Document and Entity Information
Document and Entity Information - USD ($) $ in Billions | 12 Months Ended | ||
Dec. 31, 2021 | Jan. 31, 2022 | Jun. 30, 2021 | |
Document Information [Line Items] | |||
Document Type | 10-K | ||
Amendment Flag | false | ||
Document Period End Date | Dec. 31, 2021 | ||
Document Fiscal Year Focus | 2021 | ||
Document Fiscal Period Focus | FY | ||
Trading Symbol | UHS | ||
Entity Registrant Name | UNIVERSAL HEALTH SERVICES, INC. | ||
Entity Central Index Key | 0000352915 | ||
Current Fiscal Year End Date | --12-31 | ||
Entity Well-known Seasoned Issuer | Yes | ||
Entity Current Reporting Status | Yes | ||
Entity Voluntary Filers | No | ||
Entity Filer Category | Large Accelerated Filer | ||
ICFR Auditor Attestation Flag | true | ||
Entity Shell Company | false | ||
Entity Small Business | false | ||
Entity Emerging Growth Company | false | ||
Entity Public Float | $ 10.8 | ||
Entity File Number | 1-10765 | ||
Entity Incorporation, State or Country Code | DE | ||
Entity Tax Identification Number | 23-2077891 | ||
Entity Address, Address Line One | UNIVERSAL CORPORATE CENTER | ||
Entity Address, Address Line Two | P.O. Box 61558 | ||
Entity Address, Address Line Three | 367 South Gulph Road | ||
Entity Address, City or Town | King of Prussia | ||
Entity Address, State or Province | PA | ||
Entity Address, Postal Zip Code | 19406-0958 | ||
City Area Code | 610 | ||
Local Phone Number | 768-3300 | ||
Entity Interactive Data Current | Yes | ||
Security Exchange Name | NYSE | ||
Title of 12(b) Security | Class B Common Stock, $0.01 par value | ||
Document Annual Report | true | ||
Document Transition Report | false | ||
Auditor Name | PricewaterhouseCoopers LLP | ||
Auditor Location | Philadelphia, Pennsylvania | ||
Auditor Firm ID | 238 | ||
Documents Incorporated by Reference | DOCUMENTS INCORPORATED BY REFERENCE: Portions of the registrant’s definitive proxy statement for our 2022 Annual Meeting of Stockholders, which will be filed with the Securities and Exchange Commission within 120 days after December 31, 2021 (incorporated by reference under Part III). | ||
Class A | |||
Document Information [Line Items] | |||
Entity Common Stock, Shares Outstanding | 6,577,100 | ||
Class B | |||
Document Information [Line Items] | |||
Entity Common Stock, Shares Outstanding | 67,552,047 | ||
Class C | |||
Document Information [Line Items] | |||
Entity Common Stock, Shares Outstanding | 661,688 | ||
Class D | |||
Document Information [Line Items] | |||
Entity Common Stock, Shares Outstanding | 14,625 |
Consolidated Statements of Inco
Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Income Statement [Abstract] | |||
Net revenues | $ 12,642,117 | $ 11,558,897 | $ 11,378,259 |
Operating charges: | |||
Salaries, wages and benefits | 6,163,944 | 5,613,097 | 5,588,893 |
Other operating expenses | 3,035,869 | 2,672,762 | 2,723,911 |
Supplies expense | 1,427,134 | 1,288,132 | 1,251,346 |
Depreciation and amortization | 533,213 | 510,493 | 490,392 |
Lease and rental expense | 118,863 | 116,059 | 107,809 |
Operating Expenses, Total | 11,279,023 | 10,200,543 | 10,162,351 |
Income from operations | 1,363,094 | 1,358,354 | 1,215,908 |
Interest expense, net | 83,672 | 106,285 | 162,733 |
Other (income) expense, net | (13,891) | (14) | (13,162) |
Income before income taxes | 1,293,313 | 1,252,083 | 1,066,337 |
Provision for income taxes | 305,681 | 299,293 | 238,794 |
Net income | 987,632 | 952,790 | 827,543 |
Less: Net (loss) income attributable to noncontrolling interests | (3,958) | 8,837 | 12,689 |
Net income attributable to UHS | $ 991,590 | $ 943,953 | $ 814,854 |
Basic earnings per share attributable to UHS | $ 11.99 | $ 11.06 | $ 9.16 |
Diluted earnings per share attributable to UHS | $ 11.82 | $ 10.99 | $ 9.13 |
Weighted average number of common shares—basic | 82,519 | 85,061 | 88,762 |
Add: Other share equivalents | 1,173 | 526 | 278 |
Weighted average number of common shares and equivalents—diluted | 83,692 | 85,587 | 89,040 |
Consolidated Statements of Comp
Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Statement Of Income And Comprehensive Income [Abstract] | |||
Net income | $ 987,632 | $ 952,790 | $ 827,543 |
Other comprehensive income (loss): | |||
Unrealized derivative losses on cash flow hedges | 0 | 0 | (3,925) |
Minimum pension liability | 1,427 | 4,428 | 8,503 |
Foreign currency translation adjustment | (20,743) | 13,619 | 27,886 |
Other comprehensive income before tax | (19,316) | 18,047 | 32,464 |
Income tax expense related to items of other comprehensive income | (1,487) | 1,820 | 4,813 |
Total other comprehensive income (loss), net of tax | (17,829) | 16,227 | 27,651 |
Comprehensive income | 969,803 | 969,017 | 855,194 |
Less: Comprehensive income attributable to noncontrolling interests | (3,958) | 8,837 | 12,689 |
Comprehensive income attributable to UHS | $ 973,761 | $ 960,180 | $ 842,505 |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Current assets: | ||
Cash and cash equivalents | $ 115,301 | $ 1,224,490 |
Accounts receivable, net | 1,746,635 | 1,728,928 |
Supplies | 206,839 | 190,417 |
Other current assets | 194,781 | 138,034 |
Total current assets | 2,263,556 | 3,281,869 |
Property and Equipment | ||
Land | 732,717 | 665,000 |
Buildings and improvements | 6,509,629 | 6,030,183 |
Equipment | 2,759,934 | 2,607,692 |
Property under finance lease | 102,940 | 75,611 |
Property Equipment Gross | 10,105,220 | 9,378,486 |
Accumulated depreciation | (4,896,427) | (4,512,764) |
Property and equipment excluding construction in progress net | 5,208,793 | 4,865,722 |
Construction-in-progress | 665,482 | 507,402 |
Property, plant and equipment, net, Total | 5,874,275 | 5,373,124 |
Other assets: | ||
Goodwill | 3,962,624 | 3,882,715 |
Deferred income taxes | 45,707 | 22,689 |
Right of use assets-operating leases | 367,477 | 336,513 |
Deferred charges | 6,525 | 4,985 |
Other | 573,379 | 574,984 |
Other assets | 4,955,712 | 4,821,886 |
Total Assets | 13,093,543 | 13,476,879 |
Current liabilities: | ||
Current maturities of long-term debt | 48,409 | 331,998 |
Accounts payable | 658,900 | 570,523 |
Accrued liabilities | ||
Compensation and related benefits | 466,353 | 410,165 |
Interest | 14,408 | 9,458 |
Taxes other than income | 160,793 | 152,227 |
Operating lease liabilities | 64,484 | 59,796 |
Medicare accelerated payments and deferred CARES Act and other grants | 6 | 376,151 |
Other | 560,036 | 526,298 |
Current federal and state income taxes | 10,720 | 44,423 |
Total current liabilities | 1,984,109 | 2,481,039 |
Other noncurrent liabilities | 464,759 | 458,549 |
Medicare accelerated payments and deferred CARES Act noncurrent | 0 | 322,617 |
Operating lease liabilities noncurrent | 304,624 | 278,303 |
Long-term debt | 4,141,879 | 3,524,253 |
Deferred income taxes | 0 | 5,582 |
Commitments and contingencies (Note 8) | ||
Redeemable noncontrolling interest | 5,119 | 4,569 |
Equity: | ||
Cumulative dividends | (545,487) | (479,503) |
Retained earnings | 6,604,089 | 6,747,678 |
Accumulated other comprehensive income | 30,291 | 48,120 |
Universal Health Services, Inc. common stockholders’ equity | 6,089,664 | 6,317,146 |
Noncontrolling interest | 103,389 | 84,821 |
Total Equity | 6,193,053 | 6,401,967 |
Total Liabilities and Stockholders’ Equity | 13,093,543 | 13,476,879 |
Class A | ||
Equity: | ||
Common Stock | 66 | 66 |
Class B | ||
Equity: | ||
Common Stock | 698 | 778 |
Class C | ||
Equity: | ||
Common Stock | 7 | 7 |
Class D | ||
Equity: | ||
Common Stock | $ 0 | $ 0 |
Consolidated Balance Sheets (Pa
Consolidated Balance Sheets (Parenthetical) - $ / shares | Dec. 31, 2021 | Dec. 31, 2020 |
Class A | ||
Common Stock, par value | $ 0.01 | $ 0.01 |
Common Stock, shares authorized | 12,000,000 | 12,000,000 |
Common Stock, shares issued | 6,577,100 | 6,577,100 |
Common Stock, shares outstanding | 6,577,100 | 6,577,100 |
Class B | ||
Common Stock, par value | $ 0.01 | $ 0.01 |
Common Stock, shares authorized | 150,000,000 | 150,000,000 |
Common Stock, shares issued | 69,834,320 | 77,805,530 |
Common Stock, shares outstanding | 69,834,320 | 77,805,530 |
Class C | ||
Common Stock, par value | $ 0.01 | $ 0.01 |
Common Stock, shares authorized | 1,200,000 | 1,200,000 |
Common Stock, shares issued | 661,688 | 661,688 |
Common Stock, shares outstanding | 661,688 | 661,688 |
Class D | ||
Common Stock, par value | $ 0.01 | $ 0.01 |
Common Stock, shares authorized | 5,000,000 | 5,000,000 |
Common Stock, shares issued | 17,956 | 18,251 |
Common Stock, shares outstanding | 17,956 | 18,251 |
Consolidated Statements of Chan
Consolidated Statements of Changes in Equity - USD ($) $ in Thousands | Total | Redeemable Noncontrolling Interest | Common StockClass A | Common StockClass B | Common StockClass C | Common StockClass D | Cumulative Dividends | Retained Earnings | Accumulated Other Comprehensive Income (Loss) | UHS Common Stockholders' Equity | Noncontrolling Interest |
Balance at Dec. 31, 2018 | $ 5,465,793 | $ 66 | $ 841 | $ 7 | $ 0 | $ (409,156) | $ 5,793,262 | $ 4,242 | $ 5,389,262 | $ 76,531 | |
Balance at Dec. 31, 2018 | $ 4,292 | ||||||||||
Common Stock | |||||||||||
Issued/(converted) including tax benefits from exercise of stock options | 10,940 | 10 | 10,930 | 10,940 | |||||||
Repurchased | (753,927) | (57) | (753,870) | (753,927) | |||||||
Restricted share-based compensation expense | 8,222 | 8,222 | 8,222 | ||||||||
Dividends paid | (53,003) | (53,003) | (53,003) | ||||||||
Stock option expense | 60,106 | 60,106 | 60,106 | ||||||||
Distributions to noncontrolling interests | (15,359) | (500) | (15,359) | ||||||||
Other | 1,446 | 1,446 | |||||||||
Comprehensive income: | |||||||||||
Net income to UHS / noncontrolling interests | 827,002 | 814,854 | 814,854 | 12,148 | |||||||
Net income attributable to redeemable noncontrolling interest | 541 | ||||||||||
Foreign currency translation adjustments (net of income tax effect) | 24,193 | 24,193 | 24,193 | ||||||||
Unrealized derivative gains on cash flow hedges (net of income tax effect) | (2,997) | (2,997) | (2,997) | ||||||||
Minimum pension liability (net of income tax effect) | 6,455 | 6,455 | 6,455 | ||||||||
Subtotal - comprehensive income | 854,653 | 814,854 | 27,651 | 842,505 | 12,148 | ||||||
Subtotal attributable to redeemable noncontrolling interest | 541 | ||||||||||
Balance at Dec. 31, 2019 | 5,578,871 | 66 | 794 | 7 | (462,159) | 5,933,504 | 31,893 | 5,504,105 | 74,766 | ||
Balance at Dec. 31, 2019 | 4,333 | ||||||||||
Common Stock | |||||||||||
Issued/(converted) including tax benefits from exercise of stock options | 12,758 | 4 | 12,754 | 12,758 | |||||||
Repurchased | (206,719) | (20) | (206,699) | (206,719) | |||||||
Restricted share-based compensation expense | 9,505 | 9,505 | 9,505 | ||||||||
Dividends paid | (17,344) | (17,344) | (17,344) | ||||||||
Stock option expense | 54,661 | 54,661 | 54,661 | ||||||||
Distributions to noncontrolling interests | (19,305) | (500) | (19,305) | ||||||||
Purchase of ownership interests by minority members | 17,959 | 17,959 | |||||||||
Other | 3,300 | 3,300 | |||||||||
Comprehensive income: | |||||||||||
Net income to UHS / noncontrolling interests | 952,054 | 943,953 | 943,953 | 8,101 | |||||||
Net income attributable to redeemable noncontrolling interest | 736 | ||||||||||
Foreign currency translation adjustments (net of income tax effect) | 12,870 | 12,870 | 12,870 | ||||||||
Minimum pension liability (net of income tax effect) | 3,357 | 3,357 | 3,357 | ||||||||
Subtotal - comprehensive income | 968,281 | 943,953 | 16,227 | 960,180 | 8,101 | ||||||
Subtotal attributable to redeemable noncontrolling interest | 736 | ||||||||||
Balance at Dec. 31, 2020 | 6,401,967 | 66 | 778 | 7 | (479,503) | 6,747,678 | 48,120 | 6,317,146 | 84,821 | ||
Balance at Dec. 31, 2020 | 4,569 | ||||||||||
Common Stock | |||||||||||
Issued/(converted) including tax benefits from exercise of stock options | 13,374 | 5 | 13,369 | 13,374 | |||||||
Repurchased | (1,220,875) | (85) | (1,220,790) | (1,220,875) | |||||||
Restricted share-based compensation expense | 12,936 | 12,936 | 12,936 | ||||||||
Dividends paid | (65,984) | (65,984) | (65,984) | ||||||||
Stock option expense | 59,306 | 59,306 | 59,306 | ||||||||
Distributions to noncontrolling interests | (6,878) | (202) | (6,878) | ||||||||
Purchase of ownership interests by minority members | 13,909 | 13,909 | |||||||||
Other | 16,247 | 16,247 | |||||||||
Comprehensive income: | |||||||||||
Net income to UHS / noncontrolling interests | 986,880 | 991,590 | 991,590 | (4,710) | |||||||
Net income attributable to redeemable noncontrolling interest | 752 | ||||||||||
Foreign currency translation adjustments (net of income tax effect) | (18,914) | (18,914) | (18,914) | ||||||||
Minimum pension liability (net of income tax effect) | 1,085 | 1,085 | 1,085 | ||||||||
Subtotal - comprehensive income | 969,051 | 991,590 | (17,829) | 973,761 | (4,710) | ||||||
Subtotal attributable to redeemable noncontrolling interest | 752 | ||||||||||
Balance at Dec. 31, 2021 | 6,193,053 | $ 66 | $ 698 | $ 7 | $ (545,487) | $ 6,604,089 | $ 30,291 | $ 6,089,664 | $ 103,389 | ||
Balance at Dec. 31, 2021 | $ 5,000 | $ 5,119 |
Consolidated Statements of Ch_2
Consolidated Statements of Changes in Equity (Parenthetical) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Statement Of Stockholders Equity [Abstract] | |||
Foreign currency translation adjustments, income tax effect | $ 1,829 | $ 749 | $ 3,693 |
Unrealized derivative gains on cash flow hedges, income tax effect | 928 | ||
Minimum pension liability, income tax effect | $ (342) | $ (1,071) | $ (2,048) |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Cash Flows from Operating Activities: | |||
Net income | $ 987,632 | $ 952,790 | $ 827,543 |
Adjustments to reconcile net income to net cash provided by operating activities: | |||
Depreciation & amortization | 533,213 | 510,493 | 490,392 |
Loss (Gain) on sales of assets and businesses | (5,170) | 1,957 | (7,540) |
Stock-based compensation expense | 73,686 | 65,837 | 69,431 |
Costs related to extinguishment of debt | 16,831 | 1,365 | 0 |
Provision for asset impairment | 14,391 | 0 | 97,631 |
Changes in assets & liabilities, net of effects from acquisitions and dispositions: | |||
Accounts receivable | (8,873) | (145,901) | (42,056) |
Accrued interest | 4,950 | (10,028) | 209 |
Accrued and deferred income taxes | (54,030) | 9,593 | (25,194) |
Other working capital accounts | 46,526 | 124,545 | 39,664 |
Medicare accelerated payments and deferred CARES Act and other grants | (698,762) | 698,768 | 0 |
Other assets and deferred charges | (39,337) | (4,555) | (27,205) |
Other | (82,075) | 109,167 | 7,703 |
Accrued insurance expense, net of commercial premiums paid | 186,215 | 159,223 | 105,672 |
Payments made in settlement of self-insurance claims | (91,502) | (113,085) | (97,781) |
Net cash provided by operating activities | 883,695 | 2,360,169 | 1,438,469 |
Cash Flows from Investing Activities: | |||
Property and equipment additions | (855,659) | (731,307) | (634,095) |
Acquisition of businesses and property | (105,415) | (52,009) | (8,005) |
Inflows (outflows) from foreign exchange contracts that hedge our net U.K. investment | 1,357 | (21,740) | (19,763) |
Proceeds received from sales of assets and businesses | 25,425 | 8,168 | 9,450 |
Costs incurred for purchase and implementation of information technology applications | 19,726 | (2,902) | (21,418) |
Decrease (Increase) in capital reserves of commercial insurance subsidiary | 100 | (100) | 0 |
Investment in, and advances to, joint ventures and other | 0 | (2,672) | (14,579) |
Net cash used in investing activities | (914,466) | (802,562) | (688,410) |
Cash Flows from Financing Activities: | |||
Repayments of long-term debt | (3,037,868) | (962,567) | (57,142) |
Additional borrowings | 3,254,974 | 801,599 | 39,220 |
Financing costs | (18,770) | (10,300) | 0 |
Repurchase of common shares | (1,220,875) | (206,719) | (770,504) |
Dividends paid | (65,896) | (17,344) | (53,003) |
Issuance of common stock | 13,372 | 12,318 | 10,806 |
Profit distributions to noncontrolling interests | (7,080) | (19,805) | (15,859) |
Purchase of ownership interests by minority member | 13,193 | 17,959 | 1,446 |
Net cash used in financing activities | (1,068,950) | (384,859) | (845,036) |
Effect of exchange rate changes on cash and cash equivalents | (499) | 739 | 959 |
(Decrease) increase in cash, cash equivalents and restricted cash | (1,100,220) | 1,173,487 | (94,018) |
Cash, cash equivalents and restricted cash, beginning of period | 1,279,154 | 105,667 | 199,685 |
Cash, cash equivalents and restricted cash, end of period | 178,934 | 1,279,154 | 105,667 |
Supplemental Disclosures of Cash Flow Information: | |||
Interest paid | 75,607 | 112,598 | 157,406 |
Income taxes paid, net of refunds | 362,978 | 286,247 | 260,622 |
Noncash purchases of property and equipment | $ 167,234 | $ 74,854 | $ 63,514 |
Business and Summary of Signifi
Business and Summary of Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2021 | |
Accounting Policies [Abstract] | |
Business and Summary of Significant Accounting Policies | 1) BUSINESS AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Services provided by our hospitals, all of which are operated by subsidiaries of ours, include general and specialty surgery, internal medicine, obstetrics, emergency room care, radiology, oncology, diagnostic care, coronary care, pediatric services, pharmacy services and/or behavioral health services. We, through our subsidiaries, provide capital resources as well as a variety of management services to our facilities, including central purchasing, information services, finance and control systems, facilities planning, physician recruitment services, administrative personnel management, marketing and public relations. The more significant accounting policies follow: Principles of Consolidation: The consolidated financial statements include the accounts of our majority-owned subsidiaries and partnerships controlled by us or our subsidiaries as the managing general partner. All intercompany accounts and transactions have been eliminated. Revenue Recognition We report net patient service revenue at the estimated net realizable amounts from patients and third-party payers and others for services rendered. We have agreements with third-party payers that provide for payments to us at amounts different from our established rates. Payment arrangements include rates per discharge, reimbursed costs, discounted charges and per diem payments. Estimates of contractual allowances under managed care plans, which represent explicit price concessions, are based upon the payment terms specified in the related contractual agreements. We closely monitor our historical collection rates, as well as changes in applicable laws, rules and regulations and contract terms, to assure that provisions are made using the most accurate information available. However, due to the complexities involved in these estimations, actual payments from payers may be different from the amounts we estimate and record. See Note 10- Revenue Recognition We estimate our Medicare and Medicaid revenues using the latest available financial information, patient utilization data, government provided data and in accordance with applicable Medicare and Medicaid payment rules and regulations. The laws and regulations governing the Medicare and Medicaid programs are extremely complex and subject to interpretation and as a result, there is at least a reasonable possibility that recorded estimates will change by material amounts in the near term. Certain types of payments by the Medicare program and state Medicaid programs (e.g. Medicare Disproportionate Share Hospital, Medicare Allowable Bad Debts and Inpatient Psychiatric Services) are subject to retroactive adjustment in future periods as a result of administrative review and audit and our estimates may vary from the final settlements. Such amounts are included in accounts receivable, net, on our Consolidated Balance Sheets. The funding of both federal Medicare and state Medicaid programs are subject to legislative and regulatory changes. As such, we cannot provide any assurance that future legislation and regulations, if enacted, will not have a material impact on our future Medicare and Medicaid reimbursements. Adjustments related to the final settlement of these retrospectively determined amounts did not materially impact our results in 2021, 2020 or 2019. If it were to occur, each 1% adjustment to our estimated net Medicare revenues that are subject to retrospective review and settlement as of December 31, 2021, would change our after-tax net income by approximately $1 million. Charity Care, Uninsured Discounts and Other Adjustments to Revenue: Collection of receivables from third-party payers and patients is our primary source of cash and is critical to our operating performance. Our primary collection risks relate to uninsured patients and the portion of the bill which is the patient’s responsibility, primarily co-payments and deductibles. We estimate our revenue adjustments for implicit price concessions based on general factors such as payer mix, the aging of the receivables and historical collection experience. We routinely review accounts receivable balances in conjunction with these factors and other economic conditions which might ultimately affect the collectability of the patient accounts and make adjustments to our allowances as warranted. At our acute care hospitals, third party liability accounts are pursued until all payment and adjustments are posted to the patient account. For those accounts with a patient balance after third party liability is finalized or accounts for uninsured patients, the patient receives statements and collection letters. Historically, a significant portion of the patients treated throughout our portfolio of acute care hospitals are uninsured patients which, in part, has resulted from patients who are employed but do not have health insurance or who have policies with relatively high deductibles. Patients treated at our hospitals for non-elective services, who have gross income of various amounts, dependent upon the state, ranging from 200% to 400% of the federal poverty guidelines, are deemed eligible for charity care. The federal poverty guidelines are established by the federal government and are based on income and family size. Because we do not pursue collection of amounts that qualify as charity care, the transaction price is fully adjusted and there is no impact in our net revenues or in our accounts receivable, net. A portion of the accounts receivable at our acute care facilities are comprised of Medicaid accounts that are pending approval from third-party payers but we also have smaller amounts due from other miscellaneous payers such as county indigent programs in certain states. Our patient registration process includes an interview of the patient or the patient’s responsible party at the time of registration. At that time, an insurance eligibility determination is made and an insurance plan code is assigned. There are various pre-established insurance profiles in our patient accounting system which determine the expected insurance reimbursement for each patient based on the insurance plan code assigned and the services rendered. Certain patients may be classified as Medicaid pending at registration based upon a screening evaluation if we are unable to definitively determine if they are currently Medicaid eligible. When a patient is registered as Medicaid eligible or Medicaid pending, our patient accounting system records net revenues for services provided to that patient based upon the established Medicaid reimbursement rates, subject to the ultimate disposition of the patient’s Medicaid eligibility. When the patient’s ultimate eligibility is determined, reclassifications may occur which impacts net revenues in future periods. Although the patient’s ultimate eligibility determination may result in adjustments to net revenues, these adjustments do not have a material impact on our results of operations in 2021, 20 20 or 201 9 s ince our facilities make estimates at each financial reporting period to adjust revenue based on hi storical collections. We also provide discounts to uninsured patients (included in “uninsured discounts” amounts below) who do not qualify for Medicaid or charity care. Because we do not pursue collection of amounts classified as uninsured discounts, the transaction price is fully adjusted and there is no impact in our net revenues or in our net accounts receivable. In implementing the discount policy, we first attempt to qualify uninsured patients for governmental programs, charity care or any other discount program. