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Leases | 12 Months Ended
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Dec. 31, 2023
Leases [Abstract] |
LEASES | 9. LEASES The Company utilizes operating and finance leases for the use of certain hospitals, medical office buildings, and medical equipment. All lease agreements generally require the Company to pay maintenance, repairs, property taxes and insurance costs, which are variable amounts based on actual costs incurred during each applicable period. Such costs are not included in the determination of the ROU asset or lease liability. Variable lease cost also includes escalating rent payments that are not fixed at commencement but are based on an index that is determined in future periods over the lease term based on changes in the Consumer Price Index or other measures of cost inflation. Most leases include one or more options to renew the lease at the end of the initial term, with renewal terms that generally extend the lease at the then market rate of rental payment. Certain leases also include an option to buy the underlying asset at or a short time prior to the termination of the lease. All such options are at the Company’s discretion and are evaluated at the commencement of the lease, with only those that are reasonably certain of exercise included in determining the appropriate lease term. The components of lease cost and rent expense for the years ended December 31, 2023, 2022 and 2021 are as follows (in millions):
|  | Year Ended December 31, |
Lease Cost |  | 2023 |  |  | 2022 |  |  | 2021 |
Operating lease cost: |  |  |  |  |  |  |  |  |
Operating lease cost |  | $ | 211 |  |  | $ | 211 |  |  | $ | 196 |
Short-term rent expense |  |  | 90 |  |  |  | 87 |  |  |  | 92 |
Variable lease cost |  |  | 23 |  |  |  | 24 |  |  |  | 25 |
Sublease income |  |  | (5 | ) |  |  | (5 | ) |  |  | (5 | )
Total operating lease cost |  | $ | 319 |  |  | $ | 317 |  |  | $ | 308 |
Finance lease cost: |  |  |  |  |  |  |  |  |
Amortization of ROU assets |  | $ | 13 |  |  | $ | 13 |  |  | $ | 9 |
Interest on finance lease liabilities |  |  | 13 |  |  |  | 15 |  |  |  | 9 |
Total finance lease cost |  | $ | 26 |  |  | $ | 28 |  |  | $ | 18 |
Supplemental balance sheet information related to leases was as follows (in millions):
|  | Balance Sheet Classification |  | December 31, 2023 |  |  | December 31, 2022 |
Operating Leases: |  |  |  |  |  |  |  |
Operating Lease ROU Assets |  | Other assets, net |  | $ | 665 |  |  | $ | 738 |
Finance Leases: |  |  |  |  |  |  |  |
Finance Lease ROU Assets |  | Property and equipment |  |  |  |  |  |
|  | Land and improvements |  | $ | — |  |  | $ | — |
|  | Buildings and improvements |  |  | 246 |  |  |  | 261 |
|  | Equipment and fixtures |  |  | 10 |  |  |  | 12 |
|  | Property and equipment |  |  | 256 |  |  |  | 273 |
|  | Less accumulated depreciation and amortization |  |  | (55 | ) |  |  | (56 | )
|  | Property and equipment, net |  | $ | 201 |  |  | $ | 217 |
Current finance lease liabilities |  | Current maturities of long-term debt |  | $ | 2 |  |  | $ | 3 |
Long-term finance lease liabilities |  | Long-term debt |  |  | 214 |  |  |  | 220 |
Supplemental cash flow information related to leases for the years ended December 31, 2023, 2022 and 2021 are as follows (in millions):
|  | Year Ended December 31, |
Cash flow information |  | 2023 |  |  | 2022 |  |  | 2021 |
Cash paid for amounts included in the measurement of lease liabilities: |  |  |  |  |  |  |  |  |
Operating cash flows from operating leases (1) |  | $ | 200 |  |  | $ | 204 |  |  | $ | 197 |
Operating cash flows from finance leases |  |  | 13 |  |  |  | 15 |  |  |  | 9 |
Financing cash flows from finance leases |  |  | 3 |  |  |  | 9 |  |  |  | 4 |
ROU assets obtained in exchange for new finance lease liabilities |  |  | 1 |  |  |  | 42 |  |  |  | 166 |
ROU assets obtained in exchange for new operating lease liabilities |  |  | 102 |  |  |  | 195 |  |  |  | 143 |
Weighted-average remaining lease term: |  |  |  |  |  |  |  |  |
Operating leases |  | 9 years |  |  | 8 years |  |  | 6 years |
Finance leases |  | 30 years |  |  | 31 years |  |  | 30 years |
Weighted-average discount rate: |  |  |  |  |  |  |  |  |
Operating leases |  |  | 8.8 | % |  |  | 8.0 | % |  |  | 8.1 | %
Finance leases |  |  | 6.2 | % |  |  | 6.4 | % |  |  | 6.3 | %
(1) Included in the change in other operating assets and liabilities in the consolidated statements of cash flows. Commitments relating to noncancellable operating and finance leases and financing obligations for each of the next five years and thereafter are as follows (in millions):
|  |  |  |  |  |  |  | Financing |
Year Ending December 31, |  | Operating |  |  | Finance |  |  | Obligations |
2024 |  | $ | 181 |  |  | $ | 16 |  |  | $ | 13 |
2025 |  |  | 144 |  |  |  | 15 |  |  |  | 13 |
2026 |  |  | 118 |  |  |  | 16 |  |  |  | 13 |
2027 |  |  | 92 |  |  |  | 16 |  |  |  | 13 |
2028 |  |  | 75 |  |  |  | 16 |  |  |  | 14 |
Thereafter |  |  | 467 |  |  |  | 472 |  |  |  | 59 |
Total minimum future payments |  |  | 1,077 |  |  |  | 551 |  |  |  | 125 |
Less: Imputed interest |  |  | (390 | ) |  |  | (335 | ) |  |  | 26 |
Total liabilities |  |  | 687 |  |  |  | 216 |  |  |  | 151 |
Less: Current portion |  |  | (124 | ) |  |  | (2 | ) |  |  | (3 | )
Long-term liabilities |  | $ | 563 |  |  | $ | 214 |  |  | $ | 148 |
As of December 31, 2023, there were approximately $36 million of assets underlying approved but pending leases that have not yet commenced, primarily for leases of various real-estate and medical equipment.

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