | 0 |
Increase in Due to Parent, net | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | - | - | - | 24,796 | 241,209 | 278,697 | 204,089 | 262,775 | 0 | 0 | 0 |
Increase (decrease) in receivables facility, net | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 0 | 0 | - |
Payments of debt issuance costs | ||||||||||||||||||||
- | - | 0 | 0 | - | 2,268 | 2,268 | 2,449 | 5,340 | 3,119 | 3,126 | 4,081 | 29,193 | 29,146 | 29,139 | 28,003 | 0 | - | 0 | 0 | - |
Payments on purchase contracts | ||||||||||||||||||||
0 | - | 0 | - | 0 | - | 0 | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Cancellation of restricted stock awards for payroll tax withholdings on vested shares | ||||||||||||||||||||
0 | - | 0 | - | 0 | - | 0 | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Cash paid to Parent related to the Spin-off | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | - | - | - | - | 0 | 0 | - | - | 0 | 0 | - |
Cancellation of restricted stock awards for payroll tax withholdings on vested shares | ||||||||||||||||||||
- | - | - | 617 | - | - | - | 1,962 | 1,114 | - | 1,504 | 1,529 | 1,041 | 13 | 12 | -27 | 0 | - | 0 | 0 | - |
Cash distributions to noncontrolling investors | ||||||||||||||||||||
1,532 | 2,755 | 1,753 | 2,288 | 1,955 | 1,535 | 1,481 | 803 | 840 | 3,851 | 3,873 | 4,054 | 4,180 | 2,850 | 2,929 | 2,848 | 3,977 | 1,623 | 0 | 0 | 0 |
Decrease in indebtedness of receivables facility, net | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 0 |
Purchases of shares from noncontrolling investors | ||||||||||||||||||||
- | - | - | - | - | - | - | - | - | - | 0 | - | - | 101 | 314 | 948 | 0 | - | 0 | 0 | - |
Net cash provided by (used in) financing activities | ||||||||||||||||||||
73,697 | 24,703 | -2,123 | 885 | -48,648 | -33,612 | -104,926 | -100,882 | -100,863 | -48,541 | 11,540 | 17,901 | 92,462 | 16,409 | 18,787 | 61,376 | -25,202 | 34,250 | 0 | 0 | 0 |
Net change in cash, cash equivalents and restricted cash | ||||||||||||||||||||
29,665 | -58 | 30,365 | -8,557 | -38,775 | -2,414 | -1,670 | -11,583 | -49,051 | -19,838 | -9,342 | -32,740 | 88,546 | 24,349 | 24,174 | 53,919 | -5,053 | -1,453 | 0 | 0 | 0 |
Supplemental cash flow information: | ||||||||||||||||||||
Interest payments, net | ||||||||||||||||||||
111,465 | 111,437 | 111,336 | 122,375 | 120,753 | 120,025 | 123,461 | 117,864 | 127,744 | 125,725 | 118,808 | 121,135 | 78,925 | 90,909 | 76,327 | 84,723 | 0 | - | 0 | 0 | - |
Income tax payments, net | ||||||||||||||||||||
392 | 392 | 256 | 302 | 454 | 600 | 390 | 655 | 342 | 196 | 305 | -6 | 0 | 0 | 34 | 34 | 0 | - | 0 | 0 | - |
Non-cash purchases of property and equipment under finance lease obligations | ||||||||||||||||||||
0 | - | - | - | 0 | - | - | - | 0 | - | 0 | 0 | - | 6,579 | 0 | 0 | 0 | - | - | - | - |