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. Uncompensated care (charity care and uninsured discounts): The following table shows the amounts recorded at our acute care hospitals for charity care and uninsured discounts, based on charges at established rates, for the years ended December 31, 2021, 2020 and 2019: (dollar amounts in thousands) 2021 2020 2019 Amount % Amount % Amount % Charity care $ 661,965 33 % $ 622,668 28 % $ 672,326 31 % Uninsured discounts 1,336,319 67 % 1,578,470 72 % 1,511,738 69 % Total uncompensated care $ 1,998,284 100 % $ 2,201,138 100 % $ 2,184,064 100 % The estimated cost of providing uncompensated care: The estimated cost of providing uncompensated care, as reflected below, were based on a calculation which multiplied the percentage of operating expenses for our acute care hospitals to gross charges for those hospitals by the above-mentioned total uncompensated care amounts. The percentage of cost to gross charges is calculated based on the total operating expenses for our acute care facilities divided by gross patient service revenue for those facilities. An increase in the level of uninsured patients to our facilities and the resulting adverse trends in the adjustments to net revenues and uncompensated care provided could have a material unfavorable impact on our future operating results. (amounts in thousands) 2021 2020 2019 Estimated cost of providing charity care $ 72,095 $ 73,690 $ 77,886 Estimated cost of providing uninsured discounts related care 145,538 186,804 175,128 Estimated cost of providing uncompensated care $ 217,633 $ 260,494 $ 253,014 Concentration of Revenues: Our six acute care hospitals in the Las Vegas, Nevada market contributed, on a combined basis, 16% in 2021, 15% in 2020 and 16% in 2019 of our consolidated net revenues. Cash, Cash Equivalents and Restricted Cash: We consider all highly liquid investments purchased with maturities of three months or less to be cash equivalents. Cash, cash equivalents, and restricted cash as reported in the consolidated statements of cash flows are presented separately on our consolidated balance sheets as follow: (amounts in thousands) 2021 2020 2019 Cash and cash equivalents $ 115,301 $ 1,224,490 $ 61,268 Restricted cash (a) 63,633 54,664 44,399 Total cash, cash equivalents and restricted cash $ 178,934 $ 1,279,154 $ 105,667 (a)Restricted cash is included in other assets on the accompanying consolidated balance sheet and consists of statutorily required capital reserves related to our commercial insurance subsidiary The fair value of our restricted cash was computed based upon quotes received from financial institutions. We consider these to be “level 1” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with financial securities. Property and Equipment: Property and equipment are stated at cost. Expenditures for renewals and improvements are charged to the property accounts. Replacements, maintenance and repairs which do not improve or extend the life of the respective asset are expensed as incurred. We remove the cost and the related accumulated depreciation from the accounts for assets sold or retired and the resulting gains or losses are included in the results of operations. Construction-in-progress includes both construction projects and equipment not yet placed into service. See Provision for Asset Impairment-Foundations Recovery Network, Other Assets and Intangible Assets While in progress, we capitalized interest on major construction projects and the development and implementation of information technology applications amounting to $4.4 million during 2021, $4.3 million during 2020 and $3.4 million during 2019. Depreciation is provided on the straight-line method over the estimated useful lives of buildings and improvements (twenty to forty years) and equipment (three to fifteen years). Depreciation expense was $501.6 million during 2021, $478.8 million during 2020 and $455.6 million during 2019. Long-Lived Assets: We review our long-lived assets, including intangible assets, for impairment whenever events or circumstances indicate that the carrying value of these assets may not be recoverable. The assessment of possible impairment is based on our ability to recover the carrying value of our asset based on our estimate of its undiscounted future cash flows. If the analysis indicates that the carrying value is not recoverable from future cash flows, the asset is written down to its estimated fair value and an impairment loss is recognized. Fair values are determined based on estimated future cash flows using appropriate discount rates. Goodwill: Goodwill is reviewed for impairment at the reporting unit level on an annual basis or sooner if the indicators of impairment arise. Our judgments regarding the existence of impairment indicators are based on market conditions and operational performance of each reporting unit. We have designated October 1 st Changes in the carrying amount of goodwill for the two years ended December 31, 2021 were as follows (in thousands): Acute Care Services Behavioral Health Services Total Consolidated Balance, January 1, 2020 $ 448,415 $ 3,421,345 $ 3,869,760 Goodwill acquired during the period 127 0 127 Goodwill divested during the period 0 0 0 Adjustments to goodwill (a) (1,521 ) 14,349 12,828 Balance, December 31, 2020 447,021 3,435,694 3,882,715 Goodwill acquired during the period 55,406 0 55,406 Goodwill divested during the period 0 0 0 Adjustments to goodwill (b) 13,509 10,994 24,503 Balance, December 31, 2021 $ 515,936 $ 3,446,688 $ 3,962,624 (a) The changes in the Behavioral Health Services’ goodwill consists primarily of foreign currency translation adjustments. (b) Adjustments to goodwill during 2021 consist of the following: $13.5 million in Acute Care Services consists primarily of a measurement period adjustment to the preliminary purchase price allocation related to a 2020 acquisition; and the $11.0 million in Behavioral Health Services consists of $16.3 million recorded in connection with a third party minority ownership interest in a majority owned joint venture that constructed and owns a recently opened behavioral health facility, partially offset by a $5.3 million decrease related to foreign currency translation adjustments. Other Assets and Intangible Assets: Other assets consist primarily of amounts related to: (i) intangible assets acquired in connection with our acquisitions of Cambian Group, PLC’s adult services’ division during 2015, Ascend Health Corporation during 2012 and Psychiatric Solutions, Inc. during 2010; (ii) prepaid fees for various software and other applications used by our hospitals; (iii) costs incurred in connection with the purchase and implementation of an electronic health records application for each of our acute care facilities; (iv) statutorily required capital reserves related to our commercial insurance subsidiary ($ 82 million and $ 73 million as of December 31, 20 2 1 and 20 20 , respectively ); (v) deposits; (vi) investments in various businesses, including Universal Health Realty Income Trust ($ 9 million and $ 5 million as of as of December 31, 202 1 and 20 20 , respectively ) and Premier, Inc. ($ 92 million and $ million as of December 31, 202 1 and 20 20 , respectively ); (vii) the invested assets related to a deferred compensation plan that is held by an independent trustee in a rabbi-trust and that has a related payable included in other noncurrent liabilities , and ; (viii) other miscellaneous assets. Intangible assets are reviewed for impairment on an annual basis or more often if indicators of impairment arise. Our judgments regarding the existence of impairment indicators are based on market conditions and operational performance of each asset. We have designated October 1 st Provision for Asset Impairment-Foundations Recovery Network: Our financial results for the year ended December 31, 2019 include a pre-tax provisions for asset impairment of approximately $98 million recorded in connection with Foundations Recovery Network, L.L.C. (“Foundations”), which was acquired by us in 2015. This provision for asset impairment includes: (i) a $75 million impairment provision to write-off the carrying value of the Foundations’ tradename intangible asset, and; (ii) a $23 million impairment provision to reduce the carrying value of real property assets of certain Foundations’ facilities. The provision for asset impairment recorded during 2019, which is included in other operating expenses in the accompanying consolidated statements of income, was recorded after evaluation of the estimated fair value of the Foundations’ tradename as well as certain related real property assets. The provision for asset impairment was impacted by the following: (i) decisions made by management during 2019 to cancel the opening of future planned de novo facilities; (ii) reductions in projected future patient volumes, revenues and cash flows resulting from continued operating trends and financial results experienced by existing facilities that significantly lagged expectations, and; (iii) competitive pressures experienced in certain markets that were deemed to be permanent. The following table shows the amounts recorded as net intangible assets for the years ended December 31, 2021 and 2020: (amounts in thousands) 2021 2020 Medicare licenses $ 57,226 $ 57,226 Certificates of need 8,239 8,253 Contract relationships and other (net of $54,134 and $52,804 of accumulated amortization for 2021 and 2020, respectively) 15,576 17,107 Net Intangible Assets $ 81,041 $ 82,586 Supplies: Supplies, which consist primarily of medical supplies, are stated at the lower of cost (first-in, first-out basis) or market. Self-Insured/Other Insurance Risks: We provide for self-insured risks, primarily general and professional liability claims and workers’ compensation claims. Our estimated liability for self-insured professional and general liability claims is based on a number of factors including, among other things, the number of asserted claims and reported incidents, estimates of losses for these claims based on recent and historical settlement amounts, estimate of incurred but not reported claims based on historical experience, and estimates of amounts recoverable under our commercial insurance policies. All relevant information, including our own historical experience is used in estimating the expected amount of claims. While we continuously monitor these factors, our ultimate liability for professional and general liability claims could change materially from our current estimates due to inherent uncertainties involved in making this estimate. Our estimated self-insured reserves are reviewed and changed, if necessary, at each reporting date and changes are recognized currently as additional expense or as a reduction of expense. See Note 8 - Commitments and Contingencies for discussion of adjustments to our prior year reserves for claims related to our self-insured general and professional liability and workers’ compensation liability. In addition, we also: (i) own commercial health insurers headquartered in Nevada and Puerto Rico, and; (ii) maintain self-insured employee benefits programs for employee healthcare and dental claims. The ultimate costs related to these programs/operations include expenses for claims incurred and paid in addition to an accrual for the estimated expenses incurred in connection with claims incurred but not yet reported. Given our significant insurance-related exposure, there can be no assurance that a sharp increase in the number and/or severity of claims asserted against us will not have a material adverse effect on our future results of operations. Income Taxes: Deferred tax assets and liabilities are recognized for the amount of taxes payable or deductible in future years as a result of differences between the tax bases of assets and liabilities and their reported amounts in the financial statements. We believe that future income will enable us to realize our deferred tax assets net of recorded valuation allowances relating to state net operating loss carry-forwards. We operate in multiple jurisdictions with varying tax laws. We are subject to audits by any of these taxing authorities. Our tax returns have been examined by the Internal Revenue Service (“IRS”) through the year ended December 31, 2006. We believe that adequate accruals have been provided for federal, foreign and state taxes. See Note 6 - Income Taxes, Other Noncurrent Liabilities: Other noncurrent liabilities include the long-term portion of our professional and general liability, workers’ compensation reserves, pension and deferred compensation liabilities, payment deferral of the employer’s share of Social Security taxes as provided for by the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), and liabilities incurred in connection with split-dollar life insurance agreements on the lives of our chief executive officer and his wife. Redeemable Noncontrolling Interests and Noncontrolling Interest: As of December 31, 2021, outside owners held noncontrolling, minority ownership interests of: (i) 20% in an acute care facility located in Washington, D.C.; (ii) approximately 9% in an acute care facility located in Texas; (iii) 20%, 30%, 20%, 25% and 48% in five behavioral health care facilities located in Pennsylvania, Ohio, Washington, Missouri and Iowa, respectively, and; (iv) approximately 5% in an acute care facility located in Nevada. The noncontrolling interest and redeemable noncontrolling interest balances of $103 million and $5 million, respectively, as of December 31, 2021, consist primarily of the third-party ownership interests in these hospitals. In connection with the two behavioral health care facilities located in Pennsylvania and Ohio, the minority ownership interests of which are reflected as redeemable noncontrolling interests on our Consolidated Balance Sheet, the outside owners have “put options” to put their entire ownership interest to us at any time. If exercised, the put option requires us to purchase the minority member’s interest at fair market value. Accordingly, the amounts recorded as redeemable noncontrolling interests on our Consolidated Balance Sheet reflects the estimated fair market value of these ownership interests. Accumulated Other Comprehensive Income: The accumulated other comprehensive income (“AOCI”) component of stockholders’ equity includes: net unrealized gains and losses on effective cash flow hedges, foreign currency translation adjustments and the net minimum pension liability of a non-contributory defined benefit pension plan which covers employees at one of our subsidiaries. See Note 11 - Pension Plan for additional disclosure regarding the defined benefit pension plan. The amounts recognized in AOCI for the two years ended December 31, 2021 were as follows (in thousands): Net Unrealized Gains (Losses) on Effective Cash Flow Hedges Foreign Currency Translation Adjustment Minimum Pension Liability Total AOCI Balance, January 1, 2020, net of income tax $ (17 ) $ 39,568 $ (7,658 ) $ 31,893 2020 activity: Pretax amount 0 13,619 4,428 18,047 Income tax effect 0 (749 ) (1,071 ) (1,820 ) Change, net of income tax 0 12,870 3,357 16,227 Balance, January 1, 2021, net of income tax (17 ) 52,438 (4,301 ) 48,120 2021 activity: Pretax amount 0 (20,743 ) 1,427 (19,316 ) Income tax effect 0 1,829 (342 ) 1,487 Change, net of income tax 0 (18,914 ) 1,085 (17,829 ) Balance, December 31, 2021, net of income tax $ (17 ) $ 33,524 $ (3,216 ) $ 30,291 Accounting for Derivative Financial Investments and Hedging Activities and Foreign Currency Forward Exchange Contracts: We manage our ratio of fixed and floating rate debt with the objective of achieving a mix that management believes is appropriate. To manage this risk in a cost-effective manner, we, from time to time, enter into interest rate swap agreements in which we agree to exchange various combinations of fixed and/or variable interest rates based on agreed upon notional amounts. We account for our derivative and hedging activities using the Financial Accounting Standard Board’s (“FASB”) guidance which requires all derivative instruments, including certain derivative instruments embedded in other contracts, to be carried at fair value on the balance sheet. For derivative transactions designated as hedges, we formally document all relationships between the hedging instrument and the related hedged item, as well as its risk-management objective and strategy for undertaking each hedge transaction. Derivative instruments designated in a hedge relationship to mitigate exposure to variability in expected future cash flows, or other types of forecasted transactions, are considered cash flow hedges. Cash flow hedges are accounted for by recording the fair value of the derivative instrument on the balance sheet as either an asset or liability, with a corresponding amount recorded in accumulated other comprehensive income (“AOCI”) within shareholders’ equity. Amounts are reclassified from AOCI to the income statement in the period or periods the hedged transaction affects earnings. From time to time, we use interest rate derivatives in our cash flow hedge transactions. Such derivatives are designed to be highly effective in offsetting changes in the cash flows related to the hedged liability. For hedge transactions that do not qualify for the short-cut method, at the hedge’s inception and on a regular basis thereafter, a formal assessment is performed to determine whether changes in the fair values or cash flows of the derivative instruments have been highly effective in offsetting changes in cash flows of the hedged items and whether they are expected to be highly effective in the future. In August 2017, the FASB issued new guidance on hedge accounting (ASU 2017-12) that is intended to more closely align hedge accounting with companies’ risk management strategies, simplify the application of hedge accounting, and increase transparency as to the scope and results of hedging programs. The new guidance amends the presentation and disclosure requirements, and changes how companies assess effectiveness. We adopted this guidance as of January 1, 2019 and applied to all existing hedges as of the adoption date. As of December 31, 2021 we have no cash flow hedges. We use forward exchange contracts to hedge our net investment in foreign operations against movements in exchange rates. The effective portion of the unrealized gains or losses on these contracts is recorded in foreign currency translation adjustment within accumulated other comprehensive income and remains there until either the sale or liquidation of the subsidiary. In conjunction with the January 1, 2019 adoption of ASU 2017-12, “Targeted Improvements to Accounting for Hedging Activities”, we reclassified our presentation of the net cash inflows or outflows, which were received or paid in connection with foreign exchange contracts that hedge our net investment in foreign operations against movements in exchange rates, to investing cash flows on the consolidated statements of cash flows. Stock-Based Compensation: We have a number of stock-based employee compensation plans. Pursuant to the FASB’s guidance, we expense the grant-date fair value of stock options and other equity-based compensation pursuant to the straight-line method over the stated vesting period of the award using the Black-Scholes option-pricing model. The expense associated with share-based compensation arrangements is a non-cash charge. In the Consolidated Statements of Cash Flows, share-based compensation expense is an adjustment to reconcile net income to cash provided by operating activities. Earnings per Share: Basic earnings per share are based on the weighted average number of common shares outstanding during the year. Diluted earnings per share are based on the weighted average number of common shares outstanding during the year adjusted to give effect to common stock equivalents. The following table sets forth the computation of basic and diluted earnings per share, for the periods indicated: Twelve Months Ended December 31, 2021 2020 2019 Basic and diluted: Net Income $ 987,632 $ 952,790 $ 827,543 Less: Net (income) loss attributable to noncontrolling interest 3,958 (8,837 ) (12,689 ) Less: Net income attributable to unvested restricted share grants (2,059 ) (2,981 ) (2,028 ) Net income attributable to UHS—basic and diluted $ 989,531 $ 940,972 $ 812,826 Basic earnings per share attributable to UHS: Weighted average number of common shares—basic 82,519 85,061 88,762 Total basic earnings per share $ 11.99 $ 11.06 $ 9.16 Diluted earnings per share attributable to UHS: Weighted average number of common shares 82,519 85,061 88,762 Net effect of dilutive stock options and grants based on the treasury stock method 1,173 526 278 Weighted average number of common shares and equivalents—diluted 83,692 85,587 89,040 Total diluted earnings per share $ 11.82 $ 10.99 $ 9.13 The “Net effect of dilutive stock options and grants based on the treasury stock method”, for all years presented above, excludes certain outstanding stock options applicable to each year since the effect would have been anti-dilutive. The excluded weighted-average stock options totaled approximately 4.2 million during 2021, 6.4 million during 2020 and 5.5 million during 2019. Fair Value of Financial Instruments: The fair values of our debt and investments are based on quoted market prices. The fair values of other long-term debt, including capital lease obligations, are estimated by discounting cash flows using period-end interest rates and market conditions for instruments with similar maturities and credit quality. The carrying amounts reported in the balance sheet for cash, accounts receivable, accounts payable, and short-term borrowings approximates their fair values due to the short-term nature of these instruments. Accordingly, these items have been excluded from the fair value disclosures included elsewhere in these notes to consolidated financial statements. Use of Estimates: The preparation of financial statements in conformity with U.S. generally accepted accounting principles requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Mergers and Acquisitions: The acquisition method of accounting for business combinations requires that the assets acquired and liabilities assumed be recorded at the date of acquisition at their respective fair values with limited exceptions. Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Any excess of the purchase price (consideration transferred) over the estimated fair values of net assets acquired is recorded as goodwill. Transaction costs and costs to restructure the acquired company are expensed as incurred. The fair value of intangible assets, including Medicare licenses, certificates of need, tradenames and certain contracts, is based on significant judgments made by our management, and accordingly, for significant items we typically obtain assistance from third party valuation specialists. GPO Agreement/Minority Ownership Interest: During 2013, we entered into a new group purchasing organization agreement (“GPO”) with Premier, Inc. (“Premier), a healthcare performance improvement alliance, and acquired a minority interest in the GPO for a nominal amount. During the fourth quarter of 2013, in connection with the completion of an initial public offering of the stock of Premier, we received cash proceeds for the sale of a portion of our ownership interest in the GPO, which were recorded as deferred income, on a pro rata basis, as a reduction to our supplies expense over the initial expected life of the GPO agreement. Also in connection with this GPO agreement, we received shares of restricted stock in Premier which vest ratably over a seven-year remier paid cash dividends of $1.7 million and $848,000 as of December 31, 2021 and 2020, respectively, which are included in “Other (income) expense, net” in our condensed consolidated statements of income. Provider Taxes: We incur health-care related taxes (“Provider Taxes”) imposed by states in the form of a licensing fee, assessment or other mandatory payment which are related to: (i) healthcare items or services; (ii) the provision of, or the authority to provide, the health care items or services, or; ( |
Acquisitions and Divestitures
Acquisitions and Divestitures | 12 Months Ended |
Dec. 31, 2021 | |
Business Combinations [Abstract] | |
Acquisitions and Divestitures | 2) ACQUISITIONS AND DIVESTITURES Year ended December 31, 2021: 2021 Acquisitions of Assets and Businesses: During 2021, we spent $105 million on the acquisition of businesses and property, consisting primarily of a micro acute care hospital located in Las Vegas, Nevada, and a physician practice management company located in California. 2021 Divestiture of Assets and Businesses: During 2021, we received $25 million from the sale of assets and businesses. Year ended December 31, 2020: 2020 Acquisitions of Assets and Businesses: During 2020, we spent $52 million on the acquisition of businesses and property, consisting primarily of the real estate assets of an acute care hospital located in Las Vegas, Nevada. 2020 Divestiture of Assets and Businesses: During 2020, we received $8 million from the sale of assets and businesses. Year ended December 31, 2019: 2019 Acquisitions of Assets and Businesses: During 2019, we spent $8 million to acquire various businesses and properties. 2019 Divestiture of Assets: During 2019, we received $9 million from the sales of various assets. |
Financial Instruments and Fair
Financial Instruments and Fair Value Measurement | 12 Months Ended |
Dec. 31, 2021 | |
Financial Instruments And Fair Value Measurement [Abstract] | |
Financial Instruments and Fair Value Measurement | 3) FINANCIAL INSTRUMENTS AND FAIR VALUE MEASUREMENT Cash Flow Hedges: During the years ended December 31, 2021 and 2020, we had no cash flow hedges outstanding. During 2019, we had nine interest rate swaps outstanding, all of which expired on April 15, 2019, whereby we paid a fixed rate on a total notional amount of $1.0 billion and received one-month LIBOR. The average fixed rate payable on these swaps was 1.31%. When applicable, we measure our interest rate swaps at fair value on a recurring basis. The fair value of our interest rate swaps is based on quotes from our counterparties. We consider those inputs to be “level 2” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with derivative instruments and hedging activities. Foreign Currency Forward Exchange Contracts: We use forward exchange contracts to hedge our net investment in foreign operations against movements in exchange rates. The effective portion of the unrealized gains or losses on these contracts is recorded in foreign currency translation adjustment within accumulated other comprehensive income and remains there until either the sale or liquidation of the subsidiary. In connection with these forward exchange contracts, we recorded net cash inflows of approximately $1 million during 2021, net cash outflows of approximately $22 million during 2020 and net cash inflows of approximately $20 million during 2019. Derivatives Hedging Relationships: The following table presents the effects of our interest rate swap agreements and our foreign currency foreign exchange contracts on our results of operations for the three years ended December 31 (in thousands): Gain/(Loss) recognized in AOCI December 31, December 31, December 31, 2021 2020 2019 Cash Flow Hedge relationships Interest rate swap agreements (a) $ 0 $ 0 $ (3,925 ) Net Investment Hedge relationships Foreign currency foreign exchange contracts $ (7,272 ) $ (22,097 ) $ (18,328 ) (a) The amount of No other gains or losses were recognized in income related to derivatives in Subtopic 815-20. Fair Value Measurement Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. The following fair value hierarchy classifies the inputs to valuation techniques used to measure fair value into one of three levels: • Level 1: Unadjusted quoted prices in active markets for identical assets or liabilities. • Level 2: Inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly. These included quoted prices for similar assets or liabilities in active markets and quoted prices for identical or similar assets or liabilities in markets that are not active. • Level 3: Unobservable inputs that reflect the reporting entity’s own assumptions. The following tables present the assets and liabilities recorded at fair value on a recurring basis: Balance at Balance Sheet Basis of Fair Value Measurement (in thousands) December 31, 2021 Location Level 1 Level 2 Level 3 Assets: Money market mutual funds $ 79,900 Other assets $ 79,900 Certificates of deposit 2,300 Other assets 2,300 Equity securities 91,919 Other assets 91,919 Deferred compensation assets 45,759 Other assets 45,759 Foreign currency exchange contracts 1,357 Other current assets 1,357 $ 221,235 $ 217,578 $ 3,657 - Liabilities: Deferred compensation liability $ 45,759 Other noncurrent liabilities $ 45,759 $ 45,759 $ 45,759 - - Balance at Balance Sheet Basis of Fair Value Measurement (in thousands) December 31, 2020 Location Level 1 Level 2 Level 3 Assets: Term Deposits $ 540,000 Cash and cash equivalents $ 540,000 Money market mutual funds 37,100 Cash and cash equivalents 37,100 Money market mutual funds 70,995 Other assets 70,995 Certificates of deposit 2,300 Other assets 2,300 Equity securities 78,367 Other assets 78,367 Deferred compensation assets 42,044 Other assets 42,044 Foreign currency exchange contracts 9,987 Other current assets 9,987 $ 780,793 $ 228,506 $ 552,287 - Liabilities: Deferred compensation liability $ 42,044 Other noncurrent liabilities $ 42,044 $ 42,044 $ 42,044 - - The fair value of our money market mutual funds, certificates of deposit and equity securities with a readily determinable fair value are computed based upon quoted market prices in an active market. The fair value of deferred compensation assets and the offsetting liability are computed based on market prices in an active market held in a rabbi trust. The fair value of our interest rate swaps are based on quotes from our counter parties. The fair value of our foreign currency exchange contracts is valued using quoted forward exchange rates and spot rates at the reporting date As of December 31, 2020, in addition to the $577 million reflected above in cash and cash equivalents, we have approximately $581 million of other cash accounts that earn interest at variable rates ranging from .20% to .25%. |
Long-Term Debt
Long-Term Debt | 12 Months Ended |
