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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($)
$ in Millions
6 Months Ended
Jun. 30, 2021
Jun. 30, 2020
Cash flows from operating activities:    
Net income (loss) $ 19.6 $ (12.3)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:    
Depreciation and amortization 50.9 45.2
Non-cash interest expense, net 5.7 2.2
Equity-based compensation expense 9.3 6.9
Loss on disposals and deconsolidations, net 0.1 6.4
Loss on debt extinguishment 9.6 0.0
Deferred income taxes (3.2) (16.4)
Income from equity investments, net of distributions received (0.4) (0.2)
Non-cash lease expense 20.0 20.1
Changes in operating assets and liabilities, net of acquisitions and divestitures:    
Accounts receivable (3.1) 16.3
Medicare accelerated payments and deferred governmental grants (28.8) 124.7
DOJ settlement payments (32.2) (4.0)
Other operating assets and liabilities 5.0 22.2
Net cash provided by operating activities 52.5 211.1
Cash flows from investing activities:    
Purchases of property and equipment (28.0) (19.9)
Payments for acquisitions, net of cash acquired (15.2) (12.4)
Proceeds from disposals of facilities and other assets 2.5 9.4
Other investing activities 0.0 0.4
Net cash used in investing activities (40.7) (22.5)
Cash flows from financing activities:    
Principal payments on long-term debt (309.4) (182.8)
Borrowings of long-term debt 283.1 288.2
Payments of debt issuance costs (8.7) (6.5)
Payment of premium on debt extinguishment (2.4) 0.0
Proceeds from equity offering 260.9 0.0
Payments of equity offering costs (12.7) 0.0
Payment of preferred dividends (5.1) 0.0
Distributions to non-controlling interest holders (63.4) (51.7)
Receipts (payments) related to ownership transactions with non-controlling interest holders 3.4  
Receipts (payments) related to ownership transactions with non-controlling interest holders   (1.9)
Other financing activities (10.9) (0.3)
Net cash provided by financing activities 134.8 45.0
Net increase in cash, cash equivalents and restricted cash 146.6 233.6
Cash, cash equivalents and restricted cash at beginning of period 318.2 93.0
Cash, cash equivalents and restricted cash at end of period $ 464.8 $ 326.6