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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions | 12 Months Ended
--- | ---
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019
Cash flows from operating activities: |  |  |
Net income | $ 70.7 | $ 1.3 | $ 45.1
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 98.8 | 94.8 | 76.5
Non-cash interest expense, net | 22.0 | 4.5 | 2.5
Equity-based compensation expense | 17.4 | 13.2 | 10.2
Loss (gain) on disposals, net | 2.2 | 5.7 | (4.4)
Impairment charges | 0.0 | 33.5 | 7.9
Loss on debt extinguishment | 9.1 | 0.0 | 11.7
Deferred income taxes | 8.9 | (21.9) | 8.5
Income from equity investments, net of distributions received | 0.2 | 0.5 | 0.3
Non-cash lease expense | 39.1 | 39.4 | 40.0
Changes in operating assets and liabilities, net of acquisitions and divestitures: |  |  |
Accounts receivable | (32.1) | (46.6) | (23.5)
Medicare accelerated payments and deferred governmental grants | (73.6) | 135.2 | 0.0
DOJ settlement payments | (32.2) | (4.0) | 0.0
Other operating assets and liabilities | (43.4) | (8.7) | (45.3)
Net cash provided by operating activities | 87.1 | 246.9 | 129.5
Cash flows from investing activities: |  |  |
Purchases of property and equipment | (57.6) | (42.9) | (73.6)
Payments for acquisitions, net of cash acquired | (285.8) | (104.6) | (13.8)
Proceeds from disposals of facilities and other assets | 6.0 | 58.5 | 17.6
Sale (purchase) of equity investments | 5.4 | 0.0 | (15.2)
Other investing activities | 0.3 | 0.6 | (0.2)
Net cash used in investing activities | (331.7) | (88.4) | (85.2)
Cash flows from financing activities: |  |  |
Principal payments on long-term debt | (343.2) | (216.3) | (490.8)
Borrowings of long-term debt | 299.4 | 429.4 | 506.9
Payments of debt issuance costs | (11.7) | (8.5) | (8.9)
Proceeds from equity offerings | 581.8 | 0.0 | 0.0
Payments of equity offering costs | (27.6) | 0.0 | 0.0
Payment of premium on debt extinguishment | 0.0 | 0.0 | (17.8)
Distributions to non-controlling interest holders | (131.0) | (109.6) | (121.2)
Payments related to ownership transactions with non-controlling interest holders | (28.4) | (27.4) | (3.2)
Payments of preferred dividends | (5.1) | 0.0 | 0.0
Other financing activities | (17.9) | (0.9) | (0.9)
Net cash provided by (used in) financing activities | 316.3 | 66.7 | (135.9)
Net increase (decrease) in cash, cash equivalents and restricted cash | 71.7 | 225.2 | (91.6)
Cash, cash equivalents and restricted cash at beginning of period | 318.2 | 93.0 | 184.6
Cash, cash equivalents and restricted cash at end of period | 389.9 | 318.2 | 93.0
Supplemental cash flow information: |  |  |
Interest paid, net of interest income received | 194.3 | 203.6 | 180.3
Cash paid for income taxes | 1.5 | 1.7 | 1.6
Non-cash purchases of property and equipment | $ 22.3 | $ 27.7 | $ 30.7

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