Dec. 31, 2021 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | 4) LONG-TERM DEBT A summary of long-term debt follows: December 31, 2021 2020 (amounts in thousands) Long-term debt: Notes and Mortgages payable (including obligations under finance leases of $79,331 in 2021 and $52,905 in 2020) and term loans with varying maturities through 2099; weighted average interest rates of 5.6% in 2021 and 6.8% in 2020 (see Note 7 regarding finance leases) $ 185,027 $ 61,638 Tranche A term loan 1,689,375 1,900,000 Revolving credit facility 342,600 — 2.65% Senior Secured Notes due 2030, net of unamortized discount of $1,968 in 2021 and $2,193 in 2020 798,032 797,806 1.65% Senior Secured Notes due 2026, net of unamortized discount of $813 in 2021 699,187 — 2.65% Senior Secured Notes due 2032, net of unamortized discount of $1,254 in 2021 498,746 — Term Loan B — 490,000 Accounts receivable securitization program — 225,000 5.00% Senior Secured Notes due 2026 — 400,000 Total debt before unamortized financing costs 4,212,967 3,874,444 Less-Unamortized financing costs (22,679 ) (18,193 ) Total debt after unamortized financing costs 4,190,288 3,856,251 Less-Amounts due within one year (48,409 ) (331,998 ) Long-term debt $ 4,141,879 $ 3,524,253 Credit Facilities and Outstanding Debt Securities On August 24, 2021, we entered into a seventh amendment to our credit agreement dated as of November 15, 2010, as amended and restated as of September 21, 2012, August 7, 2014 and October 23, 2018, among UHS, as borrower, the several banks and other financial institutions from time to time parties thereto, as lenders, and JPMorgan Chase Bank, N.A., as administrative agent, (the “Credit Agreement”). In September, 2021, we entered into an eighth amendment to our Credit Agreement which modified the definition of “Adjusted LIBO Rate”. The seventh amendment to the Credit Agreement, among other things, provided for the following: o a $1.2 billion aggregate amount revolving credit facility, which is scheduled to mature on August 24, 2026, representing an increase of $200 million over the $1.0 billion previous commitment. As of December 31, 2021, this facility had $343 million of borrowings outstanding and $854 million of available borrowing capacity, net of $4 million of outstanding letters of credit o a $1.7 billion tranche A term loan facility, which is scheduled to mature on August 24, 2026, resulting in an initial reduction of $150 million from the $1.85 billion of borrowings outstanding under the previous tranche A term loan facility, and; o repayment of approximately $488 million of outstanding borrowings and termination of the previous tranche B term loan facility Pursuant to the terms of the seventh amendment, the tranche A term loan, which had $1.689 billion of borrowings outstanding as of December 31, 2021, provides for installment payments of $10.625 million per quarter beginning on December 31, 2021 through September 30, 2023 and $21.25 million per quarter beginning on December 31, 2023 through June 30, 2026. The unpaid principal balance at June 30, 2026 is due on the maturity date. Revolving credit and tranche A term loan borrowings under the Credit Agreement bear interest at our election at either (1) the ABR rate which is defined as the rate per annum equal to the greatest of (a) the lender’s prime rate, (b) the weighted average of the federal funds rate, plus 0.5% and (c) one month LIBOR rate plus 1%, in each case, plus an applicable margin based upon our consolidated leverage ratio at the end of each quarter ranging from 0.25% to 0.625%, or (2) the one, three or six month LIBOR rate (at our election), plus an applicable margin based upon our consolidated leverage ratio at the end of each quarter ranging from 1.25% to 1.625%. As of December 31, 2021, the applicable margins were 0.25% for ABR-based loans and 1.25% for LIBOR-based loans under the revolving credit and term loan A facilities. The revolving credit facility includes a $125 million sub-limit for letters of credit. The Credit Agreement is secured by certain assets of the Company and our material subsidiaries (which generally excludes asset classes such as substantially all of the patient-related accounts receivable of our acute care hospitals, and certain real estate assets and assets held in joint-ventures with third parties) and is guaranteed by our material subsidiaries. The Credit Agreement includes a material adverse change clause that must be represented at each draw. The Credit Agreement also contains covenants that include a limitation on sales of assets, mergers, change of ownership, liens and indebtedness, transactions with affiliates, dividends and stock repurchases; and requires compliance with financial covenants including maximum leverage. We were in compliance with all required covenants as of December 31, 2021 and December 31, 2020. On August 24, 2021, we completed the following via private offerings to qualified institutional buyers under Rule 144A and to non-U.S. persons outside the United States in reliance on Regulation S under the Securities Act of 1933, as amended: o Issued $700 million of aggregate principal amount of 1.65% senior secured notes due on September 1, 2026, and; o Issued $500 million of aggregate principal amount of 2.65% senior secured notes due on January 15, 2032. In April, 2021, our accounts receivable securitization program (“Securitization”) was amended (the eighth amendment) to: (i) reduce the aggregate borrowing commitments to $20 million (from $450 million previously); (ii) slightly reduce the borrowing rates and commitment fee, and; (iii) extend the maturity date to April 25, 2022 (from April, 2021 previously). Substantially all other material terms and conditions remained unchanged. There were no borrowings outstanding pursuant to the Securitization as of December 31, 2021. On September 13, 2021, we redeemed $400 million of aggregate principal amount of 5.00% senior secured notes, that were scheduled to mature on June 1, 2026, at 102.50% of the aggregate principal, or $410 million. As of December 31, 2021, we had combined aggregate principal of $2.0 billion from the following senior secured notes: o $700 million aggregate principal amount of 1.65% senior secured notes due in September, 2026 (“2026 Notes”) which were issued on August 24, 2021. o $800 million aggregate principal amount of 2.65% senior secured notes due in October, 2030 (“2030 Notes”) which were issued on September 21, 2020. o $500 million of aggregate principal amount of 2.65% senior secured notes due in January, 2032 (“2032 Notes”) which were issued on August 24, 2021. On September 28, 2020, we redeemed the entire $700 million aggregate principal amount of our previously outstanding 4.75% senior secured notes, which were scheduled to mature in August, 2022, at 100% of the aggregate principal amount. Interest on the 2026 Notes is payable on March 1st and September 1st until the maturity date of September 1, 2026. Interest on the 2030 Notes payable on April 15th and October 15th, until the maturity date of October 15, 2030. th th The 2026 Notes, 2030 Notes and 2032 Notes (collectively “The Notes”) were offered only to qualified institutional buyers under Rule 144A and to non-U.S. persons outside the United States in reliance on Regulation S under the Securities Act of 1933, as amended (the “Securities Act”). The Notes have not been registered under the Securities Act and may not be offered or sold in the United States absent registration or an applicable exemption from registration requirements. The Notes are guaranteed (the “ Guarantees ”) on a senior secured basis by all of our existing and future direct and indirect subsidiaries (the “ Subsidiary Guarantors ”) that guarantee our Credit Agreement, or other first lien obligations or any junior lien obligations. The Notes and the Guarantees are secured by first-priority liens, subject to permitted liens, on certain of the Company’s and the Subsidiary Guarantors’ assets now owned or acquired in the future by the Company or the Subsidiary Guarantors (other than real property, accounts receivable sold pursuant to the Company’s Existing Receivables Facility (as defined in the Indenture pursuant to which The Notes were issued (the “Indenture”)), and certain other excluded assets). The Company’s obligations with respect to The Notes, the obligations of the Subsidiary Guarantors under the Guarantees, and the performance of all of the Company’s and the Subsidiary Guarantors’ other obligations under the Indenture, are secured equally and ratably with the Company’s and the Subsidiary Guarantors’ obligations under the Credit Agreement and The Notes by a perfected first-priority security interest, subject to permitted liens, in the collateral owned by the Company and its Subsidiary Guarantors, whether now owned or hereafter acquired. However, the liens on the collateral securing The Notes and the Guarantees will be released if: (i) The Notes have investment grade ratings; (ii) no default has occurred and is continuing, and; (iii) the liens on the collateral securing all first lien obligations (including the Credit Agreement and The Notes) and any junior lien obligations are released or the collateral under the Credit Agreement, any other first lien obligations and any junior lien obligations is released or no longer required to be pledged. The liens on any collateral securing The Notes and the Guarantees will also be released if the liens on that collateral securing the Credit Agreement, other first lien obligations and any junior lien obligations are released. In connection with the issuance of The Notes, the Company, the Subsidiary Guarantors and the representatives of the several initial purchasers, entered into Registration Rights Agreements (the “ Registration Rights Agreements ”), whereby the Company and the Subsidiary Guarantors have agreed, at their expense, to use commercially reasonable best efforts to: (i) cause to be filed a registration statement enabling the holders to exchange The Notes and the Guarantees for registered senior secured notes issued by the Company and guaranteed by the then Subsidiary Guarantors under the Indenture (the “ Exchange Securities ”), containing terms identical to those of The Notes (except that the Exchange Securities will not be subject to restrictions on transfer or to any increase in annual interest rate for failure to comply with the Registration Rights Agreements); (ii) cause the registration statement to become effective; (iii) complete the exchange offer not later than 60 days after such effective date and in any event on or prior to a target registration date of March 21, 2023 in the case of the 2030 Notes and February 24, 2024 in the case of the 2026 and 2032 Notes, and; (iv) file a shelf registration statement for the resale of The Notes if the exchange offers cannot be effected within the time periods listed above. The interest rate on The Notes will increase and additional interest thereon will be payable if the Company does not comply with its obligations under the Registration Rights Agreements. As discussed in Note 9-Relationship with Universal Health Realty Income Trust and Other Related Party Transactions As a result of our purchase option within the Aiken and Canyon Spring lease agreements, this asset purchase and sale transaction is accounted for as a failed sale leaseback in accordance with U.S. GAAP and we have accounted for the transaction as a financing arrangement. Our monthly lease payments payable to the Trust will be recorded to interest expense and as a reduction of the outstanding financial liability. The amount allocated to interest expense will be determined using our incremental borrowing rate and will be based on the outstanding financial liability. In connection with this transaction, our Consolidated Balance Sheet as of December 31, 2021 reflects a financial liability of approximately $82 million which is included in Notes and Mortgages payable in the table above. At December 31, 2021, the carrying value and fair value of our debt were each approximately $4.2 billion. At December 31, 2020, the carrying value and fair value of our debt were each approximately $3.9 billion. The aggregate scheduled maturities of our total debt outstanding as of December 31, 2021 are as follows: (000s) 2022 $ 48,409 2023 59,648 2024 92,012 2025 91,274 2026 2,472,172 Later 1,449,452 Total maturities before unamortized financing costs 4,212,967 Less-Unamortized financing costs (22,679 ) Total $ 4,190,288 |
Common Stock
Common Stock | 12 Months Ended |
Dec. 31, 2021 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
Common Stock | 5) COMMON STOCK Dividends We declared and paid cash dividends of $.80 per share ($65.9 million in the aggregate) during 2021. We declared and paid cash dividends of $17.3 million, or $.20 per share, during the first quarter of 2020 ( in April, 2020, as part of various COVID-19 initiatives, Stock Repurchase Programs During the second quarter of 2021, our Board of Directors approved a resumption of our stock repurchase program which had been suspended since April, 2020, as part of various COVID-19 initiatives. As of December 31, 2021 we had an aggregate authorization of $3.7 billion related to our stock repurchase program which was approved by our Board of Directors in various increments since 2014, including an authorized $1.0 billion increase in July, 2021. Pursuant to this program, which had an aggregate remaining available repurchase authorization of $358.2 million as of December 31, 2021, shares of our Class B Common Stock may be repurchased, from time to time as conditions allow, on the open market or in negotiated private transactions. There is no expiration date for our stock repurchase programs. program and 336,943 shares ($ 47.7 million in the aggregate) were repurchased in connection with the income tax withholding obligations resulting from stock-based compensation programs . Additional dollars authorized for repurchase (in thousands) Total number of shares purchased (a.) Total number of shares cancelled Average price paid per share for forfeited restricted shares Total number of shares purchased as part of publicly announced programs Average price paid per share for shares purchased as part of publicly announced program Aggregate purchase price paid (in thousands) Aggregate purchase price paid for shares purchased as part of publicly announced program Maximum number of dollars that may yet be purchased under the program (in thousands) Balance as of January 1, 2019 $ 462,344 2019 $ 1,000,000 5,762,409 27,713 $ 0.01 5,397,753 $ 130.84 $ 753,928 $ 706,221 $ 756,123 2020 $ — 2,050,735 17,779 $ 0.01 1,951,899 $ 100.70 $ 206,719 $ 196,560 $ 559,563 2021 $ 1,000,000 8,559,946 15,761 $ 0.01 8,409,721 $ 142.85 $ 1,220,876 $ 1,201,330 $ 358,233 Total for three year period ended December 31, 2021 $ 2,000,000 16,373,090 61,253 $ 0.01 15,759,373 $ 133.51 $ 2,181,523 $ 2,104,111 (a.) Includes 15,761, 17,779 and, 27,713 Stock-based Compensation Plans At December 31, 2021, we have a number of stock-based employee compensation plans. Pursuant to the FASB’s guidance, we expense the grant-date fair value of stock options (computed utilizing the Black-Scholes option-pricing model) and other equity-based compensation pursuant to the straight-line method over the stated vesting period of the awards. Pre-tax share-based compensation costs of $59.3 million during 2021, $54.7 million during 2020 and $60.1 million during 2019 were recognized related to outstanding stock options. In addition, pre-tax compensation costs of $14.4 million during 2021, $11.2 million during 2020 and $9.3 million during 2019 were recognized related to amortization of restricted stock and units as well as discounts provided in connection with shares purchased pursuant to our 2005 Employee Stock Purchase Plan. As of December 31, 2021, there was approximately $126.0 million of unrecognized compensation cost related to unvested stock options and restricted stock which is expected to be recognized over the remaining average vesting period of 2.6 years The expense associated with stock-based compensation arrangements is a non-cash charge. In the Consolidated Statements of Cash Flows, stock-based compensation expense is an adjustment to reconcile net income to cash provided by operating activities and aggregated to $73.7 million in 2021, $65.8 million in 2020 and $69.4 million in 2019. In connection with our January 1, 2017 adoption of ASU 2016-09, “Compensation-Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting”, our provision for income taxes and our net income attributable to UHS were favorably impacted by $2.4 million in 2021, unfavorably impacted by $7.4 million during 2020 and favorably impacted by $12.2 million during 2019. In 2005, we adopted the 2005 Stock Incentive Plan (the “Stock Incentive Plan”) which was amended in 2008, 2010, 2015 and 2017 and was cancelled in 2020, as discussed below. An aggregate of 35.6 million shares of Class B Common Stock had been reserved under the Stock Incentive Plan, the remaining balance of which was cancelled in 2020. During 2020 and 2019, stock options, net of cancellations, of approximately 2.4 million and 2.1 million, respectively, were granted under the Stock Incentive Plan. Stock options to purchase Class B Common Stock have been granted to our officers, key employees and members of our Board of Directors. Commencing in 2018, our key employees and non-executive officers began receiving a portion of their stock-based compensation in the form of restricted stock (as discussed below) in addition to receiving options to purchase Class B Common Stock. In 2020, we adopted the 2020 Omnibus Stock and Incentive Plan (the “2020 Stock Incentive Plan”) which was approved by our shareholders in May, 2020. A total of 6.1 million shares of Class B Common Stock were approved for issuance under the 2020 Stock Incentive Plan. Under the 2020 Stock Incentive Plan, shares that are subject to stock options shall be counted as one share per stock option, and every share that is subject to restricted stock awards or restricted stock units shall be counted as four shares. Various other types of equity awards are also permitted under the 2020 Stock Incentive Plan. During 2021, approximately 2.3 million stock options, net of cancellations, and 138,114 of restricted stock units, net of cancellations, were granted under the 2020 Stock Incentive Plan. During 2020, 44,000 stock options and 3,000 restricted stock units were granted under the 2020 Stock Incentive Plan to our key employees, and no shares were cancelled. Restricted stock and restricted stock units issued under the 2020 Stock Incentive Plan do not have rights to receive dividends on unvested restricted awards, however, the accrual of dividend equivalents on unvested restricted awards may be permitted. Upon adoption of the 2020 Stock Incentive Plan, no additional awards were granted under the 2005 Stock Incentive Plan or the 2010 Employees’ Restricted Stock Purchase Plan, and reserves for future issuance pursuant to each plan were cancelled. The per option weighted-average grant-date fair value of options granted during 2021 under the 2020 Stock Incentive Plan was $39.66. The per option weighted-average grant-date fair value of options granted during 2020 (including the 2005 and 2020 Stock Incentive Plans) and 2019 were $14.60 and $30.40, respectively. Stock options granted during 2021 and 2020 were either granted with an exercise price equal to the fair market value on the date of grant, or for our named executive officers, half of their total option award value was issued with a premium exercise price of 10% above the grant date fair market value. All stock options issued in 2019 were granted with an exercise price equal to the fair market value on the date of the grant. The majority of options are exercisable ratably over a four-year period beginning one year after the date of the grant. All outstanding options expire five years after the date of the grant. As of December 31, 2021, approximately 3.2 million shares of Class B Common Stock remain available for issuance pursuant to the 2020 Stock Incentive Plan. The fair value of each option grant was estimated on the date of grant using the Black-Scholes option-pricing model. The following weighted average assumptions were derived from averaging the number of options granted during the most recent five-year period. The weighted-average assumptions reflected below were based upon twenty-eight option grants for the five-year period ending December 31, 2021, twenty-nine option grants for the five-year period ending December 31, 2020 Year Ended December 31, 2021 2020 2019 Expected volatility 31 % 28 % 27 % Risk free Interest rate 2 % 2 % 2 % Expected life (years) 3.5 3.5 3.4 Forfeiture rate 8 % 8 % 9 % Dividend yield 0.5 % 0.5 % 0.3 % The risk-free rate is based on the U.S. Treasury zero coupon four year yield curve in effect at the time of grant. The expected life of the stock options granted was estimated using the historical behavior of employees. Expected volatility was based on historical volatility for a period equal to the stock option’s expected life. Expected dividend yield is based on our dividend yield at the time of grant. The forfeiture rate is based upon the actual historical forfeitures utilizing the 5-year term of the option. The table below summarizes our stock option activity during the year ended December 31, 2021: Outstanding Options Number of Shares Weighted Average Exercise Price Balance, January 1, 2021 8,238,966 $ 109.47 Granted 2,401,402 $ 141.08 Exercised (1,737,286 ) $ 116.38 Expired — $ — Cancelled (346,967 ) $ 112.84 Balance, December 31, 2021 8,556,115 $ 116.80 Outstanding options vested and exercisable as of December 31, 2021 2,997,296 $ 119.00 The following table provides information about unvested options for the year ended December 31, 2021: Shares Weighted Average Grant Date Fair Value Unvested options as of January 1, 2021 5,716,060 $ 22.74 Granted 2,401,402 $ 39.66 Vested (2,218,647 ) $ 24.61 Cancelled (339,996 ) $ 28.70 Unvested options as of December 31, 2021 5,558,819 $ 28.93 The following table provides information regarding all options outstanding at December 31, 2021: Options Outstanding Options Exercisable Number of options outstanding 8,556,115 2,997,296 Weighted average exercise price $ 116.80 $ 119.00 Aggregate intrinsic value as of December 31, 2021 $ 144,921,069 $ 35,394,928 Weighted average remaining contractual life 2.6 1.4 The total in-the-money value of all stock options exercised during the years ended December 31, 2021, 2020 and 2019 were $52.0 million, $22.2 million and $126.7 million, respectively. The weighted average remaining contractual life for options outstanding and weighted average exercise price per share for exercisable options at December 31, 2019, 2020 and 2021 were as follows: Year Ended: Options Outstanding Weighted Average Exercise Price Per Share Weighted Average Remaining Contractual Life (in Years) Exercisable Options Weighted Average Exercise Price Per Share Expected to Vest Options Weighted Average Exercise Price Per Share Shares Shares Shares 2019 8,133,176 124.52 2.7 2,551,267 119.86 5,073,423 126.62 2020 8,238,966 109.47 2.9 2,522,906 124.62 5,099,823 110.47 2021 8,556,115 116.80 2.6 2,997,296 119.00 5,005,113 116.94 Under our Amended and Restated 2010 Employees’ Restricted Stock Purchase Plan (the “Restricted Stock Plan”), which was cancelled during 2020 upon the approval of the 2020 Stock Incentive Plan, as mentioned above, eligible participants were allowed to purchase shares of Class B Common Stock at par value, subject to certain restrictions and had 600,000 shares of Class B Common Stock reserved. The reserve balance in the Restricted Stock Plan was cancelled during 2020 and no shares were issued under the Restricted Stock Plan during 2021. During 2020 and 2019, restricted shares, net of cancellations, of approximately 111,554 and 122,336, respectively, were granted and issued under the Restricted Stock Plan, with various ratable vesting periods ranging up to five years from the date of grant. The weighted-average grant-date fair value of the restricted shares granted during 2020 and 2019 under the Restricted Stock Plan was $68.06 and $133.98, respectively. As mentioned above, in 2020, we adopted the 2020 Stock Incentive Plan. During 2021 and 2020 restricted stock units, net of cancellations, of approximately 138,114 and 3,000 respectively, were granted under the 2020 Stock Incentive Plan with four-year vesting periods from the date of grant. The weighted average grant-date fair value of the restricted stock units issued during 2021 and 2020 under the 2020 Stock Incentive Plan was $138.80 and $109.72, respectively. The fair value of each restricted stock grant or restricted stock unit was determined as the closing UHS market price on the date of grant. Restricted shares and units of Class B Common Stock have been granted to our officers and key employees. In addition to the 2020 Stock Incentive Plan, we have our 2005 Employee Stock Purchase Plan (the “Employee Stock Plan”) which allows eligible employees to purchase shares of Class B Common Stock at a ten percent discount. There were 96,179, 115,008 and 82,449 shares issued pursuant to the Employee Stock Purchase Plan during 2021, 2020 and 2019, respectively. In connection with the Employee Stock Plan, we have reserved 2.0 million shares of Class B Common Stock for issuance and have issued approximately 1.6 million shares as of December 31, 2021. As of December 31, 2021, approximately 400,000 shares of Class B Common Stock remain available for issuance pursuant to this plan. At December 31, 2021, 20,034,442 shares of Class B Common Stock were reserved for issuance upon conversion of shares of Class A, C and D Common Stock outstanding, for issuance upon exercise of options to purchase Class B Common Stock and for issuance of stock under other incentive plans. Class A, C and D Common Stock are convertible on a share for share basis into Class B Common Stock. |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | 6) INCOME TAXES Components of income tax expense/(benefit) are as follows (amounts in thousands): Year Ended December 31, 2021 2020 2019 Current Federal $ 276,471 $ 268,974 $ 225,663 Foreign 13,754 13,978 9,284 State 44,993 43,333 40,152 335,218 326,285 275,099 Deferred Federal (26,638 ) (20,382 ) (27,073 ) Foreign 1,521 (2,496 ) 1,874 State (4,420 ) (4,114 ) (11,106 ) (29,537 ) (26,992 ) (36,305 ) Total $ 305,681 $ 299,293 $ 238,794 On December 22, 2017, the President of the United States signed into law comprehensive tax legislation commonly referred to as the Tax Cuts and Jobs Act of 2017 (the “TCJA-17”). The TCJA-17 contains two new anti-base erosion tax provisions, (1) the global intangible low-taxed income (“GILTI”) provisions and (2) the base erosion and anti-abuse tax (“BEAT”) provisions: GILTI: The GILTI provisions require the inclusion of the earnings of certain foreign subsidiaries in excess of an acceptable rate of return on certain assets of the respective subsidiaries in our U.S. tax return for tax years beginning after December 31, 2017. An accounting policy election was made during 2018 to treat taxes related to GILTI as a period cost when the tax is incurred. We recorded a GILTI tax provision of zero for the years ended December 31, 2021, 2020 and 2019, respectively. BEAT: The BEAT provisions limit the deduction for U.S. tax base erosion related payments made by U.S. operations to related foreign affiliates. We were not subject to BEAT for the years ended December 31, 2021, 2020 and 2019. The foreign provision for income taxes is based on foreign pre-tax earnings of $79 million in 2021, $72 million in 2020 and $69 million in 2019. In the future, we anticipate repatriating only previously taxed foreign earnings subjected as well as any future earnings that would qualify for a full dividend received deduction for distributions post-December 31, 2017. As of December 31, 2021, the amount of previously taxed earnings and earnings that would qualify for a full dividend received deduction total $116 million. At this time, there are no material tax effects related to future cash repatriation of undistributed foreign earnings. As such, we have not recognized a deferred tax liability related to existing undistributed earnings. Our provision for income taxes for the year ended December 31, 2021, 2020 and 2019 included tax benefits of $2 million, tax expenses of $7 million and tax benefits of $12 million, respectively. Excess tax benefits (when the deductible amount related to the settlement of employee equity awards for tax purposes exceeds the cumulative compensation cost recognized for financial reporting purposes) and deficiencies, if applicable, are recorded as a component of our tax provision. A reconciliation between the federal statutory rate and the effective tax rate is as follows: Year Ended December 31, 2021 2020 2019 Federal statutory rate 21.0 % 21.0 % 21.0 % State taxes, net of federal income tax benefit 2.5 % 2.5 % 2.2 % Tax effects of foreign operations -0.1 % -0.3 % -0.3 % Tax benefit from settlement of employee equity awards -0.2 % 0.5 % -1.0 % Other items 0.3 % 0.4 % 0.8 % Impact of income attributable to noncontrolling interests 0.1 % -0.2 % -0.3 % Effective tax rate 23.6 % 23.9 % 22.4 % Our effective tax rates were 23.6%, 23.9% and 22.4% for the years ended December 31, 2021, 2020 and 2019, respectively. The decrease in our effective tax rate for the year ended December 31, 2021 as compared to 2020 is due primarily to tax benefit of $2 million and tax expense of $7 million from employee share-based payments during the year ended December 2021 and 2020, respectively. The increase in our effective tax rate for the year ended December 31, 2020 as compared to 2019 is due primarily to tax expense from employee share-based payments of $7 million and tax benefits of $12 million during the year ended December 2020 and 2019, respectively. Included in “Other current assets” on our Consolidated Balance Sheet are prepaid federal, state and foreign income taxes amounting to approximately $6 million and $11 million as of December 31, 2021 and 2020, respectively. The components of deferred taxes are as follows (amounts in thousands): Year Ended December 