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Business and Summary of Significant Accounting Policies (Tables) | 12 Months Ended
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Dec. 31, 2023
Accounting Policies [Abstract] |
Uncompensated Care | The following table shows the amounts recorded at our acute care hospitals for charity care and uninsured discounts, based on charges at established rates, for the years ended December 31, 2023, 2022 and 2021:
|  | (dollar amounts in thousands) |
|  | 2023 |  |  | 2022 |  |  | 2021 |
|  | Amount |  |  | % |  |  | Amount |  |  | % |  |  | Amount |  |  | % |
Charity care |  | $ | 843,449 |  |  |  | 32 | % |  | $ | 786,962 |  |  |  | 35 | % |  | $ | 661,965 |  |  |  | 33 | %
Uninsured discounts |  |  | 1,792,493 |  |  |  | 68 | % |  |  | 1,474,933 |  |  |  | 65 | % |  |  | 1,336,319 |  |  |  | 67 | %
Total uncompensated care |  | $ | 2,635,942 |  |  |  | 100 | % |  | $ | 2,261,895 |  |  |  | 100 | % |  | $ | 1,998,284 |  |  |  | 100 | %
Estimated Cost of Providing Uncompensated Care | The estimated cost of providing uncompensated care, as reflected below, were based on a calculation which multiplied the percentage of operating expenses for our acute care hospitals to gross charges for those hospitals by the above-mentioned total uncompensated care amounts. The percentage of cost to gross charges is calculated based on the total operating expenses for our acute care facilities divided by gross patient service revenue for those facilities. An increase in the level of uninsured patients to our facilities and the resulting adverse trends in the adjustments to net revenues and uncompensated care provided could have a material unfavorable impact on our future operating results.
|  | (amounts in thousands) |
|  | 2023 |  |  | 2022 |  |  | 2021 |
Estimated cost of providing charity care |  | $ | 83,383 |  |  | $ | 85,434 |  |  | $ | 72,095 |
Estimated cost of providing uninsured discounts |  |  | 177,206 |  |  |  | 160,122 |  |  |  | 145,538 |
Estimated cost of providing uncompensated care |  | $ | 260,589 |  |  | $ | 245,556 |  |  | $ | 217,633 |
Summary of Cash, Cash Equivalents and Restricted Cash Reported In Consolidated Statements of Cash Flows | Cash, cash equivalents, and restricted cash as reported in the consolidated statements of cash flows are presented separately on our consolidated balance sheets as follow:
|  | (amounts in thousands) |
|  | 2023 |  |  | 2022 |  |  | 2021 |
Cash and cash equivalents |  | $ | 119,439 |  |  | $ | 102,818 |  |  | $ | 115,301 |
Restricted cash (a) |  |  | 95,031 |  |  |  | 98,019 |  |  |  | 63,633 |
Total cash, cash equivalents and restricted cash |  | $ | 214,470 |  |  | $ | 200,837 |  |  | $ | 178,934 |
(a) Restricted cash is included in other assets on the accompanying consolidated balance sheets and consists of statutorily required capital reserves related to our commercial insurance subsidiary. The fair value of our restricted cash was computed based upon quotes received from financial institutions. We consider these to be “level 1” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with financial securities. |
Summary of Changes in Carrying Amount of Goodwill | Changes in the carrying amount of goodwill for the two years ended December 31, 2023 were as follows (in thousands):
|  | Acute Care Services |  |  | Behavioral Health Services |  |  | Total Consolidated |
Balance, January 1, 2022 |  | $ | 515,936 |  |  | $ | 3,446,688 |  |  | $ | 3,962,624 |
Goodwill acquired during the period |  |  | 0 |  |  |  | 0 |  |  |  | — |
Goodwill divested during the period |  |  | 0 |  |  |  | 0 |  |  |  | 0 |
Adjustments to goodwill (a) |  |  | 690 |  |  |  | (53,858 | ) |  |  | (53,168 | )
Balance, December 31, 2022 |  |  | 516,626 |  |  |  | 3,392,830 |  |  |  | 3,909,456 |
Goodwill acquired during the period |  |  | 0 |  |  |  | 4,598 |  |  |  | 4,598 |
Goodwill divested during the period |  |  | 0 |  |  |  | (6,062 | ) |  |  | (6,062 | )
Adjustments to goodwill (a) |  |  | 2 |  |  |  | 24,413 |  |  |  | 24,415 |
Balance, December 31, 2023 |  | $ | 516,628 |  |  | $ | 3,415,779 |  |  | $ | 3,932,407 |
(a) The changes in the Behavioral Health Services’ goodwill consist of foreign currency translation adjustments.
