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Consolidated Statements of Cash Flows - USD ($) | 12 Months Ended
--- | ---
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Cash flows from operating activities: |  |  |
Net income | $ 368,800,000 | $ 445,800,000 | $ 375,400,000
Loss (income) from discontinued operations, net of tax | 0 | 600,000 | (1,100,000)
Adjustments to reconcile net income to net cash provided by operating activities— |  |  |
Provision for government, class action, and related settlements | 2,800,000 | 0 | 52,000,000.0
Depreciation and amortization | 243,000,000.0 | 218,700,000 | 199,700,000
Amortization of debt-related items | 7,200,000 | 4,500,000 | 4,000,000.0
Loss on early extinguishment of debt | 2,300,000 | 7,700,000 | 0
Equity in net income of nonconsolidated affiliates | (3,500,000) | (6,700,000) | (8,700,000)
Distributions from nonconsolidated affiliates | 3,800,000 | 6,600,000 | 8,300,000
Stock-based compensation | 29,500,000 | 114,400,000 | 85,900,000
Deferred tax expense (benefit) | 52,400,000 | 40,000,000.0 | (9,100,000)
Gain on consolidation of Yuma Rehabilitation Hospital | 0 | (19,200,000) | 0
Other, net | 5,900,000 | 7,400,000 | 9,200,000
Changes in assets and liabilities, net of acquisitions — |  |  |
Accounts receivable | (38,100,000) | (22,900,000) | 7,000,000.0
Prepaid expenses and other assets | 100,000 | (35,400,000) | 11,500,000
Accounts payable | 13,600,000 | (6,100,000) | 6,600,000
Accrued payroll | 92,000,000.0 | 13,200,000 | 14,800,000
Other liabilities | (74,900,000) | (128,900,000) | 6,100,000
Net cash (used in) provided by operating activities of discontinued operations | (200,000) | (4,400,000) | 800,000
Total adjustments | 335,900,000 | 188,900,000 | 388,100,000
Net cash provided by operating activities | 704,700,000 | 635,300,000 | 762,400,000
Cash flows from investing activities: |  |  |
Acquisition of businesses, net of cash acquired | (1,100,000) | (231,500,000) | (143,900,000)
Purchases of property and equipment | (396,000,000.0) | (372,400,000) | (254,500,000)
Additions to capitalized software costs | (8,700,000) | (13,000,000.0) | (16,000,000.0)
Purchases of intangible assets | (3,500,000) | (18,700,000) | (5,700,000)
Proceeds from sale of restricted investments | 12,600,000 | 17,600,000 | 11,600,000
Purchases of restricted investments | (8,700,000) | (32,900,000) | (13,300,000)
Other, net | (2,100,000) | (6,500,000) | (2,700,000)
Net cash used in investing activities | (407,500,000) | (657,400,000) | (424,500,000)
Cash flows from financing activities: |  |  |
Proceeds from bond issuance | 992,500,000 | 1,000,000,000.0 | 0
Principal payments on debt, including pre-payments | (718,300,000) | (519,500,000) | (20,600,000)
Borrowings on revolving credit facility | 330,000,000.0 | 635,000,000.0 | 325,000,000.0
Payments on revolving credit facility | (375,000,000.0) | (620,000,000.0) | (390,000,000.0)
Principal payments under finance lease obligations | (22,500,000) | (19,500,000) |
Principal payments under finance lease obligations |  |  | (17,900,000)
Debt amendment and issuance costs | (20,300,000) | (21,500,000) | (100,000)
Repurchases of common stock, including fees and expenses | (6,100,000) | (45,900,000) | 0
Dividends paid on common stock | (111,900,000) | (108,700,000) | (100,800,000)
Purchase of equity interests in consolidated affiliates | (162,300,000) | (162,900,000) | (65,100,000)
Distributions paid to noncontrolling interests of consolidated affiliates | (72,200,000) | (79,800,000) | (75,400,000)
Taxes paid on behalf of employees for shares withheld | (15,700,000) | (16,600,000) | (8,300,000)
Contributions from consolidated affiliates | 34,900,000 | 15,900,000 | 12,600,000
Other, net | 1,000,000.0 | (8,300,000) | 19,400,000
Net cash (used in) provided by financing activities | (145,900,000) | 48,200,000 | (321,200,000)
Increase in cash, cash equivalents, and restricted cash | 151,300,000 | 26,100,000 | 16,700,000
Cash, cash equivalents, and restricted cash at beginning of year | 159,600,000 | 133,500,000 | 116,800,000
Cash, cash equivalents and restricted cash at end of year | 310,900,000 | 159,600,000 | 133,500,000
Reconciliation of Cash, Cash Equivalents, and Restricted Cash |  |  |
Cash and cash equivalents at beginning of period | 94,800,000 | 69,200,000 | 54,400,000
Restricted cash at beginning of period | 57,400,000 | 59,000,000.0 | 62,400,000
Restricted cash included in other long-term assets at beginning of period | 7,400,000 | 5,300,000 | 0
Cash, cash equivalents, and restricted cash at beginning of year | 159,600,000 | 133,500,000 | 116,800,000
Cash and cash equivalents at end of period | 224,000,000.0 | 94,800,000 | 69,200,000
Restricted cash at end of period | 65,400,000 | 57,400,000 | 59,000,000.0
Restricted cash included in other long-term assets at end of period | 21,500,000 | 7,400,000 | 5,300,000
Cash, cash equivalents and restricted cash at end of year | 310,900,000 | 159,600,000 | 133,500,000
Supplemental cash flow information: |  |  |
Interest | (168,400,000) | (155,700,000) | (149,600,000)
Income tax refunds | 1,400,000 | 100,000 | 600,000
Income tax payments | (34,300,000) | (104,200,000) | (115,400,000)
Supplemental schedule of noncash financing activities: |  |  |
Adoption of ASC 842 | $ 0 | $ 349,400,000 | $ 0

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