31, 2021 2020 Assets Liabilities Assets Liabilities Self-insurance reserves $ 97,024 $ $ 75,648 $ Compensation accruals 77,917 71,054 Doubtful accounts and other reserves 127,876 94,295 Other currently non-deductible accrued liabilities 31,240 61,634 Depreciable and amortizable assets 303,079 296,588 Operating lease liabilities 86,652 89,865 Right of use assets-operating leases 86,269 89,493 State and foreign net operating loss carryforwards and other state and foreign deferred tax assets 79,499 81,036 Net pension liabilities – OCI only 1,014 1,356 Other liabilities 3,811 3,697 $ 501,222 $ 393,159 $ 474,888 $ 389,778 Valuation Allowance (62,356 ) 0 (68,003 ) 0 Total deferred income taxes $ 438,866 $ 393,159 $ 406,885 $ 389,778 At December 31, 2021, state net operating loss carryforwards (losses originating in tax years beginning prior to January 1, 2021, expiring in years 2022 through 2040), and credit carryforwards available to offset future taxable income approximated $891 million representing approximately $60 million in deferred state tax benefit (net of the federal benefit); and state related interest expense carryforwards approximated $158 million representing approximately $5 million in deferred state tax benefit (net of the federal benefit). At December 31, 2021, there were foreign net operating losses and interest expense carryforwards of approximately $51 million, most of which are carried forward indefinitely, representing approximately $13 million in deferred foreign tax benefit. At December 31, 2021, related to the acquisition of Riverside Medical Clinic Patient Services, LLC, there were estimated federal and state net operating losses of approximately $11 million carried forward indefinitely for federal purposes and $10 million through 2038 for state purposes representing approximately $2 million in deferred federal tax benefits and less than $1 million of state tax benefits. A valuation allowance is required when it is more likely than not that some portion of the deferred tax assets will not be realized. Based on available evidence, it is more likely than not that certain of our state tax benefits will not be realized. Therefore, valuation allowances of approximately $57 million and $64 million have been reflected as of December 31, 2021 and 2020, respectively. During 2021, the valuation allowance on these state tax benefits decreased by $7 million primarily due to expired net operating losses not realized. In addition, valuation allowances of approximately $5 million and $4 million have been reflected as of December 31, 2021 and 2020, respectively, related to foreign net operating losses and credit carryforwards. During 2021 and 2020, the estimated liabilities for uncertain tax positions (including accrued interest and penalties) were increased less than $1 million due to tax positions taken in the current and prior years. The balance at each of the years ended December 31, 2021 and 2020, if subsequently recognized, that would favorably affect the effective tax rate and the provision for income taxes is approximately $2 million as of each date. We recognize accrued interest and penalties associated with uncertain tax positions as part of the tax provision. As of December 31, 2021 and 2020, we have accrued interest and penalties of less than $1 million as of each date. The U.S. federal statute of limitations remains open for the 2018 and subsequent years. Foreign and U.S. state and local jurisdictions have statutes of limitations generally ranging for 3 to 4 years. The statute of limitations on certain jurisdictions could expire within the next twelve months. It is reasonably possible that the amount of unrecognized tax benefits will change during the next 12 months, however, it is anticipated that any such change, if it were to occur, would not have a material impact on our results of operations. The tabular reconciliation of unrecognized tax benefits for the years ended December 31, 2021, 2020 and 2019 is as follows (amounts in thousands): As of December 31, 2021 2020 2019 Balance at January 1, $ 2,806 $ 2,164 $ 1,553 Additions based on tax positions related to the current year 500 500 500 Additions for tax positions of prior years 213 142 113 Reductions for tax positions of prior years (261 ) 0 0 Settlements (714 ) 0 (2 ) Balance at December 31, $ 2,544 $ 2,806 $ 2,164 |
Lease Commitments
Lease Commitments | 12 Months Ended |
Dec. 31, 2021 | |
Leases [Abstract] | |
Lease Commitments | 7) LEASE COMMITMENTS In February 2016, the FASB issued ASU 2016-02 (Topic 842) "Leases." Topic 842 supersedes the lease requirements in Accounting Standards Codification Topic 840, "Leases." Under Topic 842, lessees are required to recognize assets and liabilities on the balance sheet for most leases and provide enhanced disclosures. Leases will be classified as either finance or operating. We adopted Topic 842 effective January 1, 2019. We applied Topic 842 to all leases as of January 1, 2019 with comparative periods continuing to be reported under Topic 840. We have elected the practical expedient package to not reassess at adoption (i) expired or existing contracts for whether they are or contain a lease, (ii) the lease classification of any existing leases or (iii) initial indirect costs for existing leases. We determine if an arrangement is or contains a lease at inception of the contract. Our right-of-use assets represent our right to use the underlying assets for the lease term and our lease liabilities represent our obligation to make lease payments arising from the leases. Right-of-use assets and lease liabilities are recognized at commencement date based on the present value of lease payments over the lease term. We use the implicit rate noted within the contract if known or determinable. If the implicit rate is not readily available, we use our estimated incremental borrowing rate, which is derived using a collateralized borrowing rate for the same currency and term as the associated lease. Our operating leases are primarily for real estate, including certain acute care facilities, off-campus outpatient facilities, medical office buildings, and corporate and other administrative offices. Our real estate lease agreements typically have initial terms of five to 10 years. These real estate leases may include one or more options to renew, with renewals that can extend the lease term from five to 10 years. The exercise of lease renewal options is at our sole discretion. When determining the lease term, we included options to extend or terminate the lease when it is reasonably certain that we will exercise that option. Five of our hospital facilities are held under operating leases with Universal Health Realty Income Trust with two hospital terms expiring in 2026, two expiring in 2033, and one expiring in 2040 (see Note 9 for additional disclosure). We also lease the real property of certain facilities (see Item 2. Properties for additional disclosure). The components of lease expense for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands): Twelve months ended December 31, 2021 2020 2019 Operating lease cost $ 77,420 $ 73,841 $ 72,098 Variable and short term lease cost (a) 41,443 42,218 35,711 Total lease and rental expense $ 118,863 $ 116,059 $ 107,809 Finance lease cost: Amortization of property under capital lease $ 3,626 $ 1,985 $ 1,877 Interest on debt of property under capital lease 4,124 1,763 1,876 Total finance lease cost $ 7,750 $ 3,748 $ 3,753 (a) Supplemental cash flow information related to leases for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands): Twelve months ended December 31, 2021 2020 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 118,433 $ 115,270 $ 107,239 Operating cash flows from finance leases $ 4,612 $ 1,885 $ 2,078 Financing cash flows from finance leases $ 2,849 $ 2,586 $ 1,959 Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 95,805 $ 69,678 $ 383,857 Finance leases $ 28,600 $ 37,029 $ - Included in the $383.9 million of right-of-use assets obtained in exchange for operating lease obligations is $29.3 million of new and modified operating leases entered into during the year ended December 31, 2019. Supplemental balance sheet information related to leases as of December 31, 2021 and 2020 are as follows (in thousands): December 31, December 31, 2021 2020 Operating Leases Right of use assets-operating leases $ 367,477 $ 336,513 Operating lease liabilities $ 64,484 $ 59,796 Operating lease liabilities noncurrent 304,624 278,303 Total operating lease liabilities $ 369,108 $ 338,099 Finance Leases Property and equipment $ 102,940 $ 75,611 Accumulated depreciation (30,949 ) (28,595 ) Property and equipment, net $ 71,991 $ 47,016 Current maturities of long-term debt $ 2,740 $ 2,060 Long-term debt 76,591 50,845 Total finance lease liabilities $ 79,331 $ 52,905 Weighted Average remaining lease term, years Operating leases 9.1 10.9 Finance leases 20.8 8.1 Weighted Average discount rate Operating leases 3.8 % 4.4 % Finance leases 7.1 % 9.7 % Future maturities of lease liabilities as of December 31, 2021 are as follows (in thousands): Operating Leases Finance Leases Year ending December 31, 2022 $ 75,790 $ 6,809 2023 67,994 6,993 2024 59,354 7,162 2025 52,098 6,047 2026 43,193 6,057 Later years 150,024 110,263 Total lease payments 448,453 143,331 less imputed interest (79,345 ) (64,000 ) Total $ 369,108 $ 79,331 We assumed $29 million and $37 million in finance lease obligations during 2021 and 2020, respectively. No finance lease were assumed during 2019. In the ordinary course of business, our facilities routinely lease equipment pursuant to new lease arrangements that will likely result in future lease and rental expense in excess of amounts indicated above. |
Commitments and Contingencies
Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2021 | |
Commitments And Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | 8) COMMITMENTS AND CONTINGENCIES Professional and General Liability, Workers’ Compensation Liability The vast majority of our subsidiaries are self-insured for professional and general liability exposure up to: (i) $20 $3 $5 $3 These subsidiaries are provided with several excess policies through commercial insurance carriers which provide for coverage in excess of the applicable per occurrence and aggregate self-insured retention or underlying policy limits $250 2014 through 2020. As of December 31, 2021, the total net accrual for our professional and general liability claims was $349 million, of which $74 million was included in current liabilities. As of December 31, 2020, the total net accrual for our professional and general liability claims was $264 million, of which $74 million was included in current liabilities. As a result of unfavorable trends experienced during 2021 and 2020, included in our results of operations were pre-tax increases of $52 million during 2021, and $25 million during 2020, to increase our reserves for self-insured professional and general liability claims. Our 2019 results of operations were not materially impacted by adjustments to our reserves for professional and general liability claims. Our estimated liability for self-insured professional and general liability claims is based on a number of factors including, among other things, the number of asserted claims and reported incidents, estimates of losses for these claims based on recent and historical settlement amounts, estimates of incurred but not reported claims based on historical experience, and estimates of amounts recoverable under our commercial insurance policies. While we continuously monitor these factors, our ultimate liability for professional and general liability claims could change materially from our current estimates due to inherent uncertainties involved in making this estimate. Given our significant self-insured exposure for professional and general liability claims, there can be no assurance that a sharp increase in the number and/or severity of claims asserted against us will not have a material adverse effect on our future results of operations. As of December 31, 2021, the total accrual for our workers’ compensation liability claims was $115 million, $55 million of which was included in current liabilities. As of December 31, 2020, the total accrual for our workers’ compensation liability claims was $105 million, $55 million of which was included in current liabilities. Our results of operations for 2021 and 2019 were not materially impacted by adjustments to our reserves for workers’ compensation claims. However, during 2020, as a result of unfavorable trends experienced during the year, including, among other things, increased claims volumes and certain other factors resulting from the COVID-19 pandemic, our results of operations included a $20 million increase to our reserves for workers’ compensation claims, a portion of which related to prior years. Although we are unable to predict whether or not our future financial statements will require updates to estimates for our prior year reserves for self-insured general and professional and workers’ compensation claims, given the relatively unpredictable nature of these potential liabilities and the factors impacting these reserves, as discussed above, it is reasonably likely that our future financial results may include material adjustments to prior period reserves. Property Insurance We have commercial property insurance policies for our properties covering catastrophic losses, including windstorm damage, up to a $1 billion policy limit, subject to a per occurrence/per location deductible of $2.5 million as of June 1, 2020. Losses resulting from named windstorms are subject to deductibles between 3% and 5% of the total insurable value of the property. In addition, we have commercial property insurance policies covering catastrophic losses resulting from earthquake and flood damage, each subject to aggregated loss limits (as opposed to per occurrence losses). Commercially insured earthquake coverage for our facilities is subject to various deductibles and limitations including: (i) $200 million limitation for our facilities located in Nevada; (ii) $150 million limitation for our facilities located in California; (iii) $100 million limitation for our facilities located in fault zones within the United States; (iv) $40 million limitation for our facilities located in Puerto Rico, and; (v) $250 million limitation for many of our facilities located in other states. Our commercially insured flood coverage has a limit of $100 million annually. There is also a $10 million sublimit for one of our facilities located in Houston, Texas, and a $1 million sublimit for our facilities located in Puerto Rico. Property insurance for our behavioral health facilities located in the U.K. are provided on an all risk basis up to a £1.5 billion policy limit, with coverage caps per location, that includes coverage for real and personal property as well as business interruption losses. Although we are unable to predict whether or not our future financial statements will require updates to estimates for our reserves for self-insured general and professional and workers’ compensation claims, given the relatively unpredictable nature of the these potential liabilities and the factors impacting these reserves, as discussed above, it is reasonably likely that our future financial results may include material adjustments to prior period reserves. Below is a schedule showing the changes in our general and professional liability and workers’ compensation reserves during the three years ended December 31, 2021 (amount in thousands): General and Professional Workers’ Liability Compensation Total Balance at January 1, 2019 $ 243,051 $ 71,890 $ 314,941 Plus: Accrued insurance expense, net of commercial premiums paid 56,452 49,220 105,672 Less: Payments made in settlement of self-insured claims (57,683 ) (40,106 ) (97,789 ) Balance at January 1, 2020 241,820 81,004 322,824 Plus: Accrued insurance expense, net of commercial premiums paid 91,518 67,705 159,223 Less: Payments made in settlement of self-insured claims (69,559 ) (43,524 ) (113,083 ) Balance at January 1, 2021 263,779 105,185 368,964 Plus: Accrued insurance expense, net of commercial premiums paid 129,690 56,525 186,215 Less: Payments made in settlement of self-insured claims (44,776 ) (46,725 ) (91,501 ) Balance at December 31, 2021 $ 348,693 $ 114,985 $ 463,678 Information Technology Incident W e experienced an information technology security incident in the early morning hours of September 27, 2020. As a result of this cyberattack, we suspended user access to our information technology applications related to operations located in the United States. Immediately after the incident, we worked diligently with our information technology security partners to restore our information technology infrastructure and business operations as quickly as possible. In parallel, we began investigating the nature and potential impact of the security incident and engaged third-party information technology and forensic vendors to assist. No evidence of unauthorized access, copying or misuse of any patient or employee data has been identified to date. Given the disruption to the standard operating procedures at our facilities during the period of September 27, 2020 into October, 2020, certain patient activity, including ambulance traffic and elective/scheduled procedures at our acute care hospitals, were diverted to competitor facilities. We also incurred significant incremental labor expense, both internal and external, to restore information technology operations as expeditiously as possible. Additionally, certain administrative functions such as coding and billing were delayed into December, 2020, which had a negative impact on our operating cash flows during the fourth quarter of 2020. In connection with this incident, our results of operations for the year ended December 31, 2021 were favorably impacted by an aggregate of approximately $45 million resulting from: (i) receipt of commercial cyber insurance proceeds (approximately $28 million), and; (ii) collection of revenues previously reserved during 2020 (approximately $17 million). Other Contractual Commitments: In addition to our long-term debt obligations as discussed in Note 4 - Long-Term Debt Lease Commitments Legal Proceedings We operate in a highly regulated and litigious industry which subjects us to various claims and lawsuits in the ordinary course of business as well as regulatory proceedings and government investigations. These claims or suits include claims for damages for personal injuries, medical malpractice, commercial/contractual disputes, wrongful restriction of, or interference with, physicians’ staff privileges, and employment related claims. In addition, health care companies are subject to investigations and/or actions by various state and federal governmental agencies or those bringing claims on their behalf. Government action has increased with respect to investigations and/or allegations against healthcare providers concerning possible violations of fraud and abuse and false claims statutes as well as compliance with clinical and operational regulations. Currently, and from time to time, we and some of our facilities are subjected to inquiries in the form of subpoenas, Civil Investigative Demands, audits and other document requests from various federal and state agencies. These inquiries can lead to notices and/or actions including repayment obligations from state and federal government agencies associated with potential non-compliance with laws and regulations. Further, the federal False Claims Act allows private individuals to bring lawsuits (qui tam actions) against healthcare providers that submit claims for payments to the government. Various states have also adopted similar statutes. When such a claim is filed, the government will investigate the matter and decide if they are going to intervene in the pending case. These qui tam lawsuits are placed under seal by the court to comply with the False Claims Act’s requirements. If the government chooses not to intervene, the private individual(s) can proceed independently on behalf of the government. Health care providers that are found to violate the False Claims Act may be subject to substantial monetary fines/penalties as well as face potential exclusion from participating in government health care programs or be required to comply with Corporate Integrity Agreements as a condition of a settlement of a False Claims Act matter. In September 2014, the Criminal Division of the Department of Justice (“DOJ”) announced that all qui tam cases will be shared with their Division to determine if a parallel criminal investigation should be opened. The DOJ has also announced an intention to pursue civil and criminal actions against individuals within a company as well as the corporate entity or entities. In addition, health care facilities are subject to monitoring by state and federal surveyors to ensure compliance with program Conditions of Participation. In the event a facility is found to be out of compliance with a Condition of Participation and unable to remedy the alleged deficiency(s), the facility faces termination from the Medicare and Medicaid programs or compliance with a System Improvement Agreement to remedy deficiencies and ensure compliance. The laws and regulations governing the healthcare industry are complex covering, among other things, government healthcare participation requirements, licensure, certification and accreditation, privacy of patient information, reimbursement for patient services as well as fraud and abuse compliance. These laws and regulations are constantly evolving and expanding. Further, the Legislation has added additional obligations on healthcare providers to report and refund overpayments by government healthcare programs and authorizes the suspension of Medicare and Medicaid payments “pending an investigation of a credible allegation of fraud.” We monitor our business and have developed an ethics and compliance program with respect to these complex laws, rules and regulations. Although we believe our policies, procedures and practices comply with government regulations, there is no assurance that we will not be faced with the sanctions referenced above which include fines, penalties and/or substantial damages, repayment obligations, payment suspensions, licensure revocation, and expulsion from government healthcare programs. Even if we were to ultimately prevail in any action brought against us or our facilities or in responding to any inquiry, such action or inquiry could have a material adverse effect on us. Certain legal matters are described below: Litigation: Shareholder Derivative Cases In March 2017, a shareholder derivative suit was filed by plaintiff David Heed in the Court of Common Pleas of Philadelphia County. A notice of removal to the United States District Court for the Eastern District of Pennsylvania was filed (Case No. 2:17-cv-01476-LS). Plaintiff filed a motion to remand. In December 2017, the Court denied plaintiff’s motion to remand and retained the case in federal court. In May, June and July 2017, additional shareholder derivative suits were filed in the United States District Court for the Eastern District of Pennsylvania. The plaintiffs in those cases are: Central Laborers’ Pension Fund (Case No. 17-cv-02187-LS); Firemen’s Retirement System of St. Louis (Case No. 17—cv-02317-LS); Waterford Township Police & Fire Retirement System (Case No. 17-cv-02595-LS); and Amalgamated Bank Longview Funds (Case No. 17-cv-03404-LS). The Fireman’s Retirement System case has since been voluntarily dismissed. The federal court consolidated all of the cases pending in the Eastern District of Pennsylvania and appointed co-lead plaintiffs and co-lead counsel. Lead Plaintiffs filed a consolidated, amended complaint. We filed a motion to dismiss the amended complaint. In addition, a shareholder derivative case was filed in Chancery Court in Delaware by the Delaware County Employees’ Retirement Fund (Case No. 2017-0475-JTL). In December 2017, the Chancery Court stayed this case pending resolution of other contemporaneous matters. Each of these cases have named certain current and former members of the Board of Directors individually and certain officers of Universal Health Services, Inc. as defendants. UHS has also been named as a nominal defendant in these cases. The derivative cases make allegations relating to admission and discharge practices at our behavioral health facilities and board and corporate oversight of these facilities as well as claims relating to the stock trading by the individual defendants and company repurchase of shares during the relevant time period. The cases make claims of breaches of fiduciary duties by the named board members and officers; alleged violations of federal securities laws; and common law causes of action against the individual defendants including unjust enrichment, corporate waste, abuse of control, constructive fraud and gross mismanagement. The cases seek monetary damages allegedly incurred by the company; restitution and disgorgement of profits, benefits and other compensation from the individual defendants and various forms of equitable relief relating to corporate governance matters. In August 2019, the court granted our motion to dismiss. Plaintiffs subsequently filed a motion with the court seeking leave to file a second amended complaint. In April 2020, the court denied Plaintiffs motion to file a second amended complaint. Plaintiffs filed an appeal with the 3rd Circuit Court of Appeals. The defendants denied liability and defended these cases vigorously. The parties engaged in settlement negotiations during the pendency of the appeal and a settlement was reached. In December, 2021, the Court granted final approval of the settlement, which did not have a material impact on our financial statements, and the cases have been dismissed. Following the Court’s approval of the settlement, a p laintiff’s attorney fee award was negotiated by our commercial insurance carrier, for an amount which was not material to our financial statements. We anticipate that the legal fee award will be covered in full by our insurance carrier. In July 2021, a shareholder derivative lawsuit was filed by plaintiff, Robin Knight, in the Chancery Court in Delaware against the members of the Board of Directors of the Company as well as certain officers (C.A. No.: 2021-0581-SG). The Company was named as a nominal defendant. The lawsuit alleges that in March 2020 stock options were awarded with exercise prices that did not reflect the Company’s fundamentals and business prospects, and in anticipation of future market rebound resulting in excessive gains. The lawsuit makes claims of breaches of fiduciary duties, waste of corporate assets, and unjust enrichment. The lawsuit seeks monetary damages allegedly incurred by the Company, disgorgement of the March 2020 stock awards as well as any proceeds derived therefrom and unspecified equitable relief. Defendants deny the allegations. We have filed a motion to dismiss the complaint. We are uncertain as to potential liability or financial exposure, if any, which may be associated with this matter. The George Washington University v. Universal Health Services, Inc., et. al. In December 2019, The George Washington University (“University”) filed a lawsuit in the Superior Court for the District of Columbia against Universal Health Services, Inc. as well as certain subsidiaries and individuals associated with the ownership and management of The George Washington University Hospital (“GW Hospital”) in Washington, D.C. (case No. 2019 CA 008019 B). The lawsuit claims that UHS failed to provide sufficient financial compensation to the University under the terms of various agreements entered into in 1997 between the University and UHS for the joint venture ownership of GW Hospital. The lawsuit includes claims for breach of contract, breach of fiduciary duty, and unjust enrichment. We deny liability and intend to defend this matter vigorously. We filed a motion to dismiss the complaint. In June 2020, the Court granted the motion in part dismissing the majority of the claims against UHS. At this time, we are uncertain as to potential liability or financial exposure, if any, which may be associated with this matter. Disproportionate Share Hospital Payment Matter: In late September, 2015, many hospitals in Pennsylvania, including certain of our behavioral health care hospitals located in the state, received letters from the Pennsylvania Department of Human Services (the “Department”) demanding repayment of allegedly excess Medicaid Disproportionate Share Hospital payments (“DSH”), primarily consisting of managed care payments characterized as DSH payments, for the federal fiscal year (“FFY”) 2011 amounting to approximately $4 Boley, et al. v. UHS, et al. Former UHS subsidiary facility employees Mary K. Boley, Kandie Sutter, and Phyllis Johnson, individually and on behalf of a putative class of participants in the UHS Retirement Savings Plan (the “Plan”), filed a complaint in the U.S. District Court for the Eastern District of Pennsylvania against UHS, the Board of Directors of UHS, and the “Plan Committee” of UHS (Case No. 2:20-cv-02644). In subsequent amended complaints, Plaintiffs have dropped the Board of Directors and the “Plan Committee” as defendants and added the UHS Retirement Plans Investment Committee as a new defendant. Plaintiffs allege that UHS breached its fiduciary duties under the Employee Retirement Income Security Act (“ERISA”) by offering to participants in the Plan overly expensive investment options when less expensive investment options were available in the marketplace; caused participants to pay excessive recordkeeping fees associated with the Plan; breached its duty to monitor appointed fiduciaries and: in the alternative, engaged in a “knowing breach of trust” separate from the alleged violations under ERISA. UHS disputes Plaintiffs’ allegations and is actively defending against Plaintiffs’ claims. UHS’ motion for partial dismissal of Plaintiffs’ claims was denied by the Court. In March 2021, the Court granted Plaintiffs’ motion for class certification. The Third Circuit Court of Appeal has agreed to hear an appeal of the trial court’s order granting class certification. The case will be stayed in the trial court pending conclusion of the appellate proceedings. We are uncertain as to potential liability or financial exposure, if any, which may be associated with this matter. We maintain commercial insurance coverage for claims of this nature, subject to specified deductibles and limitations. Other Matters: Various other suits, claims and investigations, including government subpoenas, arising against, or issued to, us are pending and additional such matters may arise in the future. Management will consider additional disclosure from time to time to the extent it believes such matters may be or become material. The outcome of any current or future litigation or governmental or internal investigations, including the matters described above, cannot be accurately predicted, nor can we predict any resulting penalties, fines or other sanctions that may be imposed at the discretion of federal or state regulatory authorities. We record accruals for such contingencies to the extent that we conclude it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. No estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made at this time regarding the matters described above or that are otherwise pending because the inherently unpredictable nature of legal proceedings may be exacerbated by various factors, including, but not limited to: (i) the damages sought in the proceedings are unsubstantiated or indeterminate; (ii) discovery is not complete; (iii) the matter is in its early stages; (iv) the matters present legal uncertainties; (v) there are significant facts in dispute; (vi) there are a large number of parties, or; (vii) there is a wide range of potential outcomes. It is possible that the outcome of these matters could have a material adverse impact on our future results of operations, financial position, cash flows and, potentially, our reputation. |