Summary of Net Intangible Assets | The following table shows the amounts recorded as net intangible assets for the years ended December 31, 2023 and 2022:
|  | (amounts in thousands) |
|  | 2023 |  |  | 2022 |
Medicare licenses (a) |  | $ | 57,226 |  |  | $ | 57,226 |
Certificates of need |  |  | 7,501 |  |  |  | 7,989 |
Contract relationships and other (net of $56,288 and $55,353 of accumulated amortization for 2023 and 2022, respectively) |  |  | 12,291 |  |  |  | 12,887 |
Net Intangible Assets |  | $ | 77,018 |  |  | $ | 78,102 |
(a) Indefinite lives.
Amounts Recognized in AOCI | The amounts recognized in AOCI for the two years ended December 31, 2023 were as follows (in thousands):
|  | Net Unrealized Gains (Losses) on Effective Cash Flow Hedges |  |  | Foreign Currency Translation Adjustment |  |  | Minimum Pension Liability |  |  | Total AOCI |
Balance, January 1, 2022, net of income tax |  | $ | (17 | ) |  | $ | 33,524 |  |  | $ | (3,216 | ) |  | $ | 30,291 |
2022 activity: |  |  |  |  |  |  |  |  |  |  |  |
Pretax amount |  |  | 0 |  |  |  | (37,310 | ) |  |  | (2,869 | ) |  |  | (40,179 | )
Income tax effect |  |  | 0 |  |  |  | (469 | ) |  |  | 689 |  |  |  | 220 |
Change, net of income tax |  |  | 0 |  |  |  | (37,779 | ) |  |  | (2,180 | ) |  |  | (39,959 | )
Balance, January 1, 2023, net of income tax |  |  | (17 | ) |  |  | (4,255 | ) |  |  | (5,396 | ) |  |  | (9,668 | )
2023 activity: |  |  |  |  |  |  |  |  |  |  |  |
Pretax amount |  |  | 0 |  |  |  | 15,271 |  |  |  | 4,166 |  |  |  | 19,437 |
Income tax effect |  |  | 0 |  |  |  | 520 |  |  |  | (1,000 | ) |  |  | (480 | )
Change, net of income tax |  |  | 0 |  |  |  | 15,791 |  |  |  | 3,166 |  |  |  | 18,957 |
Balance, December 31, 2023, net of income tax |  | $ | (17 | ) |  | $ | 11,536 |  |  | $ | (2,230 | ) |  | $ | 9,289 |
Computation of Basic and Diluted Earnings Per Share | The following table sets forth the computation o f basic and diluted earnings per share, for the periods indicated (in thousands, except per share data):
|  | Twelve Months Ended December 31, |
|  | 2023 |  |  | 2022 |  |  | 2021 |
Basic and diluted: |  |  |  |  |  |  |  |  |
Net Income |  | $ | 719,307 |  |  | $ | 656,982 |  |  | $ | 987,632 |
Less: Net (income) loss attributable to noncontrolling interest ("NCI") |  |  | (1,512 | ) |  |  | 18,627 |  |  |  | 3,958 |
Less: Net income attributable to unvested restricted share grants |  |  | (308 | ) |  |  | (748 | ) |  |  | (2,059 | )
Net income attributable to UHS—basic and diluted |  | $ | 717,487 |  |  | $ | 674,861 |  |  | $ | 989,531 |
Basic earnings per share attributable to UHS: |  |  |  |  |  |  |  |  |
Weighted average number of common shares—basic |  |  | 69,321 |  |  |  | 73,118 |  |  |  | 82,519 |
Total basic earnings per share |  | $ | 10.35 |  |  | $ | 9.23 |  |  | $ | 11.99 |
Diluted earnings per share attributable to UHS: |  |  |  |  |  |  |  |  |
Weighted average number of common shares |  |  | 69,321 |  |  |  | 73,118 |  |  |  | 82,519 |
Net effect of dilutive stock options and grants based on the treasury stock method |  |  | 804 |  |  |  | 714 |  |  |  | 1,173 |
Weighted average number of common shares and equivalents—diluted |  |  | 70,125 |  |  |  | 73,832 |  |  |  | 83,692 |
Total diluted earnings per share |  | $ | 10.23 |  |  | $ | 9.14 |  |  | $ | 11.82 |

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