XML 19 R8.htm IDEA: XBRL DOCUMENT v3.24.3
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