Relationship with Universal Hea
Relationship with Universal Health Realty Income Trust and Other Related Party Transactions | 12 Months Ended |
Dec. 31, 2021 | |
Related Party Transactions [Abstract] | |
Relationship with Universal Health Realty Income Trust and Other Related Party Transactions | 9) RELATIONSHIP WITH UNIVERSAL HEALTH REALTY INCOME TRUST AND OTHER RELATED PARTY TRANSACTIONS Relationship with Universal Health Realty Income Trust: At December 31, 2021, we held approximately 5.7% of the outstanding shares of Universal Health Realty Income Trust (the “Trust”). We serve as Advisor to the Trust under an annually renewable advisory agreement, which is scheduled to expire on December 31 st In addition, certain of our officers and directors are also officers and/or directors of the Trust. Management believes that it has the ability to exercise significant influence over the Trust, therefore we account for our investment in the Trust using the equity method of accounting. Our pre-tax share of income from the Trust was $6.2 million during 2021 and $1.1 million during each of 2020 and 2019, which are included in other income, net, on the accompanying consolidated statements of income for each year. We received dividends from the Trust amounting to $2.2 million during each of 2021 and 2020 and $2.1 million 2019. Included in our share of the Trust’s income during 2021 was approximately $5.0 million related to our share of gains on various transactions recorded by the Trust, including an asset purchase and sale transaction between the Trust and UHS, as discussed below. The carrying value of our investment in the Trust was $9.4 million and $5.4 million at December 31, 2021 and 2020, respectively, and is included in other assets in the accompanying consolidated balance sheets. The market value of our investment in the Trust was $46.8 million at December 31, 2021 and $50.6 million at December 31, 2020, based on the closing price of the Trust’s stock on the respective dates. The Trust commenced operations in 1986 by purchasing certain hospital properties from us and immediately leasing the properties back to our respective subsidiaries. Most of the leases were entered into at the time the Trust commenced operations and provided for initial terms of 13 to 15 years with up to six additional 5-year renewal terms. Each lease, at that time, also provided for additional or bonus rental, as discussed below. The base rents are paid monthly and the bonus rents are computed and paid on a quarterly basis, based upon a computation that compares current quarter revenue to a corresponding quarter in the base year. The leases with those subsidiaries are unconditionally guaranteed by us and are cross-defaulted with one another. On December 31, 2021 we entered into an asset purchase and sale agreement with the Trust, pursuant to the terms of which: • a wholly-owned subsidiary of ours purchased from the Trust, the real estate assets of the Inland Valley Campus of Southwest Healthcare System located in Wildomar, California, at its fair market value of $79.6 million • two wholly-owned subsidiaries of ours transferred to the Trust, the real estate assets of the following properties: o Aiken Regional Medical Center (“Aiken”), located in Aiken, South Carolina (which includes a 211-bed acute care hospital and a 62-bed behavioral health facility), at its fair-market value of approximately $57.7 million, and; o Canyon Creek Behavioral Health (“Canyon Creek”), located in Temple, Texas, at its fair-market value of approximately $24.7 million. • in connection with this transaction, since the fair-market value of Aiken and Canyon Creek, which totaled approximately $82.4 million in the aggregate, exceeded the $79.6 million fair-market value of the Inland Valley Campus of Southwest Healthcare System, we received approximately $2.8 million in cash from the Trust. This transaction generated a gain of approximately $68.4 million for the Trust, our share of which (approximately $4.0 million) is included in our consolidated statement of income for the year ended December 31, 2021. Also on December 31, 2021, Aiken and Canyon Creek (as lessees), entered into a master lease and individual property leases (with the Trust as lessor), for initial lease terms on each property of approximately twelve years, ending on December 31, 2033. Subject to the terms of the master lease, Aiken and Canyon Creek have the right to renew their leases, at the then current fair market rent (as defined in the master lease), for seven, five-year st As a result of the purchase options within the lease agreements for Aiken and Canyon Creek, the asset purchase and sale transaction is accounted for as a failed sale leaseback in accordance with U.S. GAAP. We have accounted for the asset exchange and substitution transaction with the Trust as a financing arrangement and, since we did not derecognize the real property related to Aiken and Canyon Creek, we will continue to depreciate the assets. Our Consolidated Balance Sheet as of December 31, 2021 reflects a financial liability of $82.4 million, which is included in debt, for the fair value of real estate assets that we exchanged as part of the transaction. Our monthly lease payments payable to the Trust will be recorded to interest expense and as reduction to the outstanding financial liability. The amount allocated to interest expense will be determined using our incremental borrowing rate and will be based on the outstanding financial liability. Total aggregate rent expense under the operating leases on three hospital facilities with the Trust (McAllen Medical Center, Wellington Regional Medical Center and Inland Valley Campus of Southwest Healthcare System) was $17.7 million, $17.1 million and $16.4 million during 2021, 2020 and 2019, respectively. Pursuant to the Master Leases by certain subsidiaries of ours and the Trust as described in the table below, dated 1986 and 2021 (“the Master Leases”) which govern the leases of McAllen Medical Center and Wellington Regional Medical Center (each of which is governed by the Master Lease dated 1986), and Aiken Regional Medical Center and Canyon Creek Behavioral Health (each of which is governed by the Master Lease dated 2021), we have the option to renew the leases at the lease terms described above and below by providing notice to the Trust at least 90 days prior to the termination of the then current term. We also have the right to purchase the respective leased hospitals at their appraised fair market value upon any of the following: (i) at the end of the lease terms or any renewal terms; (ii) upon one month’s notice should a change of control of the Trust occur, or; (iii) within the time period as specified in the lease in the event that we provide notice to the Trust of our intent to offer a substitution property/properties in exchange for one (or more) of the hospital properties leased from the Trust should we be unable to reach an agreement with the Trust on the properties to be substituted. In addition, we have rights of first refusal to: (i) purchase the respective leased facilities during and for 180 days after the lease terms at the same price, terms and conditions of any third-party offer, or; (ii) renew the lease on the respective leased facility at the end of, and for 180 days after, the lease term at the same terms and conditions pursuant to any third-party offer. In addition, we are the managing, majority member in a joint venture with an unrelated third-party that operates Clive Behavioral Health, a 100-bed behavioral health care facility located in Clive, Iowa. The real property of this newly constructed facility, which was completed and opened in late, 2020, is also leased from the Trust (annual rental expense of approximately $2.5 million during 2021) pursuant to the lease terms as provided in the table below. In connection with the lease on this facility, the joint venture has the right to purchase the leased facility from the Trust at its appraised fair market value upon either of the following: (i) by providing notice at least 270 days prior to the end of the lease terms or any renewal terms, or; (ii) upon 30 days’ notice anytime within 12 months of a change of control of the Trust (UHS also has this right should the joint venture decline to exercise its purchase right). Additionally, the joint venture has rights of first offer to purchase the facility prior to any third-party sale. The table below provides certain details for each of the hospitals leased from the Trust as of January 1, 2022: Hospital Name Annual Minimum Rent End of Lease Term Renewal Term (years) McAllen Medical Center $ 5,485,000 December, 2026 5 (a) Wellington Regional Medical Center $ 6,319,000 December, 2026 5 (b) Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services $ 3,895,000 December, 2033 35 (c) Canyon Creek Behavioral Health $ 1,670,000 December, 2033 35 (c) Clive Behavioral Health Hospital $ 2,628,000 December, 2040 50 (d) (a) We have one 5-year renewal option at existing lease rates (through 2031). (b) We have one 5-year renewal option at fair market value lease rates ( through 2031 ). Upon the December 31, 2021 expiration of the lease on Wellington Regional Medical Center, a wholly-owned subsidiary of ours exercised its fair market value renewal option and renewed the lease for a 5-year term scheduled to expire on December 31, 2026 . Effective January 1, 2022, the annual fair market value lease rate for this hospital is $ 6.3 million (there is no longer a bonus rental component of the lease payment). Beginning on January 1, 2023, and thereafter on each January 1 st through 2026, the annual rent will increase by 2.50 % on a cumulative and compounded basis. (c) We have seven 5-year (d) This facility is operated by a joint venture in which we are the managing, majority member and an unrelated third-party holds a minority ownership interest. The joint venture has three, 10-year renewal options at computed lease rates as stipulated in the lease (2041 through 2070) and two additional, 10-year renewal options at fair market values lease rates (2071 through 2090). Beginning in January, 2022, and thereafter in each January through 2040 (and potentially through 2070 if three, 10-year renewal options are exercised), the annual rental will increase by 2.75% on a cumulative and compounded basis. In addition, certain of our subsidiaries are tenants in several medical office buildings (“MOBs”) and two free-standing emergency departments owned by the Trust or by limited liability companies in which the Trust holds 95% to 100% of the ownership interest. In January, 2022, the Trust commenced construction on a new 86,000 rentable square feet multi-tenant MOB that is located on the campus of Northern Nevada Sierra Medical Center in Reno, Nevada. Northern Nevada Sierra Medical Center, which is currently under construction and will be owned and operated by a wholly-owned subsidiary of ours, is a 170-bed Other Related Party Transactions: In December, 2010, our Board of Directors approved the Company’s entering into supplemental life insurance plans and agreements on the lives of our chief executive officer (“CEO”) and his wife. As a result of these agreements, as amended in October, 2016, based on actuarial tables and other assumptions, during the life expectancies of the insureds, we would pay approximately $28 million in premiums, and certain trusts owned by our CEO, would pay approximately $9 million in premiums. Based on the projected premiums mentioned above, and assuming the policies remain in effect until the death of the insureds, we will be entitled to receive death benefit proceeds of no less than approximately $37 million representing the $28 million of aggregate premiums paid by us as well as the $9 million of aggregate premiums paid by the trusts. In connection with these policies, we paid approximately $1.0 million, net, in premium payments during 2021 and approximately $1.1 million, net, in premium payments during each of 2020 and 2019. In August, 2015, Marc D. Miller, our President and Chief Executive Officer and member of our Board of Directors, was appointed to the Board of Directors of Premier, Inc. (“Premier”), a healthcare performance improvement alliance. During 2013, we entered into a new group purchasing organization agreement (“GPO”) with Premier. In conjunction with the GPO agreement, we acquired a minority interest in Premier for a nominal amount. During the fourth quarter of 2013, in connection with the completion of an initial public offering of the stock of Premier, we received cash proceeds for the sale of a portion of our ownership interest in the GPO. Also in connection with this GPO agreement, we received shares of restricted stock of Premier which vested ratably over a seven-year During 2021, Premier declared annual cash dividends of $.78 per share paid on a quarterly basis. Additionally, during 2020, Premier declared a quarterly cash dividend during each of the third and fourth quarters of $0.19 per share per quarter. Our share of the dividends for the years ended December 31, 2021 and 2020 are approximately $1.7 million and $800,000, respectively, and are included in A member of our Board of Directors and member of the Executive Committee and Finance Committee is a partner in Norton Rose Fulbright US LLP, a law firm engaged by us for a variety of legal services. The Board member and his law firm also provide personal legal services to our Executive Chairman and he acts as trustee of certain trusts for the benefit of our Executive Chairman and his family. |
Revenue Recognition
Revenue Recognition | 12 Months Ended |
Dec. 31, 2021 | |
Revenue From Contract With Customer [Abstract] | |
Revenue Recognition | 10) REVENUE RECOGNITION The company recognizes revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. Our estimate for amounts not expected to be collected based on historical experience will continue to be recognized as a reduction to net revenue. However, subsequent changes in estimate of collectability due to a change in the financial status of a payer, for example a bankruptcy, will be recognized as bad debt expense in operating charges. The performance obligation is separately identifiable from other promises in the customer contract. As the performance obligations are met (i.e.: room, board, ancillary services, level of care), revenue is recognized based upon allocated transaction price. . In assessing collectability, we have elected the portfolio approach. This portfolio approach is being used as we have large volume of similar contracts with similar classes of customers. We reasonably expect that the effect of applying a portfolio approach to a group of contracts would not differ materially from considering each contract separately. Management’s judgment to group the contracts by portfolio is based on the payment behavior expected in each portfolio category. As a result, aggregating all of the contracts (which are at the patient level) by the particular payer or group of payers, will result in the recognition of the same amount of revenue as applying the analysis at the individual patient level. We group our revenues into categories based on payment behaviors. Each component has its own reimbursement structure which allows us to disaggregate the revenue into categories that share the nature and timing of payments. The other patient revenue consists primarily of self-pay, government-funded non-Medicaid, and other. The following table disaggregates our revenue by major source for the years ended December 31, 2021, 2020 and 2019 (in thousands): For the year ended December 31, 2021 Acute Care Behavioral Health Other Total Medicare $ 1,292,205 18 % $ 361,914 7 % $ 1,654,119 13 % Managed Medicare 1,118,901 16 % 244,061 4 % 1,362,962 11 % Medicaid 539,741 8 % 751,951 14 % 1,291,692 10 % Managed Medicaid 618,727 9 % 1,328,536 24 % 1,947,263 15 % Managed Care (HMO and PPOs) 2,521,089 35 % 1,435,938 26 % 3,957,027 31 % UK Revenue 0 0 % 687,725 12 % 687,725 5 % Other patient revenue and adjustments, net 358,458 5 % 484,742 9 % 843,200 7 % Other non-patient revenue 659,133 9 % 208,777 4 % 30,219 898,129 7 % Total Net Revenue $ 7,108,254 100 % $ 5,503,644 100 % $ 30,219 12,642,117 100 % For the year ended December 31, 2020 Acute Care Behavioral Health Other Total Medicare $ 1,242,268 20 % $ 448,323 9 % $ 1,690,591 15 % Managed Medicare 869,488 14 % 235,442 5 % 1,104,930 10 % Medicaid 551,551 9 % 651,081 12 % 1,202,632 10 % Managed Medicaid 491,234 8 % 1,224,205 24 % 1,715,439 15 % Managed Care (HMO and PPOs) 2,146,018 34 % 1,280,919 25 % 3,426,937 30 % UK Revenue 0 0 % 584,000 11 % 584,000 5 % Other patient revenue and adjustments, net 248,047 4 % 497,297 10 % 745,344 6 % Other non-patient revenue (a) 788,698 12 % 287,455 6 % 12,871 1,089,024 9 % Total Net Revenue $ 6,337,304 100 % $ 5,208,722 100 % $ 12,871 11,558,897 100 % For the year ended December 31, 2019 Acute Care Behavioral Health Other Total Medicare $ 1,336,200 22 % $ 553,045 11 % $ 1,889,245 17 % Managed Medicare 827,216 13 % 220,543 4 % 1,047,759 9 % Medicaid 519,508 8 % 688,141 13 % 1,207,649 11 % Managed Medicaid 560,029 9 % 1,118,612 21 % 1,678,641 15 % Managed Care (HMO and PPOs) 2,271,002 37 % 1,363,815 26 % 3,634,817 32 % UK Revenue 0 0 % 553,831 11 % 553,831 5 % Other patient revenue and adjustments, net 191,422 3 % 505,144 10 % 696,566 6 % Other non-patient revenue 459,183 7 % 206,932 4 % 3,636 669,751 6 % Total Net Revenue $ 6,164,560 100 % $ 5,210,063 100 % $ 3,636 11,378,259 100 % (a) The 2020 other non-patient revenue includes Acute Care CARES Act and other grant revenue of $316 million and Behavioral Health CARES Act and other grant revenue of $97 million. As an accounting policy election, we have utilized ASC 958 by analogy to recognize funds received under the CARES Act from the Provider Relief Fund as revenue, given no direct authoritative guidance available to for-profit organizations to recognize revenue for government contributions and grants . CARES Act revenues may be subject to future adjustments based on future changes to statutes. |
Pension Plan
Pension Plan | 12 Months Ended |
Dec. 31, 2021 | |
Compensation And Retirement Disclosure [Abstract] | |
Pension Plan | 11) PENSION PLAN We maintain contributory and non-contributory retirement plans for eligible employees. Our contributions to the contributory plan amounted to $69.8 million, $67.1 million and $56.3 million in 2021, 2020 and 2019, respectively. The non-contributory plan is a defined benefit pension plan which covers employees of one of our subsidiaries. The benefits are based on years of service and the employee’s highest compensation for any five years of employment. Our funding policy is to contribute annually at least the minimum amount that should be funded in accordance with the provisions of ERISA. For defined benefit pension plans, the benefit obligation is the “projected benefit obligation”, the actuarial present value, as of December 31 measurement date, of all benefits attributed by the pension benefit formula to employee service rendered to that date. The amount of benefit to be paid depends on a number of future events incorporated into the pension benefit formula, including estimates of the average life of employees/survivors and average years of service rendered. It is measured based on assumptions concerning future interest rates and future compensation levels. The following table shows the reconciliation of the defined benefit pension plan as of December 31, 2021 and 2020: 2021 2020 (000s) Change in plan assets: Fair value of plan assets at beginning of year $ 131,685 $ 120,287 Actual return (loss) on plan assets 2,771 18,169 Benefits paid (6,389 ) (6,260 ) Administrative expenses (707 ) (511 ) Fair value of plan assets at end of year $ 127,360 $ 131,685 Change in benefit obligation: Benefit obligation at beginning of year $ 123,237 $ 117,556 Service cost $ 546 $ 615 Interest cost $ 2,493 $ 3,357 Benefits paid $ (6,389 ) $ (6,260 ) Actuarial (gain) loss $ (3,853 ) $ 7,969 Benefit obligation at end of year $ 116,034 $ 123,237 Amounts recognized in the Consolidated Balance Sheet: Other non-current assets $ 11,327 $ 8,449 Total amounts recognized at end of year $ 11,327 $ 8,449 2021 2020 2019 (000s) Components of net periodic cost (benefit) Service cost $ 546 $ 615 $ 725 Interest cost 2,493 3,357 4,237 Expected return on plan assets (4,490 ) (5,261 ) (4,558 ) Amortization of actuarial loss — — 1,533 Net periodic cost $ (1,451 ) $ (1,289 ) $ 1,937 2021 2020 Measurement Dates Benefit obligations 12/31/2021 12/31/2020 Fair value of plan assets 12/31/2021 12/31/2020 2021 2020 Weighted average assumptions as of December 31 Discount rate 2.52 % 2.08 % Rate of compensation increase 4.00 % 4.00 % 2021 2020 2019 Weighted-average assumptions for net periodic benefit cost calculations Discount rate 2.08 % 2.94 % 4.03 % Expected long-term rate of return on plan assets 3.50 % 4.50 % 4.50 % Rate of compensation increase 4.00 % 4.00 % 4.00 % The “accumulated benefit obligation” for our pension plan represents the actuarial present value of benefits based on employee service and compensation as of a certain date and does not include an assumption about future compensation levels. The accumulated benefit obligation for our plan was $116.0 million and $123.2 million as of December 31, 2021 and 2020, respectively. The fair value of plan assets exceeded the accumulated benefit obligation by $11.3 million and $8.4 million as of December 31, 2021 and 2020, respectively. We estimate that there will be no net loss or prior service cost amortized from accumulated other comprehensive income during 2022. The market values of our pension plan assets at December 31, 2021 and December 31, 2020, reported using net asset value as a practical expedient, by asset category are as follows: 2021 2020 Equities: U.S. Large Cap $ 7,306 $ 10,946 U.S. Mid Cap $ 2,014 $ 3,403 U.S. Small Cap $ 1,913 $ 3,581 International Developed $ 5,062 $ 8,315 Emerging Markets $ 3,152 $ 5,631 Fixed income: Core Fixed Income $ 22,904 $ 27,782 Long Duration Fixed Income $ 84,277 $ 68,886 Real Estate: REIT Fund $ — $ 2,474 Cash/Currency: Cash Equivalents $ 732 $ 667 Total market value $ 127,360 $ 131,685 To develop the expected long-term rate of return on plan assets assumption, we considered the historical returns and the future expectations for returns for each asset class, as well as the target asset allocation of the pension portfolio. The following table shows expected benefit payments for the years 2022 through 2031 for our defined pension plan. There will be benefit payments under this plan beyond 2031. Estimated Future Benefit Payments (000s) 2022 $ 6,994 2023 7,056 2024 7,057 2025 7,029 2026 6,973 2027-2031 33,438 Total $ 68,547 2021 2020 Plan Assets Asset Category Equity securities 15 % 24 % Fixed income securities 84 % 73 % Other 1 % 3 % Total 100 % 100 % Investment Policy, Guidelines and Objectives have been established for the defined benefit pension plan. The investment policy is in keeping with the fiduciary requirements under existing federal laws and managed in accordance with the Prudent Investor Rule. Total portfolio risk is regularly evaluated and compared to that of the plan’s policy target allocation and judged on a relative basis over a market cycle. The following asset allocation policy and ranges have been established in accordance with the overall risk and return objectives of the portfolio: As of 12/31/2021 Permitted Range Total Equity 15 % 10-30% Total Fixed Income 84 % 70-90% Other 1 % 0-10% In accordance with the investment policy, the portfolio will invest in high quality, large and small capitalization companies traded on national exchanges, and investment grade securities. The investment managers will not write or buy options for speculative purposes; securities may not be margined or sold short. The manager may employ futures or options for the purpose of hedging exposure, and will not purchase unregistered sectors, private placements, partnerships or commodities. |
Segment Reporting
Segment Reporting | 12 Months Ended |
Dec. 31, 2021 | |
Segment Reporting [Abstract] | |
