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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions | 12 Months Ended
--- | ---
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020
Cash flows from operating activities: |  |  |
Net income | $ 87.0 | $ 70.7 | $ 1.3
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 114.8 | 98.8 | 94.8
Non-cash lease expense | 34.8 | 39.1 | 39.4
Non-cash interest expense, net | 25.9 | 22.0 | 4.5
Equity-based compensation expense | 18.4 | 17.4 | 13.2
Loss on disposals and deconsolidations, net | 11.1 | 2.2 | 5.7
Loss on debt extinguishment | 14.9 | 9.1 | 0.0
Deferred income taxes | 21.9 | 8.9 | (21.9)
Equity in earnings of unconsolidated affiliates, net of distributions received | (1.8) | 0.2 | 0.5
Impairment charges | 0.0 | 0.0 | 33.5
Other non-cash income | (7.5) | 0.0 | 0.0
Changes in operating assets and liabilities, net of acquisitions and divestitures: |  |  |
Accounts receivable | (35.3) | (32.1) | (46.6)
Medicare accelerated payments and deferred governmental grants | (58.4) | (73.6) | 135.2
DOJ settlement payments | 0.0 | (32.2) | (4.0)
Other operating assets and liabilities | (67.0) | (43.4) | (8.7)
Net cash provided by operating activities | 158.8 | 87.1 | 246.9
Cash flows from investing activities: |  |  |
Purchases of property and equipment | (80.6) | (57.6) | (42.9)
Payments for acquisitions, net of cash acquired | (146.4) | (285.8) | (104.6)
Proceeds from disposals of facilities and other assets | 12.9 | 6.0 | 58.5
Purchases of equity investments | (95.1) | 0.0 | 0.0
Proceeds from sales of equity investments | 12.8 | 5.4 | 0.0
Other investing activities | (11.5) | 0.3 | 0.6
Net cash used in investing activities | (307.9) | (331.7) | (88.4)
Cash flows from financing activities: |  |  |
Principal payments on long-term debt | (862.0) | (343.2) | (216.3)
Borrowings of long-term debt | 217.8 | 299.4 | 429.4
Payment of premium on debt extinguishment | (11.3) | 0.0 | 0.0
Proceeds from equity offerings | 882.9 | 581.8 | 0.0
Payments of equity offering costs | (25.2) | (27.6) | 0.0
Distributions to non-controlling interest holders | (146.8) | (131.0) | (109.6)
Payments related to ownership transactions with non-controlling interest holders | (3.4) | (28.4) | (27.4)
Payments of debt issuance costs | 0.0 | (11.7) | (8.5)
Payments of preferred dividends | 0.0 | (5.1) | 0.0
Other financing activities | (9.9) | (17.9) | (0.9)
Net cash provided by financing activities | 42.1 | 316.3 | 66.7
Net (decrease) increase in cash and cash equivalents | (107.0) | 71.7 | 225.2
Cash and cash equivalents at beginning of period | 389.9 | 318.2 | 93.0
Cash and cash equivalents at end of period | 282.9 | 389.9 | 318.2
Supplemental cash flow information: |  |  |
Interest paid, net of interest income received | 218.7 | 194.3 | 203.6
Cash paid for income taxes | 1.8 | 1.5 | 1.7
Non-cash purchases of property and equipment | $ 29.9 | $ 22.3 | $ 27.7

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