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v3.24.0.1

Consolidated Statements of Cash Flows - USD ($) $ in Millions | 12 Months Ended
--- | ---
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021
Cash flows from operating activities: |  |  |
Net income | $ 16 | $ 179 | $ 368
Adjustments to reconcile net income to net cash provided by (used in) operating activities: |  |  |
Depreciation and amortization | 505 | 534 | 540
Deferred income taxes | 35 | 165 | 170
Stock-based compensation expense | 22 | 20 | 25
Impairment and (gain) loss on sale of businesses, net | (87) | 71 | 24
(Gain) loss from early extinguishment of debt | (72) | (253) | 79
Gain on sale of equity interests in Macon Healthcare, LLC |  |  | (39)
Gain from CoreTrust Transaction |  | (119) |
Other non-cash expenses, net | 181 | 182 | 78
Changes in operating assets and liabilities, net of effects of acquisitions and divestitures: |  |  |
Patient accounts receivable | (193) | 22 | (136)
Supplies, prepaid expenses and other current assets | (82) | (128) | 1
Repayment/derecognition of Medicare accelerated payments |  |  | (1,081)
Accounts payable, accrued liabilities and income taxes | (50) | (158) | 16
Other | (65) | (215) | (176)
Net cash provided by (used in) operating activities | 210 | 300 | (131)
Cash flows from investing activities: |  |  |
Acquisitions of facilities and other related businesses | (38) | (9) | (3)
Purchases of property and equipment | (467) | (415) | (469)
Proceeds from disposition of hospitals and other ancillary operations | 432 | 89 | 17
Proceeds from sale of property and equipment | 28 | 38 | 10
Purchases of available-for-sale debt securities and equity securities | (137) | (114) | (171)
Proceeds from sales of available-for-sale debt securities and equity securities | 232 | 110 | 102
Purchases of investments in unconsolidated affiliates | (11) | (19) | (7)
Proceeds from sale of equity interests in Macon Healthcare, LLC |  |  | 110
Distribution of CoreTrust Transaction proceeds |  | 121 |
Increase in other investments | (65) | (60) | (113)
Net cash used in investing activities | (26) | (259) | (524)
Cash flows from financing activities: |  |  |
Repurchase of restricted stock shares for payroll tax withholding requirements | (4) | (8) | (5)
Deferred financing costs and other debt-related costs | (3) | (74) | (313)
Proceeds from noncontrolling investors in joint ventures | 5 | 13 |
Redemption of noncontrolling investments in joint ventures | (1) | (5) | (19)
Distributions to noncontrolling investors in joint ventures | (141) | (125) | (121)
Other borrowings | 39 | 48 | 60
Issuance of long-term debt | 989 | 1,535 | 4,310
Proceeds from ABL Facility | 3,176 | 542 |
Repayments of long-term indebtedness | (4,324) | (2,356) | (4,426)
Net cash used in financing activities | (264) | (430) | (514)
Net change in cash and cash equivalents | (80) | (389) | (1,169)
Cash and cash equivalents at beginning of period | 118 | 507 | 1,676
Cash and cash equivalents at end of period | 38 | 118 | 507
Supplemental disclosure of cash flow information: |  |  |
Interest payments | (801) | (835) | (778)
Income tax (payments) refunds, net | $ (91) | $ (6) | $ (4)

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