Segment Reporting | 12) SEGMENT REPORTING Our reportable operating segments consist of acute care hospital services and behavioral health care services. The “Other” segment column below includes centralized services including, but not limited to, information technology, purchasing, reimbursement, accounting and finance, taxation, legal, advertising and design and construction. The chief operating decision making group for our acute care services and behavioral health care services is comprised of our Chief Executive Officer and the Presidents of each operating segment. The Presidents for each operating segment also manage the profitability of each respective segment’s various facilities. The operating segments are managed separately because each operating segment represents a business unit that offers different types of healthcare services or operates in different healthcare environments. The accounting policies of the operating segments are the same as those described in the summary of significant accounting policies included in Note 1- Business and Summary of Significant Accounting Policies 2021 Acute Care Hospital Services Behavioral Health Services (a.) Other Total Consolidated (Dollar amounts in thousands) Gross inpatient revenues $ 36,522,155 $ 9,927,401 $ — $ 46,449,556 Gross outpatient revenues $ 20,633,921 $ 1,013,547 $ — $ 21,647,468 Total net revenues $ 7,108,254 $ 5,503,644 $ 30,219 $ 12,642,117 Income (loss) before allocation of corporate overhead and income taxes $ 734,666 $ 1,025,557 $ (466,910 ) $ 1,293,313 Allocation of corporate overhead $ (233,298 ) $ (172,512 ) $ 405,810 $ 0 Income (loss) after allocation of corporate overhead and before income taxes $ 501,368 $ 853,045 $ (61,100 ) $ 1,293,313 Total assets $ 5,534,912 $ 7,250,427 $ 308,204 $ 13,093,543 2020 Acute Care Hospital Services Behavioral Health Services (a.) Other Total Consolidated (Dollar amounts in thousands) Gross inpatient revenues $ 30,562,093 $ 9,718,934 $ — $ 40,281,027 Gross outpatient revenues $ 16,272,520 $ 963,799 $ — $ 17,236,319 Total net revenues $ 6,337,304 $ 5,208,722 $ 12,871 $ 11,558,897 Income (loss) before allocation of corporate overhead and income taxes $ 693,427 $ 1,023,257 $ (464,601 ) $ 1,252,083 Allocation of corporate overhead $ (223,921 ) $ (170,849 ) $ 394,770 $ 0 Income (loss) after allocation of corporate overhead and before income taxes $ 469,506 $ 852,408 $ (69,831 ) $ 1,252,083 Total assets $ 4,927,456 $ 7,044,617 $ 1,504,806 $ 13,476,879 2019 Acute Care Hospital Services Behavioral Health Services (a.) Other Total Consolidated (Dollar amounts in thousands) Gross inpatient revenues $ 28,430,922 $ 10,100,903 $ — $ 38,531,825 Gross outpatient revenues $ 17,666,629 $ 1,066,704 $ — $ 18,733,333 Total net revenues $ 6,164,560 $ 5,210,063 $ 3,636 $ 11,378,259 Income (loss) before allocation of corporate overhead and income taxes $ 713,410 $ 900,965 $ (548,038 ) $ 1,066,337 Allocation of corporate overhead $ (230,166 ) $ (166,571 ) $ 396,737 $ 0 Income (loss) after allocation of corporate overhead and before income taxes $ 483,244 $ 734,394 $ (151,301 ) $ 1,066,337 Total assets $ 4,405,643 $ 6,910,790 $ 351,817 $ 11,668,250 (a.) Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $688 million in 2021, $584 million in 2020 and $554 million in 2019. Total assets at our U.K. behavioral health care facilities were approximately $1.351 billion as of December 31, 2021, $1.334 billion as of December 31, 2020 and $1.270 billion as of December 31, 2019. In addition, included in our 2019 Behavioral Health Services operating segment Income (loss) before allocation of corporate overhead and income taxes is a pre-tax $98 million provision for asset impairment to reduce the carrying value of a tradename intangible asset and real property assets. |
Schedule II-Valuation and Quali
Schedule II-Valuation and Qualifying Accounts | 12 Months Ended |
Dec. 31, 2021 | |
Valuation And Qualifying Accounts [Abstract] | |
Schedule Of Valuation And Qualifying Accounts | SCHEDULE II—VALUATION AND QUALIFYING ACCOUNTS (amounts in thousands) Balance at Charges to Balance beginning costs and at end Valuation Allowance for Deferred Tax Assets: of period expenses of period Year ended December 31, 2021 $ 68,003 $ (5,647 ) $ 62,356 Year ended December 31, 2020 $ 75,277 $ (7,274 ) $ 68,003 Year ended December 31, 2019 $ 79,264 $ (3,987 ) $ 75,277 |
Business and Summary of Signi_2
Business and Summary of Significant Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2021 | |
Accounting Policies [Abstract] | |
Principles of Consolidation | Principles of Consolidation: The consolidated financial statements include the accounts of our majority-owned subsidiaries and partnerships controlled by us or our subsidiaries as the managing general partner. All intercompany accounts and transactions have been eliminated. |
Revenue Recognition | Revenue Recognition We report net patient service revenue at the estimated net realizable amounts from patients and third-party payers and others for services rendered. We have agreements with third-party payers that provide for payments to us at amounts different from our established rates. Payment arrangements include rates per discharge, reimbursed costs, discounted charges and per diem payments. Estimates of contractual allowances under managed care plans, which represent explicit price concessions, are based upon the payment terms specified in the related contractual agreements. We closely monitor our historical collection rates, as well as changes in applicable laws, rules and regulations and contract terms, to assure that provisions are made using the most accurate information available. However, due to the complexities involved in these estimations, actual payments from payers may be different from the amounts we estimate and record. See Note 10- Revenue Recognition We estimate our Medicare and Medicaid revenues using the latest available financial information, patient utilization data, government provided data and in accordance with applicable Medicare and Medicaid payment rules and regulations. The laws and regulations governing the Medicare and Medicaid programs are extremely complex and subject to interpretation and as a result, there is at least a reasonable possibility that recorded estimates will change by material amounts in the near term. Certain types of payments by the Medicare program and state Medicaid programs (e.g. Medicare Disproportionate Share Hospital, Medicare Allowable Bad Debts and Inpatient Psychiatric Services) are subject to retroactive adjustment in future periods as a result of administrative review and audit and our estimates may vary from the final settlements. Such amounts are included in accounts receivable, net, on our Consolidated Balance Sheets. The funding of both federal Medicare and state Medicaid programs are subject to legislative and regulatory changes. As such, we cannot provide any assurance that future legislation and regulations, if enacted, will not have a material impact on our future Medicare and Medicaid reimbursements. Adjustments related to the final settlement of these retrospectively determined amounts did not materially impact our results in 2021, 2020 or 2019. If it were to occur, each 1% adjustment to our estimated net Medicare revenues that are subject to retrospective review and settlement as of December 31, 2021, would change our after-tax net income by approximately $1 million. |
Charity Care, Uninsured Discounts and Other Adjustments to Revenue | Charity Care, Uninsured Discounts and Other Adjustments to Revenue: Collection of receivables from third-party payers and patients is our primary source of cash and is critical to our operating performance. Our primary collection risks relate to uninsured patients and the portion of the bill which is the patient’s responsibility, primarily co-payments and deductibles. We estimate our revenue adjustments for implicit price concessions based on general factors such as payer mix, the aging of the receivables and historical collection experience. We routinely review accounts receivable balances in conjunction with these factors and other economic conditions which might ultimately affect the collectability of the patient accounts and make adjustments to our allowances as warranted. At our acute care hospitals, third party liability accounts are pursued until all payment and adjustments are posted to the patient account. For those accounts with a patient balance after third party liability is finalized or accounts for uninsured patients, the patient receives statements and collection letters. Historically, a significant portion of the patients treated throughout our portfolio of acute care hospitals are uninsured patients which, in part, has resulted from patients who are employed but do not have health insurance or who have policies with relatively high deductibles. Patients treated at our hospitals for non-elective services, who have gross income of various amounts, dependent upon the state, ranging from 200% to 400% of the federal poverty guidelines, are deemed eligible for charity care. The federal poverty guidelines are established by the federal government and are based on income and family size. Because we do not pursue collection of amounts that qualify as charity care, the transaction price is fully adjusted and there is no impact in our net revenues or in our accounts receivable, net. A portion of the accounts receivable at our acute care facilities are comprised of Medicaid accounts that are pending approval from third-party payers but we also have smaller amounts due from other miscellaneous payers such as county indigent programs in certain states. Our patient registration process includes an interview of the patient or the patient’s responsible party at the time of registration. At that time, an insurance eligibility determination is made and an insurance plan code is assigned. There are various pre-established insurance profiles in our patient accounting system which determine the expected insurance reimbursement for each patient based on the insurance plan code assigned and the services rendered. Certain patients may be classified as Medicaid pending at registration based upon a screening evaluation if we are unable to definitively determine if they are currently Medicaid eligible. When a patient is registered as Medicaid eligible or Medicaid pending, our patient accounting system records net revenues for services provided to that patient based upon the established Medicaid reimbursement rates, subject to the ultimate disposition of the patient’s Medicaid eligibility. When the patient’s ultimate eligibility is determined, reclassifications may occur which impacts net revenues in future periods. Although the patient’s ultimate eligibility determination may result in adjustments to net revenues, these adjustments do not have a material impact on our results of operations in 2021, 20 20 or 201 9 s ince our facilities make estimates at each financial reporting period to adjust revenue based on hi storical collections. We also provide discounts to uninsured patients (included in “uninsured discounts” amounts below) who do not qualify for Medicaid or charity care. Because we do not pursue collection of amounts classified as uninsured discounts, the transaction price is fully adjusted and there is no impact in our net revenues or in our net accounts receivable. In implementing the discount policy, we first attempt to qualify uninsured patients for governmental programs, charity care or any other discount program. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. Uncompensated care (charity care and uninsured discounts): The following table shows the amounts recorded at our acute care hospitals for charity care and uninsured discounts, based on charges at established rates, for the years ended December 31, 2021, 2020 and 2019: (dollar amounts in thousands) 2021 2020 2019 Amount % Amount % Amount % Charity care $ 661,965 33 % $ 622,668 28 % $ 672,326 31 % Uninsured discounts 1,336,319 67 % 1,578,470 72 % 1,511,738 69 % Total uncompensated care $ 1,998,284 100 % $ 2,201,138 100 % $ 2,184,064 100 % The estimated cost of providing uncompensated care: The estimated cost of providing uncompensated care, as reflected below, were based on a calculation which multiplied the percentage of operating expenses for our acute care hospitals to gross charges for those hospitals by the above-mentioned total uncompensated care amounts. The percentage of cost to gross charges is calculated based on the total operating expenses for our acute care facilities divided by gross patient service revenue for those facilities. An increase in the level of uninsured patients to our facilities and the resulting adverse trends in the adjustments to net revenues and uncompensated care provided could have a material unfavorable impact on our future operating results. (amounts in thousands) 2021 2020 2019 Estimated cost of providing charity care $ 72,095 $ 73,690 $ 77,886 Estimated cost of providing uninsured discounts related care 145,538 186,804 175,128 Estimated cost of providing uncompensated care $ 217,633 $ 260,494 $ 253,014 |
Concentration of Revenues | Concentration of Revenues: Our six acute care hospitals in the Las Vegas, Nevada market contributed, on a combined basis, 16% in 2021, 15% in 2020 and 16% in 2019 of our consolidated net revenues. |
Cash, Cash Equivalents and Restricted Cash | Cash, Cash Equivalents and Restricted Cash: We consider all highly liquid investments purchased with maturities of three months or less to be cash equivalents. Cash, cash equivalents, and restricted cash as reported in the consolidated statements of cash flows are presented separately on our consolidated balance sheets as follow: (amounts in thousands) 2021 2020 2019 Cash and cash equivalents $ 115,301 $ 1,224,490 $ 61,268 Restricted cash (a) 63,633 54,664 44,399 Total cash, cash equivalents and restricted cash $ 178,934 $ 1,279,154 $ 105,667 (a)Restricted cash is included in other assets on the accompanying consolidated balance sheet and consists of statutorily required capital reserves related to our commercial insurance subsidiary The fair value of our restricted cash was computed based upon quotes received from financial institutions. We consider these to be “level 1” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with financial securities. |
Property and Equipment | Property and Equipment: Property and equipment are stated at cost. Expenditures for renewals and improvements are charged to the property accounts. Replacements, maintenance and repairs which do not improve or extend the life of the respective asset are expensed as incurred. We remove the cost and the related accumulated depreciation from the accounts for assets sold or retired and the resulting gains or losses are included in the results of operations. Construction-in-progress includes both construction projects and equipment not yet placed into service. See Provision for Asset Impairment-Foundations Recovery Network, Other Assets and Intangible Assets While in progress, we capitalized interest on major construction projects and the development and implementation of information technology applications amounting to $4.4 million during 2021, $4.3 million during 2020 and $3.4 million during 2019. Depreciation is provided on the straight-line method over the estimated useful lives of buildings and improvements (twenty to forty years) and equipment (three to fifteen years). Depreciation expense was $501.6 million during 2021, $478.8 million during 2020 and $455.6 million during 2019. |
Long-Lived Assets | Long-Lived Assets: We review our long-lived assets, including intangible assets, for impairment whenever events or circumstances indicate that the carrying value of these assets may not be recoverable. The assessment of possible impairment is based on our ability to recover the carrying value of our asset based on our estimate of its undiscounted future cash flows. If the analysis indicates that the carrying value is not recoverable from future cash flows, the asset is written down to its estimated fair value and an impairment loss is recognized. Fair values are determined based on estimated future cash flows using appropriate discount rates. |
Goodwill | Goodwill: Goodwill is reviewed for impairment at the reporting unit level on an annual basis or sooner if the indicators of impairment arise. Our judgments regarding the existence of impairment indicators are based on market conditions and operational performance of each reporting unit. We have designated October 1 st Changes in the carrying amount of goodwill for the two years ended December 31, 2021 were as follows (in thousands): Acute Care Services Behavioral Health Services Total Consolidated Balance, January 1, 2020 $ 448,415 $ 3,421,345 $ 3,869,760 Goodwill acquired during the period 127 0 127 Goodwill divested during the period 0 0 0 Adjustments to goodwill (a) (1,521 ) 14,349 12,828 Balance, December 31, 2020 447,021 3,435,694 3,882,715 Goodwill acquired during the period 55,406 0 55,406 Goodwill divested during the period 0 0 0 Adjustments to goodwill (b) 13,509 10,994 24,503 Balance, December 31, 2021 $ 515,936 $ 3,446,688 $ 3,962,624 (a) The changes in the Behavioral Health Services’ goodwill consists primarily of foreign currency translation adjustments. (b) Adjustments to goodwill during 2021 consist of the following: $13.5 million in Acute Care Services consists primarily of a measurement period adjustment to the preliminary purchase price allocation related to a 2020 acquisition; and the $11.0 million in Behavioral Health Services consists of $16.3 million recorded in connection with a third party minority ownership interest in a majority owned joint venture that constructed and owns a recently opened behavioral health facility, partially offset by a $5.3 million decrease related to foreign currency translation adjustments. |
Other Assets and Intangible Assets | Other Assets and Intangible Assets: Other assets consist primarily of amounts related to: (i) intangible assets acquired in connection with our acquisitions of Cambian Group, PLC’s adult services’ division during 2015, Ascend Health Corporation during 2012 and Psychiatric Solutions, Inc. during 2010; (ii) prepaid fees for various software and other applications used by our hospitals; (iii) costs incurred in connection with the purchase and implementation of an electronic health records application for each of our acute care facilities; (iv) statutorily required capital reserves related to our commercial insurance subsidiary ($ 82 million and $ 73 million as of December 31, 20 2 1 and 20 20 , respectively ); (v) deposits; (vi) investments in various businesses, including Universal Health Realty Income Trust ($ 9 million and $ 5 million as of as of December 31, 202 1 and 20 20 , respectively ) and Premier, Inc. ($ 92 million and $ million as of December 31, 202 1 and 20 20 , respectively ); (vii) the invested assets related to a deferred compensation plan that is held by an independent trustee in a rabbi-trust and that has a related payable included in other noncurrent liabilities , and ; (viii) other miscellaneous assets. Intangible assets are reviewed for impairment on an annual basis or more often if indicators of impairment arise. Our judgments regarding the existence of impairment indicators are based on market conditions and operational performance of each asset. We have designated October 1 st Provision for Asset Impairment-Foundations Recovery Network: Our financial results for the year ended December 31, 2019 include a pre-tax provisions for asset impairment of approximately $98 million recorded in connection with Foundations Recovery Network, L.L.C. (“Foundations”), which was acquired by us in 2015. This provision for asset impairment includes: (i) a $75 million impairment provision to write-off the carrying value of the Foundations’ tradename intangible asset, and; (ii) a $23 million impairment provision to reduce the carrying value of real property assets of certain Foundations’ facilities. The provision for asset impairment recorded during 2019, which is included in other operating expenses in the accompanying consolidated statements of income, was recorded after evaluation of the estimated fair value of the Foundations’ tradename as well as certain related real property assets. The provision for asset impairment was impacted by the following: (i) decisions made by management during 2019 to cancel the opening of future planned de novo facilities; (ii) reductions in projected future patient volumes, revenues and cash flows resulting from continued operating trends and financial results experienced by existing facilities that significantly lagged expectations, and; (iii) competitive pressures experienced in certain markets that were deemed to be permanent. The following table shows the amounts recorded as net intangible assets for the years ended December 31, 2021 and 2020: (amounts in thousands) 2021 2020 Medicare licenses $ 57,226 $ 57,226 Certificates of need 8,239 8,253 Contract relationships and other (net of $54,134 and $52,804 of accumulated amortization for 2021 and 2020, respectively) 15,576 17,107 Net Intangible Assets $ 81,041 $ 82,586 |
Supplies | Supplies: Supplies, which consist primarily of medical supplies, are stated at the lower of cost (first-in, first-out basis) or market. |
Self-Insured/Other Insurance Risks | Self-Insured/Other Insurance Risks: We provide for self-insured risks, primarily general and professional liability claims and workers’ compensation claims. Our estimated liability for self-insured professional and general liability claims is based on a number of factors including, among other things, the number of asserted claims and reported incidents, estimates of losses for these claims based on recent and historical settlement amounts, estimate of incurred but not reported claims based on historical experience, and estimates of amounts recoverable under our commercial insurance policies. All relevant information, including our own historical experience is used in estimating the expected amount of claims. While we continuously monitor these factors, our ultimate liability for professional and general liability claims could change materially from our current estimates due to inherent uncertainties involved in making this estimate. Our estimated self-insured reserves are reviewed and changed, if necessary, at each reporting date and changes are recognized currently as additional expense or as a reduction of expense. See Note 8 - Commitments and Contingencies for discussion of adjustments to our prior year reserves for claims related to our self-insured general and professional liability and workers’ compensation liability. In addition, we also: (i) own commercial health insurers headquartered in Nevada and Puerto Rico, and; (ii) maintain self-insured employee benefits programs for employee healthcare and dental claims. The ultimate costs related to these programs/operations include expenses for claims incurred and paid in addition to an accrual for the estimated expenses incurred in connection with claims incurred but not yet reported. Given our significant insurance-related exposure, there can be no assurance that a sharp increase in the number and/or severity of claims asserted against us will not have a material adverse effect on our future results of operations. |
Income Taxes | Income Taxes: Deferred tax assets and liabilities are recognized for the amount of taxes payable or deductible in future years as a result of differences between the tax bases of assets and liabilities and their reported amounts in the financial statements. We believe that future income will enable us to realize our deferred tax assets net of recorded valuation allowances relating to state net operating loss carry-forwards. We operate in multiple jurisdictions with varying tax laws. We are subject to audits by any of these taxing authorities. Our tax returns have been examined by the Internal Revenue Service (“IRS”) through the year ended December 31, 2006. We believe that adequate accruals have been provided for federal, foreign and state taxes. See Note 6 - Income Taxes, |
Other Noncurrent Liabilities | Other Noncurrent Liabilities: Other noncurrent liabilities include the long-term portion of our professional and general liability, workers’ compensation reserves, pension and deferred compensation liabilities, payment deferral of the employer’s share of Social Security taxes as provided for by the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), and liabilities incurred in connection with split-dollar life insurance agreements on the lives of our chief executive officer and his wife. |
Redeemable Noncontrolling Interests and Noncontrolling Interest | Redeemable Noncontrolling Interests and Noncontrolling Interest: As of December 31, 2021, outside owners held noncontrolling, minority ownership interests of: (i) 20% in an acute care facility located in Washington, D.C.; (ii) approximately 9% in an acute care facility located in Texas; (iii) 20%, 30%, 20%, 25% and 48% in five behavioral health care facilities located in Pennsylvania, Ohio, Washington, Missouri and Iowa, respectively, and; (iv) approximately 5% in an acute care facility located in Nevada. The noncontrolling interest and redeemable noncontrolling interest balances of $103 million and $5 million, respectively, as of December 31, 2021, consist primarily of the third-party ownership interests in these hospitals. In connection with the two behavioral health care facilities located in Pennsylvania and Ohio, the minority ownership interests of which are reflected as redeemable noncontrolling interests on our Consolidated Balance Sheet, the outside owners have “put options” to put their entire ownership interest to us at any time. If exercised, the put option requires us to purchase the minority member’s interest at fair market value. Accordingly, the amounts recorded as redeemable noncontrolling interests on our Consolidated Balance Sheet reflects the estimated fair market value of these ownership interests. |
Accumulated Other Comprehensive Income | Accumulated Other Comprehensive Income: The accumulated other comprehensive income (“AOCI”) component of stockholders’ equity includes: net unrealized gains and losses on effective cash flow hedges, foreign currency translation adjustments and the net minimum pension liability of a non-contributory defined benefit pension plan which covers employees at one of our subsidiaries. See Note 11 - Pension Plan for additional disclosure regarding the defined benefit pension plan. The amounts recognized in AOCI for the two years ended December 31, 2021 were as follows (in thousands): Net Unrealized Gains (Losses) on Effective Cash Flow Hedges Foreign Currency Translation Adjustment Minimum Pension Liability Total AOCI Balance, January 1, 2020, net of income tax $ (17 ) $ 39,568 $ (7,658 ) $ 31,893 2020 activity: Pretax amount 0 13,619 4,428 18,047 Income tax effect 0 (749 ) (1,071 ) (1,820 ) Change, net of income tax 0 12,870 3,357 16,227 Balance, January 1, 2021, net of income tax (17 ) 52,438 (4,301 ) 48,120 2021 activity: Pretax amount 0 (20,743 ) 1,427 (19,316 ) Income tax effect 0 1,829 (342 ) 1,487 Change, net of income tax 0 (18,914 ) 1,085 (17,829 ) Balance, December 31, 2021, net of income tax $ (17 ) $ 33,524 $ (3,216 ) $ 30,291 |
