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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Operating activities:      
Net (loss) income $ (669,199) $ 110,122 $ (175,486)
Adjustments to reconcile net income (loss) to net cash provided by continuing operating activities:      
Depreciation and amortization 95,256 87,923 80,342
Amortization of debt issuance costs 12,636 11,987 10,456
Equity-based compensation expense 22,504 17,307 22,001
Deferred income taxes 53,108 1,089 (6,737)
Loss (income) from discontinued operations, net of taxes 812,390 (56,812) 232,974
Debt extinguishment costs 7,233   1,815
Legal settlements expense     22,076
Loss on impairment 4,751 27,217  
Other 1,041 3,916 12,505
Change in operating assets and liabilities, net of effect of acquisitions:      
Accounts receivable, net 15,340 (18,714) (19,702)
Other current assets 9,675 (501) 14,447
Other assets 1,519 (2,372) 2,725
Accounts payable and other accrued liabilities 77,993 (20,135) 7,701
Accrued salaries and benefits 9,632 5,540 15,883
Other liabilities 48,965 16,862 4,941
Net cash provided by continuing operating activities 502,844 183,429 225,941
Net cash provided by discontinued operating activities 155,963 149,475 188,139
Net cash provided by operating activities 658,807 332,904 414,080
Investing activities:      
Cash paid for acquisitions, net of cash acquired   (44,900)  
Cash paid for capital expenditures (216,615) (225,061) (253,187)
Cash paid for real estate acquisitions (8,349) (7,618) (18,383)
Proceeds from sale of property and equipment 92 11,765  
Settlement of foreign currency derivatives   105,008  
Other (13,365) 12,975 (4,198)
Net cash used in continuing investing activities (238,237) (147,831) (275,768)
Net cash used in discontinued investing activities (43,602) (53,310) (85,196)
Net cash used in investing activities (281,839) (201,141) (360,964)
Financing activities:      
Borrowings on long-term debt 925,000    
Borrowings on revolving credit facility 100,000 76,573  
Principal payments on revolving credit facility (100,000) (76,573)  
Principal payments on long-term debt (41,291) (52,984) (39,738)
Repayment of long-term debt (909,785)   (21,920)
Payment of debt issuance costs (18,295)    
Common stock withheld for minimum statutory taxes, net 184 (1,648) (3,407)
Distributions to noncontrolling interests (916) (154)  
Other (3,146) (4,369) 828
Net cash used in continuing financing activities (48,249) (59,155) (64,237)
Net cash used in discontinued financing activities (3,250) (2,472) (3,093)
Net cash used in financing activities (51,499) (61,627) (67,330)
Effect of exchange rate changes on cash 4,087 3,546 (2,566)
Net increase (decrease) in cash and cash equivalents, including cash classified within current assets held for sale 329,556 73,682 (16,780)
Less: cash classified within current assets held for sale (75,051) (24,657) (20,318)
Net increase in cash and cash equivalents 254,505 49,025 (37,098)
Cash and cash equivalents at beginning of the period 124,192 50,510 67,290
Cash and cash equivalents at end of the period 378,697 99,535 30,192
Supplemental Cash Flow Information:      
Cash paid for interest 137,578 173,239 175,204
Cash (received) paid for income taxes (16,486) 31,915 $ 6,136
Effect of acquisitions:      
Assets acquired, excluding cash 20,200 48,594  
Liabilities assumed (53) (3,694)  
Redeemable noncontrolling interest resulting from an acquisition $ (20,147)    
Cash paid for acquisitions, net of cash acquired   $ 44,900