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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions | 9 Months Ended
--- | ---
Sep. 30, 2024 | Sep. 30, 2023
Cash flows from operating activities: |  |
Net income | $ 59.1 | $ 88.6
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation and amortization | 118.7 | 87.0
Non-cash lease expense | 29.2 | 26.4
Non-cash interest expense, net | 4.8 | 19.8
Equity-based compensation expense | 27.1 | 13.2
Net loss on disposals, consolidations and deconsolidations | 21.5 | 7.5
Loss on debt extinguishment | 5.1 | 0.0
Deferred income taxes | 10.3 | (10.8)
Equity in earnings of unconsolidated affiliates, net of distributions received | 0.3 | (2.7)
Changes in operating assets and liabilities, net of acquisitions and divestitures: |  |
Accounts receivable | (31.2) | (18.2)
Medicare accelerated payments and deferred governmental grants | 0.0 | (1.2)
Other operating assets and liabilities | (56.2) | 21.6
Net cash provided by operating activities | 188.7 | 231.2
Cash flows from investing activities: |  |
Purchases of property and equipment | (68.1) | (69.0)
Payments for acquisitions, net of cash acquired | (291.2) | (48.8)
Proceeds from disposals of facilities and other assets | 1.5 | 25.8
Purchases of equity investments | (1.7) | (50.2)
Proceeds from sales of equity investments | 4.0 | 1.0
Other investing activities | (21.3) | (26.3)
Net cash used in investing activities | (376.8) | (167.5)
Cash flows from financing activities: |  |
Principal payments on long-term debt | (1,108.8) | (107.1)
Borrowings of long-term debt | 1,463.8 | 119.4
Payments of debt issuance costs | (15.1) | (1.5)
Distributions to non-controlling interest holders | (122.4) | (111.0)
Proceeds related to ownership transactions with non-controlling interest holders | 5.6 | 0.7
Other financing activities | (9.1) | (11.1)
Net cash provided by (used in) financing activities | 214.0 | (110.6)
Net increase (decrease) in cash and cash equivalents | 25.9 | (46.9)
Cash and cash equivalents at beginning of period | 195.9 | 282.9
Cash and cash equivalents at end of period | $ 221.8 | $ 236.0

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