Accounting for Derivative Financial Investments and Hedging Activities and Foreign Currency Forward Exchange Contracts | Accounting for Derivative Financial Investments and Hedging Activities and Foreign Currency Forward Exchange Contracts: We manage our ratio of fixed and floating rate debt with the objective of achieving a mix that management believes is appropriate. To manage this risk in a cost-effective manner, we, from time to time, enter into interest rate swap agreements in which we agree to exchange various combinations of fixed and/or variable interest rates based on agreed upon notional amounts. We account for our derivative and hedging activities using the Financial Accounting Standard Board’s (“FASB”) guidance which requires all derivative instruments, including certain derivative instruments embedded in other contracts, to be carried at fair value on the balance sheet. For derivative transactions designated as hedges, we formally document all relationships between the hedging instrument and the related hedged item, as well as its risk-management objective and strategy for undertaking each hedge transaction. Derivative instruments designated in a hedge relationship to mitigate exposure to variability in expected future cash flows, or other types of forecasted transactions, are considered cash flow hedges. Cash flow hedges are accounted for by recording the fair value of the derivative instrument on the balance sheet as either an asset or liability, with a corresponding amount recorded in accumulated other comprehensive income (“AOCI”) within shareholders’ equity. Amounts are reclassified from AOCI to the income statement in the period or periods the hedged transaction affects earnings. From time to time, we use interest rate derivatives in our cash flow hedge transactions. Such derivatives are designed to be highly effective in offsetting changes in the cash flows related to the hedged liability. For hedge transactions that do not qualify for the short-cut method, at the hedge’s inception and on a regular basis thereafter, a formal assessment is performed to determine whether changes in the fair values or cash flows of the derivative instruments have been highly effective in offsetting changes in cash flows of the hedged items and whether they are expected to be highly effective in the future. In August 2017, the FASB issued new guidance on hedge accounting (ASU 2017-12) that is intended to more closely align hedge accounting with companies’ risk management strategies, simplify the application of hedge accounting, and increase transparency as to the scope and results of hedging programs. The new guidance amends the presentation and disclosure requirements, and changes how companies assess effectiveness. We adopted this guidance as of January 1, 2019 and applied to all existing hedges as of the adoption date. As of December 31, 2021 we have no cash flow hedges. We use forward exchange contracts to hedge our net investment in foreign operations against movements in exchange rates. The effective portion of the unrealized gains or losses on these contracts is recorded in foreign currency translation adjustment within accumulated other comprehensive income and remains there until either the sale or liquidation of the subsidiary. In conjunction with the January 1, 2019 adoption of ASU 2017-12, “Targeted Improvements to Accounting for Hedging Activities”, we reclassified our presentation of the net cash inflows or outflows, which were received or paid in connection with foreign exchange contracts that hedge our net investment in foreign operations against movements in exchange rates, to investing cash flows on the consolidated statements of cash flows. |
Stock-Based Compensation | Stock-Based Compensation: We have a number of stock-based employee compensation plans. Pursuant to the FASB’s guidance, we expense the grant-date fair value of stock options and other equity-based compensation pursuant to the straight-line method over the stated vesting period of the award using the Black-Scholes option-pricing model. The expense associated with share-based compensation arrangements is a non-cash charge. In the Consolidated Statements of Cash Flows, share-based compensation expense is an adjustment to reconcile net income to cash provided by operating activities. |
Earnings Per Share | Earnings per Share: Basic earnings per share are based on the weighted average number of common shares outstanding during the year. Diluted earnings per share are based on the weighted average number of common shares outstanding during the year adjusted to give effect to common stock equivalents. The following table sets forth the computation of basic and diluted earnings per share, for the periods indicated: Twelve Months Ended December 31, 2021 2020 2019 Basic and diluted: Net Income $ 987,632 $ 952,790 $ 827,543 Less: Net (income) loss attributable to noncontrolling interest 3,958 (8,837 ) (12,689 ) Less: Net income attributable to unvested restricted share grants (2,059 ) (2,981 ) (2,028 ) Net income attributable to UHS—basic and diluted $ 989,531 $ 940,972 $ 812,826 Basic earnings per share attributable to UHS: Weighted average number of common shares—basic 82,519 85,061 88,762 Total basic earnings per share $ 11.99 $ 11.06 $ 9.16 Diluted earnings per share attributable to UHS: Weighted average number of common shares 82,519 85,061 88,762 Net effect of dilutive stock options and grants based on the treasury stock method 1,173 526 278 Weighted average number of common shares and equivalents—diluted 83,692 85,587 89,040 Total diluted earnings per share $ 11.82 $ 10.99 $ 9.13 The “Net effect of dilutive stock options and grants based on the treasury stock method”, for all years presented above, excludes certain outstanding stock options applicable to each year since the effect would have been anti-dilutive. The excluded weighted-average stock options totaled approximately 4.2 million during 2021, 6.4 million during 2020 and 5.5 million during 2019. |
Fair Value of Financial Instruments | Fair Value of Financial Instruments: The fair values of our debt and investments are based on quoted market prices. The fair values of other long-term debt, including capital lease obligations, are estimated by discounting cash flows using period-end interest rates and market conditions for instruments with similar maturities and credit quality. The carrying amounts reported in the balance sheet for cash, accounts receivable, accounts payable, and short-term borrowings approximates their fair values due to the short-term nature of these instruments. Accordingly, these items have been excluded from the fair value disclosures included elsewhere in these notes to consolidated financial statements. |
Use of Estimates | Use of Estimates: The preparation of financial statements in conformity with U.S. generally accepted accounting principles requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. |
Mergers and Acquisitions | Mergers and Acquisitions: The acquisition method of accounting for business combinations requires that the assets acquired and liabilities assumed be recorded at the date of acquisition at their respective fair values with limited exceptions. Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Any excess of the purchase price (consideration transferred) over the estimated fair values of net assets acquired is recorded as goodwill. Transaction costs and costs to restructure the acquired company are expensed as incurred. The fair value of intangible assets, including Medicare licenses, certificates of need, tradenames and certain contracts, is based on significant judgments made by our management, and accordingly, for significant items we typically obtain assistance from third party valuation specialists. |
GPO Agreement/Minority Ownership Interest | GPO Agreement/Minority Ownership Interest: During 2013, we entered into a new group purchasing organization agreement (“GPO”) with Premier, Inc. (“Premier), a healthcare performance improvement alliance, and acquired a minority interest in the GPO for a nominal amount. During the fourth quarter of 2013, in connection with the completion of an initial public offering of the stock of Premier, we received cash proceeds for the sale of a portion of our ownership interest in the GPO, which were recorded as deferred income, on a pro rata basis, as a reduction to our supplies expense over the initial expected life of the GPO agreement. Also in connection with this GPO agreement, we received shares of restricted stock in Premier which vest ratably over a seven-year remier paid cash dividends of $1.7 million and $848,000 as of December 31, 2021 and 2020, respectively, which are included in “Other (income) expense, net” in our condensed consolidated statements of income. |
Provider Taxes | Provider Taxes: We incur health-care related taxes (“Provider Taxes”) imposed by states in the form of a licensing fee, assessment or other mandatory payment which are related to: (i) healthcare items or services; (ii) the provision of, or the authority to provide, the health care items or services, or; (iii) the payment for the health care items or services. Such Provider Taxes are subject to various federal regulations that limit the scope and amount of the taxes that can be levied by states in order to secure federal matching funds as part of their respective state Medicaid programs. We derive a related Medicaid reimbursement benefit from assessed Provider Taxes in the form of Medicaid claims based payment increases and/or lump sum Medicaid supplemental payments. Under these programs, including the impact of the Texas Uncompensated Care and Upper Payment Limit program, the Texas Delivery System Reform Incentive program, and various other state programs, we earned revenues (before Provider Taxes) of approximately $641 million during 2021, $488 million during 2020 and $419 million during 2019. These revenues were offset by Provider Taxes of approximately $211 million during 2021, $185 million during 2020 and $194 million during 2019, which are recorded in other operating expenses on the Consolidated Statements of Income as included herein. The aggregate net benefit from these programs was $430 million during 2021, $303 million during 2020 and $225 million during 2019. The aggregate net benefit pursuant to these programs is earned from multiple states and therefore no particular state’s portion is individually material to our consolidated financial statements. In addition, under various disproportionate share hospital payment programs and the Nevada state plan amendment program, we earned revenues of $74 million in 2021, $73 million in 2020 and $78 million in 2019. |
CARES Act and Other Governmental Grants and Medicare Accelerated Payments | CARES Act and Other Governmental Grants and Medicare Accelerated Payments: During 2021, we received approximately $189 million of additional funds from the federal government in connection with the CARES Act, which we returned during the year utilizing a portion of our cash and cash equivalents held on deposit. Therefore, t here was no impact on our earnings during 2021 in connection with receipt of those funds. Also during 2021, we made an early repayment of $695 million of funds received during 2020 pursuant to the Medicare Accelerated and Advance Payment Program (“MAAPP”). These funds, which were required to be repaid to the government beginning in the second quarter of 2021 through the third quarter of 2022, were returned to the government utilizing a portion of our cash and cash equivalents held on deposit As of December 31, 2020, we received an aggregate of $1.112 billion of funds consisting of: (i) $417 million received pursuant to various governmental stimulus programs, most notably the Public Health and Social Services Emergency Fund (the “PHSSEF”) as provided for by the CARES Act, of which approximately $413 million were recorded as net revenues during 2020 and approximately $4 million remained in the Medicare accelerated payments and deferred CARES Act and other grants liability account in our consolidated balance sheet, and; (ii) $695 million of MAAPP funds, which as discussed above, were repaid early to the government during 2021. As of December 31, 2020, $372 million of the MAAPP funds were included in the current liabilities in our consolidated balance sheet and $323 million were included noncurrent liabilities. There was no impact on our earnings during 2021 or 2020 in connection with receipt of the MAAPP funds. |
Recent Accounting Standards | Recent Accounting Standards: In March 2020, the FASB issued ASU 2020-04, “Facilitation of the Effects of Reference Rate Reform on Financial Reporting.” The ASU is intended to provide temporary optional expedients and exceptions to the US GAAP guidance on contract modifications and hedge accounting to ease the financial reporting burdens related to the expected market transition from LIBOR and other interbank offered rates to alternative reference rates. This guidance was effective beginning on March 12, 2020, and the Company may elect to apply the amendments prospectively through December 31, 2022. The Company is currently evaluating the impact this guidance may have on our consolidated financial statements . From time to time, new accounting guidance is issued by the FASB or other standard setting bodies that is adopted by the Company as of the effective date or, in some cases where early adoption is permitted, in advance of the effective date. The Company has assessed the recently issued guidance that is not yet effective and, unless otherwise indicated above, believes the new guidance will not have a material impact on our results of operations, cash flows or financial position. |
Foreign Currency Translation | Foreign Currency Translation: Assets and liabilities of our U.K. subsidiaries are denominated in pound sterling and translated into U.S. dollars at: (i) the rates of exchange at the balance sheet date, and; (ii) average rates of exchange prevailing during the year for revenues and expenses. The currency translation adjustments are reported as a component of accumulated other comprehensive income. See Note 3 - Financial Instruments , Foreign Currency Forward Exchange Contracts for additional disclosure. |
Business and Summary of Signi_3
Business and Summary of Significant Accounting Policies (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Accounting Policies [Abstract] | |
Uncompensated Care | The following table shows the amounts recorded at our acute care hospitals for charity care and uninsured discounts, based on charges at established rates, for the years ended December 31, 2021, 2020 and 2019: (dollar amounts in thousands) 2021 2020 2019 Amount % Amount % Amount % Charity care $ 661,965 33 % $ 622,668 28 % $ 672,326 31 % Uninsured discounts 1,336,319 67 % 1,578,470 72 % 1,511,738 69 % Total uncompensated care $ 1,998,284 100 % $ 2,201,138 100 % $ 2,184,064 100 % |
Estimated Cost of Providing Uncompensated Care | The estimated cost of providing uncompensated care, as reflected below, were based on a calculation which multiplied the percentage of operating expenses for our acute care hospitals to gross charges for those hospitals by the above-mentioned total uncompensated care amounts. The percentage of cost to gross charges is calculated based on the total operating expenses for our acute care facilities divided by gross patient service revenue for those facilities. An increase in the level of uninsured patients to our facilities and the resulting adverse trends in the adjustments to net revenues and uncompensated care provided could have a material unfavorable impact on our future operating results. (amounts in thousands) 2021 2020 2019 Estimated cost of providing charity care $ 72,095 $ 73,690 $ 77,886 Estimated cost of providing uninsured discounts related care 145,538 186,804 175,128 Estimated cost of providing uncompensated care $ 217,633 $ 260,494 $ 253,014 |
Summary of Cash, Cash Equivalents and Restricted Cash Reported In Consolidated Statements of Cash Flows | Cash, cash equivalents, and restricted cash as reported in the consolidated statements of cash flows are presented separately on our consolidated balance sheets as follow: (amounts in thousands) 2021 2020 2019 Cash and cash equivalents $ 115,301 $ 1,224,490 $ 61,268 Restricted cash (a) 63,633 54,664 44,399 Total cash, cash equivalents and restricted cash $ 178,934 $ 1,279,154 $ 105,667 (a)Restricted cash is included in other assets on the accompanying consolidated balance sheet and consists of statutorily required capital reserves related to our commercial insurance subsidiary |
Summary of Changes in Carrying Amount of Goodwill | Changes in the carrying amount of goodwill for the two years ended December 31, 2021 were as follows (in thousands): Acute Care Services Behavioral Health Services Total Consolidated Balance, January 1, 2020 $ 448,415 $ 3,421,345 $ 3,869,760 Goodwill acquired during the period 127 0 127 Goodwill divested during the period 0 0 0 Adjustments to goodwill (a) (1,521 ) 14,349 12,828 Balance, December 31, 2020 447,021 3,435,694 3,882,715 Goodwill acquired during the period 55,406 0 55,406 Goodwill divested during the period 0 0 0 Adjustments to goodwill (b) 13,509 10,994 24,503 Balance, December 31, 2021 $ 515,936 $ 3,446,688 $ 3,962,624 (a) The changes in the Behavioral Health Services’ goodwill consists primarily of foreign currency translation adjustments. (b) Adjustments to goodwill during 2021 consist of the following: $13.5 million in Acute Care Services consists primarily of a measurement period adjustment to the preliminary purchase price allocation related to a 2020 acquisition; and the $11.0 million in Behavioral Health Services consists of $16.3 million recorded in connection with a third party minority ownership interest in a majority owned joint venture that constructed and owns a recently opened behavioral health facility, partially offset by a $5.3 million decrease related to foreign currency translation adjustments. |
Summary of Net Intangible Assets | The following table shows the amounts recorded as net intangible assets for the years ended December 31, 2021 and 2020: (amounts in thousands) 2021 2020 Medicare licenses $ 57,226 $ 57,226 Certificates of need 8,239 8,253 Contract relationships and other (net of $54,134 and $52,804 of accumulated amortization for 2021 and 2020, respectively) 15,576 17,107 Net Intangible Assets $ 81,041 $ 82,586 |
Amounts Recognized in AOCI | The amounts recognized in AOCI for the two years ended December 31, 2021 were as follows (in thousands): Net Unrealized Gains (Losses) on Effective Cash Flow Hedges Foreign Currency Translation Adjustment Minimum Pension Liability Total AOCI Balance, January 1, 2020, net of income tax $ (17 ) $ 39,568 $ (7,658 ) $ 31,893 2020 activity: Pretax amount 0 13,619 4,428 18,047 Income tax effect 0 (749 ) (1,071 ) (1,820 ) Change, net of income tax 0 12,870 3,357 16,227 Balance, January 1, 2021, net of income tax (17 ) 52,438 (4,301 ) 48,120 2021 activity: Pretax amount 0 (20,743 ) 1,427 (19,316 ) Income tax effect 0 1,829 (342 ) 1,487 Change, net of income tax 0 (18,914 ) 1,085 (17,829 ) Balance, December 31, 2021, net of income tax $ (17 ) $ 33,524 $ (3,216 ) $ 30,291 |
Computation of Basic and Diluted Earnings Per Share | The following table sets forth the computation of basic and diluted earnings per share, for the periods indicated: Twelve Months Ended December 31, 2021 2020 2019 Basic and diluted: Net Income $ 987,632 $ 952,790 $ 827,543 Less: Net (income) loss attributable to noncontrolling interest 3,958 (8,837 ) (12,689 ) Less: Net income attributable to unvested restricted share grants (2,059 ) (2,981 ) (2,028 ) Net income attributable to UHS—basic and diluted $ 989,531 $ 940,972 $ 812,826 Basic earnings per share attributable to UHS: Weighted average number of common shares—basic 82,519 85,061 88,762 Total basic earnings per share $ 11.99 $ 11.06 $ 9.16 Diluted earnings per share attributable to UHS: Weighted average number of common shares 82,519 85,061 88,762 Net effect of dilutive stock options and grants based on the treasury stock method 1,173 526 278 Weighted average number of common shares and equivalents—diluted 83,692 85,587 89,040 Total diluted earnings per share $ 11.82 $ 10.99 $ 9.13 |
Financial Instruments and Fai_2
Financial Instruments and Fair Value Measurement (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Financial Instruments And Fair Value Measurement [Abstract] | |
Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations | The following table presents the effects of our interest rate swap agreements and our foreign currency foreign exchange contracts on our results of operations for the three years ended December 31 (in thousands): Gain/(Loss) recognized in AOCI December 31, December 31, December 31, 2021 2020 2019 Cash Flow Hedge relationships Interest rate swap agreements (a) $ 0 $ 0 $ (3,925 ) Net Investment Hedge relationships Foreign currency foreign exchange contracts $ (7,272 ) $ (22,097 ) $ (18,328 ) (a) The amount of |
Summary of Assets and Liabilities Recorded at Fair Value on Recurring Basis | The following tables present the assets and liabilities recorded at fair value on a recurring basis: Balance at Balance Sheet Basis of Fair Value Measurement (in thousands) December 31, 2021 Location Level 1 Level 2 Level 3 Assets: Money market mutual funds $ 79,900 Other assets $ 79,900 Certificates of deposit 2,300 Other assets 2,300 Equity securities 91,919 Other assets 91,919 Deferred compensation assets 45,759 Other assets 45,759 Foreign currency exchange contracts 1,357 Other current assets 1,357 $ 221,235 $ 217,578 $ 3,657 - Liabilities: Deferred compensation liability $ 45,759 Other noncurrent liabilities $ 45,759 $ 45,759 $ 45,759 - - Balance at Balance Sheet Basis of Fair Value Measurement (in thousands) December 31, 2020 Location Level 1 Level 2 Level 3 Assets: Term Deposits $ 540,000 Cash and cash equivalents $ 540,000 Money market mutual funds 37,100 Cash and cash equivalents 37,100 Money market mutual funds 70,995 Other assets 70,995 Certificates of deposit 2,300 Other assets 2,300 Equity securities 78,367 Other assets 78,367 Deferred compensation assets 42,044 Other assets 42,044 Foreign currency exchange contracts 9,987 Other current assets 9,987 $ 780,793 $ 228,506 $ 552,287 - Liabilities: Deferred compensation liability $ 42,044 Other noncurrent liabilities $ 42,044 $ 42,044 $ 42,044 - - |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Debt Disclosure [Abstract] | |
Summary of Long-Term Debt | A summary of long-term debt follows: December 31, 2021 2020 (amounts in thousands) Long-term debt: Notes and Mortgages payable (including obligations under finance leases of $79,331 in 2021 and $52,905 in 2020) and term loans with varying maturities through 2099; weighted average interest rates of 5.6% in 2021 and 6.8% in 2020 (see Note 7 regarding finance leases) $ 185,027 $ 61,638 Tranche A term loan 1,689,375 1,900,000 Revolving credit facility 342,600 — 2.65% Senior Secured Notes due 2030, net of unamortized discount of $1,968 in 2021 and $2,193 in 2020 798,032 797,806 1.65% Senior Secured Notes due 2026, net of unamortized discount of $813 in 2021 699,187 — 2.65% Senior Secured Notes due 2032, net of unamortized discount of $1,254 in 2021 498,746 — Term Loan B — 490,000 Accounts receivable securitization program — 225,000 5.00% Senior Secured Notes due 2026 — 400,000 Total debt before unamortized financing costs 4,212,967 3,874,444 Less-Unamortized financing costs (22,679 ) (18,193 ) Total debt after unamortized financing costs 4,190,288 3,856,251 Less-Amounts due within one year (48,409 ) (331,998 ) Long-term debt $ 4,141,879 $ 3,524,253 |
Aggregate Scheduled Maturities of Debt Outstanding | The aggregate scheduled maturities of our total debt outstanding as of December 31, 2021 are as follows: (000s) 2022 $ 48,409 2023 59,648 2024 92,012 2025 91,274 2026 2,472,172 Later 1,449,452 Total maturities before unamortized financing costs 4,212,967 Less-Unamortized financing costs (22,679 ) Total $ 4,190,288 |
Common Stock (Tables)
Common Stock (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
Information Related to Stock Repurchase Programs | The following schedule provides information related to our stock repurchase program for each of the three years ended December 31, 2021. During 2021, 8,409,721 shares ($1.20 billion in the aggregate) were repurchased pursuant to the terms of the stock repurchase program and 134,464 shares ($19.5 million in the aggregate) were repurchased in connection with the income tax withholding obligations resulting from stock-based compensation programs. During 2020, 1,951,899 shares ($196.6 million in the aggregate) were repurchased pursuant to the terms of the stock repurchase program and 81,057 shares ($10.2 million in the aggregate) were repurchased in connection with the income tax withholding obligations resulting from stock-based compensation programs. During 2019, 5,397,753 shares ($706.2 million in the aggregate) were repurchased pursuant to the terms of our stock repurchase program and 336,943 shares ($ 47.7 million in the aggregate) were repurchased in connection with the income tax withholding obligations resulting from stock-based compensation programs . Additional dollars authorized for repurchase (in thousands) Total number of shares purchased (a.) Total number of shares cancelled Average price paid per share for forfeited restricted shares Total number of shares purchased as part of publicly announced programs Average price paid per share for shares purchased as part of publicly announced program Aggregate purchase price paid (in thousands) Aggregate purchase price paid for shares purchased as part of publicly announced program Maximum number of dollars that may yet be purchased under the program (in thousands) Balance as of January 1, 2019 $ 462,344 2019 $ 1,000,000 5,762,409 27,713 $ 0.01 5,397,753 $ 130.84 $ 753,928 $ 706,221 $ 756,123 2020 $ — 2,050,735 17,779 $ 0.01 1,951,899 $ 100.70 $ 206,719 $ 196,560 $ 559,563 2021 $ 1,000,000 8,559,946 15,761 $ 0.01 8,409,721 $ 142.85 $ 1,220,876 $ 1,201,330 $ 358,233 Total for three year period ended December 31, 2021 $ 2,000,000 16,373,090 61,253 $ 0.01 15,759,373 $ 133.51 $ 2,181,523 $ 2,104,111 (a.) Includes 15,761, 17,779 and, 27,713 |
Weighted-Average Assumptions Fair Value of Option Grants | The weighted-average assumptions reflected below were based upon twenty-eight option grants for the five-year period ending December 31, 2021, twenty-nine option grants for the five-year period ending December 31, 2020 Year Ended December 31, 2021 2020 2019 Expected volatility 31 % 28 % 27 % Risk free Interest rate 2 % 2 % 2 % Expected life (years) 3.5 3.5 3.4 Forfeiture rate 8 % 8 % 9 % Dividend yield 0.5 % 0.5 % 0.3 % |
Stock Option Activity | The table below summarizes our stock option activity during the year ended December 31, 2021: Outstanding Options Number of Shares Weighted Average Exercise Price Balance, January 1, 2021 8,238,966 $ 109.47 Granted 2,401,402 $ 141.08 Exercised (1,737,286 ) $ 116.38 Expired — $ — Cancelled (346,967 ) $ 112.84 Balance, December 31, 2021 8,556,115 $ 116.80 Outstanding options vested and exercisable as of December 31, 2021 2,997,296 $ 119.00 |
Information about Unvested Options | The following table provides information about unvested options for the year ended December 31, 2021: Shares Weighted Average Grant Date Fair Value Unvested options as of January 1, 2021 5,716,060 $ 22.74 Granted 2,401,402 $ 39.66 Vested (2,218,647 ) $ 24.61 Cancelled (339,996 ) $ 28.70 Unvested options as of December 31, 2021 5,558,819 $ 28.93 |
Information about all Outstanding Options | The following table provides information regarding all options outstanding at December 31, 2021: Options Outstanding Options Exercisable Number of options outstanding 8,556,115 2,997,296 Weighted average exercise price $ 116.80 $ 119.00 Aggregate intrinsic value as of December 31, 2021 $ 144,921,069 $ 35,394,928 Weighted average remaining contractual life 2.6 1.4 |
Weighted Average Remaining Contractual Life for Options Outstanding and Weighted Average Exercise Price Per Share for Exercisable Options | The weighted average remaining contractual life for options outstanding and weighted average exercise price per share for exercisable options at December 31, 2019, 2020 and 2021 were as follows: Year Ended: Options Outstanding Weighted Average Exercise Price Per Share Weighted Average Remaining Contractual Life (in Years) Exercisable Options Weighted Average Exercise Price Per Share Expected to Vest Options Weighted Average Exercise Price Per Share Shares Shares Shares 2019 8,133,176 124.52 2.7 2,551,267 119.86 5,073,423 126.62 2020 8,238,966 109.47 2.9 2,522,906 124.62 5,099,823 110.47 2021 8,556,115 116.80 2.6 2,997,296 119.00 5,005,113 116.94 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |
Components of Income Tax Expense (Benefit) | Components of income tax expense/(benefit) are as follows (amounts in thousands): Year Ended December 31, 2021 2020 2019 Current Federal $ 276,471 $ 268,974 $ 225,663 Foreign 13,754 13,978 9,284 State 44,993 43,333 40,152 335,218 326,285 275,099 Deferred Federal (26,638 ) (20,382 ) (27,073 ) Foreign 1,521 (2,496 ) 1,874 State (4,420 ) (4,114 ) (11,106 ) (29,537 ) (26,992 ) (36,305 ) Total $ 305,681 $ 299,293 $ 238,794 |
Reconciliation Between Federal Statutory Rate and Effective Tax Rate | A reconciliation between the federal statutory rate and the effective tax rate is as follows: Year Ended December 31, 2021 2020 2019 Federal statutory rate 21.0 % 21.0 % 21.0 % State taxes, net of federal income tax benefit 2.5 % 2.5 % 2.2 % Tax effects of foreign operations -0.1 % -0.3 % -0.3 % Tax benefit from settlement of employee equity awards -0.2 % 0.5 % -1.0 % Other items 0.3 % 0.4 % 0.8 % Impact of income attributable to noncontrolling interests 0.1 % -0.2 % -0.3 % Effective tax rate 23.6 % 23.9 % 22.4 % |
Components of Deferred Taxes | The components of deferred taxes are as follows (amounts in thousands): Year Ended December 31, 2021 2020 Assets Liabilities Assets Liabilities Self-insurance reserves $ 97,024 $ $ 75,648 $ Compensation accruals 77,917 71,054 Doubtful accounts and other reserves 127,876 94,295 Other currently non-deductible accrued liabilities 31,240 61,634 Depreciable and amortizable assets 303,079 296,588 Operating lease liabilities 86,652 89,865 Right of use assets-operating leases 86,269 89,493 State and foreign net operating loss carryforwards and other state and foreign deferred tax assets 79,499 81,036 Net pension liabilities – OCI only 1,014 1,356 Other liabilities 3,811 3,697 $ 501,222 $ 393,159 $ 474,888 $ 389,778 Valuation Allowance (62,356 ) 0 (68,003 ) 0 Total deferred income taxes $ 438,866 $ 393,159 $ 406,885 $ 389,778 |
Reconciliation of Unrecognized Tax Benefits | The tabular reconciliation of unrecognized tax benefits for the years ended December 31, 2021, 2020 and 2019 is as follows (amounts in thousands): As of December 31, 2021 2020 2019 Balance at January 1, $ 2,806 $ 2,164 $ 1,553 Additions based on tax positions related to the current year 500 500 500 Additions for tax positions of prior years 213 142 113 Reductions for tax positions of prior years (261 ) 0 0 Settlements (714 ) 0 (2 ) Balance at December 31, $ 2,544 $ 2,806 $ 2,164 |
Lease Commitments (Tables)
Lease Commitments (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Leases [Abstract] | |
Components of Lease Expense | The components of lease expense for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands): Twelve months ended December 31, 2021 2020 2019 Operating lease cost $ 77,420 $ 73,841 $ 72,098 Variable and short term lease cost (a) 41,443 42,218 35,711 Total lease and rental expense $ 118,863 $ 116,059 $ 107,809 Finance lease cost: Amortization of property under capital lease $ 3,626 $ 1,985 $ 1,877 Interest on debt of property under capital lease 4,124 1,763 1,876 Total finance lease cost $ 7,750 $ 3,748 $ 3,753 (a) |
Supplemental Cash Flow Information Related to Leases | Supplemental cash flow information related to leases for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands): Twelve months ended December 31, 2021 2020 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 118,433 $ 115,270 $ 107,239 Operating cash flows from finance leases $ 4,612 $ 1,885 $ 2,078 Financing cash flows from finance leases $ 2,849 $ 2,586 $ 1,959 Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 95,805 $ 69,678 $ 383,857 Finance leases $ 28,600 $ 37,029 $ - |
Supplemental Balance Sheet Information Related to Leases | Supplemental balance sheet information related to leases as of December 31, 2021 and 2020 are as follows (in thousands): December 31, December 31, 2021 2020 Operating Leases Right of use assets-operating leases $ 367,477 $ 336,513 Operating lease liabilities $ 64,484 $ 59,796 Operating lease liabilities noncurrent 304,624 278,303 Total operating lease liabilities $ 369,108 $ 338,099 Finance Leases Property and equipment $ 102,940 $ 75,611 Accumulated depreciation (30,949 ) (28,595 ) Property and equipment, net $ 71,991 $ 47,016 Current maturities of long-term debt $ 2,740 $ 2,060 Long-term debt 76,591 50,845 Total finance lease liabilities $ 79,331 $ 52,905 Weighted Average remaining lease term, years Operating leases 9.1 10.9 Finance leases 20.8 8.1 Weighted Average discount rate Operating leases 3.8 % 4.4 % Finance leases 7.1 % 9.7 % |
Future Maturities of Lease Liabilities | Future maturities of lease liabilities as of December 31, 2021 are as follows (in thousands): Operating Leases Finance Leases Year ending December 31, 2022 $ 75,790 $ 6,809 2023 67,994 6,993 2024 59,354 7,162 2025 52,098 6,047 2026 43,193 6,057 Later years 150,024 110,263 Total lease payments 448,453 143,331 less imputed interest (79,345 ) (64,000 ) Total $ 369,108 $ 79,331 |
Commitments and Contingencies (
Commitments and Contingencies (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Commitments And Contingencies Disclosure [Abstract] | |
Schedule of Changes in General and Professional Liability and Workers Compensation Reserves | Below is a schedule showing the changes in our general and professional liability and workers’ compensation reserves during the three years ended December 31, 2021 (amount in thousands): General and Professional Workers’ Liability Compensation Total Balance at January 1, 2019 $ 243,051 $ 71,890 $ 314,941 Plus: Accrued insurance expense, net of commercial premiums paid 56,452 49,220 105,672 Less: Payments made in settlement of self-insured claims (57,683 ) (40,106 ) (97,789 ) Balance at January 1, 2020 241,820 81,004 322,824 Plus: Accrued insurance expense, net of commercial premiums paid 91,518 67,705 159,223 Less: Payments made in settlement of self-insured claims (69,559 ) (43,524 ) (113,083 ) Balance at January 1, 2021 263,779 105,185 368,964 Plus: Accrued insurance expense, net of commercial premiums paid 129,690 56,525 186,215 Less: Payments made in settlement of self-insured claims (44,776 ) (46,725 ) (91,501 ) Balance at December 31, 2021 $ 348,693 $ 114,985 $ 463,678 |
Relationship with Universal H_2
Relationship with Universal Health Realty Income Trust and Related Party Transactions (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Related Party Transactions [Abstract] | |
Remaining Renewal Options and Terms for Each of Three Hospital Facilities Leased from Trust | The table below provides certain details for each of the hospitals leased from the Trust as of January 1, 2022: Hospital Name Annual Minimum Rent End of Lease Term Renewal Term (years) McAllen Medical Center $ 5,485,000 December, 2026 5 (a) Wellington Regional Medical Center $ 6,319,000 December, 2026 5 (b) Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services $ 3,895,000 December, 2033 35 (c) Canyon Creek Behavioral Health $ 1,670,000 December, 2033 35 (c) Clive Behavioral Health Hospital $ 2,628,000 December, 2040 50 (d) (a) We have one 5-year renewal option at existing lease rates (through 2031). (b) We have one 5-year renewal option at fair market value lease rates ( through 2031 ). Upon the December 31, 2021 expiration of the lease on Wellington Regional Medical Center, a wholly-owned subsidiary of ours exercised its fair market value renewal option and renewed the lease for a 5-year term scheduled to expire on December 31, 2026 . Effective January 1, 2022, the annual fair market value lease rate for this hospital is $ 6.3 million (there is no longer a bonus rental component of the lease payment). Beginning on January 1, 2023, and thereafter on each January 1 st through 2026, the annual rent will increase by 2.50 % on a cumulative and compounded basis. (c) We have seven 5-year (d) This facility is operated by a joint venture in which we are the managing, majority member and an unrelated third-party holds a minority ownership interest. The joint venture has three, 10-year renewal options at computed lease rates as stipulated in the lease (2041 through 2070) and two additional, 10-year renewal options at fair market values lease rates (2071 through 2090). Beginning in January, 2022, and thereafter in each January through 2040 (and potentially through 2070 if three, 10-year renewal options are exercised), the annual rental will increase by 2.75% on a cumulative and compounded basis. |
Revenue Recognition (Tables)
Revenue Recognition (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Revenue From Contract With Customer [Abstract] | |
Schedule of Disaggregates Revenue by Major Source | The following table disaggregates our revenue by major source for the years ended December 31, 2021, 2020 and 2019 (in thousands): For the year ended December 31, 2021 Acute Care Behavioral Health Other Total Medicare $ 1,292,205 18 % $ 361,914 7 % $ 1,654,119 13 % Managed Medicare 1,118,901 16 % 244,061 4 % 1,362,962 11 % Medicaid 539,741 8 % 751,951 14 % 1,291,692 10 % Managed Medicaid 618,727 9 % 1,328,536 24 % 1,947,263 15 % Managed Care (HMO and PPOs) 2,521,089 35 % 1,435,938 26 % 3,957,027 31 % UK Revenue 0 0 % 687,725 12 % 687,725 5 % Other patient revenue and adjustments, net 358,458 5 % 484,742 9 % 843,200 7 % Other non-patient revenue 659,133 9 % 208,777 4 % 30,219 898,129 7 % Total Net Revenue $ 7,108,254 100 % $ 5,503,644 100 % $ 30,219 12,642,117 100 % For the year ended December 31, 2020 Acute Care Behavioral Health Other Total Medicare $ 1,242,268 20 % $ 448,323 9 % $ 1,690,591 15 % Managed Medicare 869,488 14 % 235,442 5 % 1,104,930 10 % Medicaid 551,551 9 % 651,081 12 % 1,202,632 10 % Managed Medicaid 491,234 8 % 1,224,205 24 % 1,715,439 15 % Managed Care (HMO and PPOs) 2,146,018 34 % 1,280,919 25 % 3,426,937 30 % UK Revenue 0 0 % 584,000 11 % 584,000 5 % Other patient revenue and adjustments, net 248,047 4 % 497,297 10 % 745,344 6 % Other non-patient revenue (a) 788,698 12 % 287,455 6 % 12,871 1,089,024 9 % Total Net Revenue $ 6,337,304 100 % $ 5,208,722 100 % $ 12,871 11,558,897 100 % For the year ended December 31, 2019 Acute Care Behavioral Health Other Total Medicare $ 1,336,200 22 % $ 553,045 11 % $ 1,889,245 17 % Managed Medicare 827,216 13 % 220,543 4 % 1,047,759 9 % Medicaid 519,508 8 % 688,141 13 % 1,207,649 11 % Managed Medicaid 560,029 9 % 1,118,612 21 % 1,678,641 15 % Managed Care (HMO and PPOs) 2,271,002 37 % 1,363,815 26 % 3,634,817 32 % UK Revenue 0 0 % 553,831 11 % 553,831 5 % Other patient revenue and adjustments, net 191,422 3 % 505,144 10 % 696,566 6 % Other non-patient revenue 459,183 7 % 206,932 4 % 3,636 669,751 6 % Total Net Revenue $ 6,164,560 100 % $ 5,210,063 100 % $ 3,636 11,378,259 100 % (a) The 2020 other non-patient revenue includes Acute Care CARES Act and other grant revenue of $316 million and Behavioral Health CARES Act and other grant revenue of $97 million. As an accounting policy election, we have utilized ASC 958 by analogy to recognize funds received under the CARES Act from the Provider Relief Fund as revenue, given no direct authoritative guidance available to for-profit organizations to recognize revenue for government contributions and grants . CARES Act revenues may be subject to future adjustments based on future changes to statutes. |
Pension Plan (Tables)
Pension Plan (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Compensation And Retirement Disclosure [Abstract] | |
Reconciliation of Defined Benefit Pension Plan | The following table shows the reconciliation of the defined benefit pension plan as of December 31, 2021 and 2020: 2021 2020 (000s) Change in plan assets: Fair value of plan assets at beginning of year $ 131,685 $ 120,287 Actual return (loss) on plan assets 2,771 18,169 Benefits paid (6,389 ) (6,260 ) Administrative expenses (707 ) (511 ) Fair value of plan assets at end of year $ 127,360 $ 131,685 Change in benefit obligation: Benefit obligation at beginning of year $ 123,237 $ 117,556 Service cost $ 546 $ 615 Interest cost $ 2,493 $ 3,357 Benefits paid $ (6,389 ) $ (6,260 ) Actuarial (gain) loss $ (3,853 ) $ 7,969 Benefit obligation at end of year $ 116,034 $ 123,237 Amounts recognized in the Consolidated Balance Sheet: Other non-current assets $ 11,327 $ 8,449 Total amounts recognized at end of year $ 11,327 $ 8,449 |
Components of Net Periodic Pension Cost (Benefit) | 2021 2020 2019 (000s) Components of net periodic cost (benefit) Service cost $ 546 $ 615 $ 725 Interest cost 2,493 3,357 4,237 Expected return on plan assets (4,490 ) (5,261 ) (4,558 ) Amortization of actuarial loss — — 1,533 Net periodic cost $ (1,451 ) $ (1,289 ) $ 1,937 |
Measurement Dates | 2021 2020 Measurement Dates Benefit obligations 12/31/2021 12/31/2020 Fair value of plan assets 12/31/2021 12/31/2020 |
Weighted-average Assumptions for Net Periodic Benefit Cost | 2021 2020 Weighted average assumptions as of December 31 Discount rate 2.52 % 2.08 % Rate of compensation increase 4.00 % 4.00 % |
Weighted Average Assumptions | 2021 2020 2019 Weighted-average assumptions for net periodic benefit cost calculations Discount rate 2.08 % 2.94 % 4.03 % Expected long-term rate of return on plan assets 3.50 % 4.50 % 4.50 % Rate of compensation increase 4.00 % 4.00 % 4.00 % |
Market Values of Our Pension Plan Assets | The market values of our pension plan assets at December 31, 2021 and December 31, 2020, reported using net asset value as a practical expedient, by asset category are as follows: 2021 2020 Equities: U.S. Large Cap $ 7,306 $ 10,946 U.S. Mid Cap $ 2,014 $ 3,403 U.S. Small Cap $ 1,913 $ 3,581 International Developed $ 5,062 $ 8,315 Emerging Markets $ 3,152 $ 5,631 Fixed income: Core Fixed Income $ 22,904 $ 27,782 Long Duration Fixed Income $ 84,277 $ 68,886 Real Estate: REIT Fund $ — $ 2,474 Cash/Currency: Cash Equivalents $ 732 $ 667 Total market value $ 127,360 $ 131,685 |
Estimated Future Benefit | There will be benefit payments under this plan beyond 2031. Estimated Future Benefit Payments (000s) 2022 $ 6,994 2023 7,056 2024 7,057 2025 7,029 2026 6,973 2027-2031 33,438 Total $ 68,547 |
Plan Assets | 2021 2020 Plan Assets Asset Category Equity securities 15 % 24 % Fixed income securities 84 % 73 % Other 1 % 3 % Total 100 % 100 % |
Asset Allocation Policy and Ranges Established in accordance with Overall Risk and Return Objectives of Portfolio | The following asset allocation policy and ranges have been established in accordance with the overall risk and return objectives of the portfolio: As of 12/31/2021 Permitted Range Total Equity 15 % 10-30% Total Fixed Income 84 % 70-90% Other 1 % 0-10% |
Segment Reporting (Tables)
Segment Reporting (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Segment Reporting [Abstract] | |
Segment Reporting | 2021 Acute Care Hospital Services Behavioral Health Services (a.) Other Total Consolidated (Dollar amounts in thousands) Gross inpatient revenues $ 36,522,155 $ 9,927,401 $ — $ 46,449,556 Gross outpatient revenues $ 20,633,921 $ 1,013,547 $ — $ 21,647,468 Total net revenues $ 7,108,254 $ 5,503,644 $ 30,219 $ 12,642,117 Income (loss) before allocation of corporate overhead and income taxes $ 734,666 $ 1,025,557 $ (466,910 ) $ 1,293,313 Allocation of corporate overhead $ (233,298 ) $ (172,512 ) $ 405,810 $ 0 Income (loss) after allocation of corporate overhead and before income taxes $ 501,368 $ 853,045 $ (61,100 ) $ 1,293,313 Total assets $ 5,534,912 $ 7,250,427 $ 308,204 $ 13,093,543 2020 Acute Care Hospital Services Behavioral Health Services (a.) Other Total Consolidated (Dollar amounts in thousands) Gross inpatient revenues $ 30,562,093 $ 9,718,934 $ — $ 40,281,027 Gross outpatient revenues $ 16,272,520 $ 963,799 $ — $ 17,236,319 Total net revenues $ 6,337,304 $ 5,208,722 $ 12,871 $ 11,558,897 Income (loss) before allocation of corporate overhead and income taxes $ 693,427 $ 1,023,257 $ (464,601 ) $ 1,252,083 Allocation of corporate overhead $ (223,921 ) $ (170,849 ) $ 394,770 $ 0 Income (loss) after allocation of corporate overhead and before income taxes $ 469,506 $ 852,408 $ (69,831 ) $ 1,252,083 Total assets $ 4,927,456 $ 7,044,617 $ 1,504,806 $ 13,476,879 2019 Acute Care Hospital Services Behavioral Health Services (a.) Other Total Consolidated (Dollar amounts in thousands) Gross inpatient revenues $ 28,430,922 $ 10,100,903 $ — $ 38,531,825 Gross outpatient revenues $ 17,666,629 $ 1,066,704 $ — $ 18,733,333 Total net revenues $ 6,164,560 $ 5,210,063 $ 3,636 $ 11,378,259 Income (loss) before allocation of corporate overhead and income taxes $ 713,410 $ 900,965 $ (548,038 ) $ 1,066,337 Allocation of corporate overhead $ (230,166 ) $ (166,571 ) $ 396,737 $ 0 Income (loss) after allocation of corporate overhead and before income taxes $ 483,244 $ 734,394 $ (151,301 ) $ 1,066,337 Total assets $ 4,405,643 $ 6,910,790 $ 351,817 $ 11,668,250 (a.) Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $688 million in 2021, $584 million in 2020 and $554 million in 2019. Total assets at our U.K. behavioral health care facilities were approximately $1.351 billion as of December 31, 2021, $1.334 billion as of December 31, 2020 and $1.270 billion as of December 31, 2019. In addition, included in our 2019 Behavioral Health Services operating segment Income (loss) before allocation of corporate overhead and income taxes is a pre-tax $98 million provision for asset impairment to reduce the carrying value of a tradename intangible asset and real property assets. |
Business and Summary of Signi_4
Business and Summary of Significant Accounting Policies - Additional Information (Detail) shares in Millions | Oct. 01, 2021USD ($) | Dec. 31, 2013 | Dec. 31, 2021USD ($)HospitalFacilityshares | Dec. 31, 2020USD ($)Hospitalshares | Dec. 31, 2019USD ($)Hospitalshares |
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Effect of change on after-tax net income | $ 987,632,000 | $ 952,790,000 | $ 827,543,000 | ||
Number of hospital facilities | Hospital | 5 | ||||
Capitalized interest | $ 4,400,000 | 4,300,000 | 3,400,000 | ||
Depreciation expense | 501,600,000 | 478,800,000 | 455,600,000 | ||
Impairment of goodwill or indefinite-lived intangible assets | $ 0 | 0 | 0 | ||
Impairment of other and intangible assets | 0 | ||||
Provision for asset impairment | $ 14,391,000 | 0 | $ 97,631,000 | ||
Behavioral health care facilities with outside owners holding non-controlling minority interest | Facility | 5 | ||||
Redeemable non-controlling interest balances | $ 5,000,000 | ||||
Non-controlling interest balances | 103,000,000 | ||||
Cash flow hedges | $ 0 | $ 0 | |||
Anti-dilutive weighted average stock options excluded from computation of earnings per share | shares | 4.2 | 6.4 | 5.5 | ||
Revenues | $ 12,642,117,000 | $ 11,558,897,000 | $ 11,378,259,000 | ||
Additional funds received from government by CARES Act | 189,000,000 | ||||
CARES Act and other Governmental grants and Medicare accelerated payments received | 1,112,000,000 | ||||
Revenues from grants | 413,000,000 | ||||
Deferred revenues from grants | 4,000,000 | ||||
MAAPP funds included in current liabilities | 6,000 | 376,151,000 | |||
MAAPP funds included in noncurrent liabilities | 0 | 322,617,000 | |||
Medicare Accelerated and Advance Payment Program | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Medicare accelerated payments received | 695,000,000 | 695,000,000 | |||
MAAPP funds included in current liabilities | 372,000,000 | ||||
MAAPP funds included in noncurrent liabilities | 323,000,000 | ||||
Public Health and Social Services Emergency Fund | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Governmental grants received by CARES Act | 417,000,000 | ||||
Foundations | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Provision for asset impairment | 98,000,000 | ||||
Impairment provision for tradename intangible asset | 75,000,000 | ||||
Impairment charges for real property assets | $ 23,000,000 | ||||
Other (Income) Expense, Net | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Provision for asset impairment | 14,000,000 | ||||
Commercial Insurance Subsidiary | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Statutorily required capital reserves | $ 82,000,000 | $ 73,000,000 | |||
Universal Health Realty Income Trust | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Number of hospital facilities | Hospital | 3 | 3 | 3 | ||
Investments | $ 9,000,000 | $ 5,000,000 | |||
Premier, Inc. | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Investments | 92,000,000 | 78,000,000 | |||
Premier, Inc. | Group Purchasing Organization Agreement | Restricted Stock | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Shares vesting period | 7 years | ||||
Shares vesting period start year | 2014 | ||||
Shares vesting period end year | 2020 | ||||
Market value of retained vested shares | 92,000,000 | 78,000,000 | |||
Acute Care Hospital Services | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Revenues | $ 7,108,254,000 | 6,337,304,000 | $ 6,164,560,000 | ||
Acute Care Hospital Services | Las Vegas, Nevada | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Number of hospital facilities | Hospital | 6 | ||||
Acute Care Facility | Washington, District of Columbia | Outside Owners | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of non-controlling, minority ownership interests held by outside owners | 20.00% | ||||
Acute Care Facility | Texas | Outside Owners | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of non-controlling, minority ownership interests held by outside owners | 9.00% | ||||
Acute Care Facility | Nevada | Outside Owners | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of non-controlling, minority ownership interests held by outside owners | 5.00% | ||||
Behavioral Health Care Facility | Pennsylvania | Outside Owners | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of non-controlling, minority ownership interests held by outside owners | 20.00% | ||||
Behavioral Health Care Facility | Ohio | Outside Owners | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of non-controlling, minority ownership interests held by outside owners | 30.00% | ||||
Behavioral Health Care Facility | Washington | Outside Owners | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of non-controlling, minority ownership interests held by outside owners | 20.00% | ||||
Behavioral Health Care Facility | Missouri | Outside Owners | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of non-controlling, minority ownership interests held by outside owners | 25.00% | ||||
Behavioral Health Care Facility | Lowa | Outside Owners | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of non-controlling, minority ownership interests held by outside owners | 48.00% | ||||
State Medicaid programs | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Revenue offset amount | $ 211,000,000 | 185,000,000 | 194,000,000 | ||
Net aggregate benefit | 430,000,000 | 303,000,000 | 225,000,000 | ||
Net revenues | $ 74,000,000 | $ 73,000,000 | $ 78,000,000 | ||
Net Revenue | Las Vegas, Nevada | Geographic Concentration Risk | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of revenue | 16.00% | 15.00% | 16.00% | ||
Minimum | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Patients treated at hospitals for non elective services gross income federal poverty guidelines | 200.00% | ||||
Minimum | Building and Building Improvements | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Property and equipment, useful lives | 20 years | ||||
Minimum | Equipment | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Property and equipment, useful lives | 3 years | ||||
Maximum | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Patients treated at hospitals for non elective services gross income federal poverty guidelines | 400.00% | ||||
Maximum | Building and Building Improvements | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Property and equipment, useful lives | 40 years | ||||
Maximum | Equipment | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Property and equipment, useful lives | 15 years | ||||
Medicare | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Revenues | $ 1,654,119,000 | $ 1,690,591,000 | $ 1,889,245,000 | ||
Medicare | Acute Care Hospital Services | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Revenues | 1,292,205,000 | 1,242,268,000 | 1,336,200,000 | ||
Health Care | State Medicaid programs | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Revenues | 641,000,000 | $ 488,000,000 | $ 419,000,000 | ||
ASU 2014-09 | Revision of Prior Period Change in Accounting Principle Adjustment | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Effect of change on after-tax net income | $ 1,000,000 | ||||
ASU 2014-09 | Medicare | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Percentage of estimated net revenue adjustment | 1.00% | 1.00% | 1.00% | ||
ASU 2016-01 | Premier, Inc. | Other (Income) Expense, Net | |||||
Summary Of Business And Significant Accounting Policies [Line Items] | |||||
Payments of cash dividends | $ 1,700,000 | $ 848,000 |
Uncompensated Care (Detail)
Uncompensated Care (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Health Care Trust Funds [Line Items] | |||
Total uncompensated care | $ 1,998,284 | $ 2,201,138 | $ 2,184,064 |
Uncompensated care, percentage | 100.00% | 100.00% | 100.00% |
Charity Care | |||
Health Care Trust Funds [Line Items] | |||
Total uncompensated care | $ 661,965 | $ 622,668 | $ 672,326 |
Uncompensated care, percentage | 33.00% | 28.00% | 31.00% |
Uninsured Discounts | |||
Health Care Trust Funds [Line Items] | |||
Total uncompensated care | $ 1,336,319 | $ 1,578,470 | $ 1,511,738 |
Uncompensated care, percentage | 67.00% | 72.00% | 69.00% |
Estimated Cost of Providing Unc
Estimated Cost of Providing Uncompensated Care (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Health Care Trust Funds [Line Items] | |||
Estimated cost of providing uncompensated care | $ 217,633 | $ 260,494 | $ 253,014 |
Charity Care | |||
Health Care Trust Funds [Line Items] | |||
Estimated cost of providing uncompensated care | 72,095 | 73,690 | 77,886 |
Uninsured Discounts | |||
Health Care Trust Funds [Line Items] | |||
Estimated cost of providing uncompensated care | $ 145,538 | $ 186,804 | $ 175,128 |
Summary of Cash, Cash Equivalen
Summary of Cash, Cash Equivalents and Restricted Cash Reported In Consolidated Statements of Cash Flows (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Cash And Cash Equivalents Period Increase Decrease [Abstract] | ||||
Cash and cash equivalents | $ 115,301 | $ 1,224,490 | $ 61,268 | |
Restricted cash | [1] | $ 63,633 | $ 54,664 | $ 44,399 |
Restricted Cash and Cash Equivalents, Noncurrent, Asset, Statement of Financial Position [Extensible List] | Other Assets | Other Assets | Other Assets | |
Total cash, cash equivalents and restricted cash | $ 178,934 | $ 1,279,154 | $ 105,667 | |
[1] | (a)Restricted cash is included in other assets on the accompanying consolidated balance sheet and consists of statutorily required capital reserves related to our commercial insurance subsidiary |
Summary of Changes in Carrying
Summary of Changes in Carrying Amount of Goodwill (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2021 | Dec. 31, 2020 | |||
Goodwill [Line Items] | ||||
Goodwill, Beginning Balance | $ 3,882,715 | $ 3,869,760 | ||
Goodwill acquired during the period | 55,406 | 127 | ||
Goodwill divested during the period | 0 | 0 | ||
Adjustments to goodwill | 24,503 | [1] | 12,828 | [2] |
Goodwill, Ending Balance | 3,962,624 | 3,882,715 | ||
Acute Care Services | ||||
Goodwill [Line Items] | ||||
Goodwill, Beginning Balance | 447,021 | 448,415 | ||
Goodwill acquired during the period | 55,406 | 127 | ||
Goodwill divested during the period | 0 | 0 | ||
Adjustments to goodwill | 13,509 | [1] | (1,521) | [2] |
Goodwill, Ending Balance | 515,936 | 447,021 | ||
Behavioral Health Services | ||||
Goodwill [Line Items] | ||||
Goodwill, Beginning Balance | 3,435,694 | 3,421,345 | ||
Goodwill acquired during the period | 0 | 0 | ||
Goodwill divested during the period | 0 | 0 | ||
Adjustments to goodwill | 10,994 | [1] | 14,349 | [2] |
Goodwill, Ending Balance | $ 3,446,688 | $ 3,435,694 | ||
[1] | Adjustments to goodwill during 2021 consist of the following: $13.5 million in Acute Care Services consists primarily of a measurement period adjustment to the preliminary purchase price allocation related to a 2020 acquisition; and the $11.0 million in Behavioral Health Services consists of $16.3 million recorded in connection with a third party minority ownership interest in a majority owned joint venture that constructed and owns a recently opened behavioral health facility, partially offset by a $5.3 million decrease related to foreign currency translation adjustments. | |||
[2] | The changes in the Behavioral Health Services’ goodwill consists primarily of foreign currency translation adjustments. |
Summary of Changes in Carryin_2
Summary of Changes in Carrying Amount of Goodwill (Parenthetical) (Detail) $ in Millions | 12 Months Ended |
Dec. 31, 2021USD ($) | |
Acute Care Services | 2020 Acquisition | |
Goodwill [Line Items] | |
Adjustments to goodwill | $ 13.5 |
Behavioral Health Services | |
Goodwill [Line Items] | |
Adjustments to goodwill | 11 |
Behavioral Health Services | Foreign Currency Translation Adjustments | |
Goodwill [Line Items] | |
Adjustments to goodwill | (5.3) |
Behavioral Health Services | Third Party Minority Ownership Interest | |
Goodwill [Line Items] | |
Adjustments to goodwill | $ 16.3 |
Summary of Net Intangible Asset
Summary of Net Intangible Assets (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Finite Lived Intangible Assets [Line Items] | ||
Net Intangible Assets | $ 81,041 | $ 82,586 |
Medicare Licenses | ||
Finite Lived Intangible Assets [Line Items] | ||
Net Intangible Assets | 57,226 | 57,226 |
Certificates of Need | ||
Finite Lived Intangible Assets [Line Items] | ||
Net Intangible Assets | 8,239 | 8,253 |
Contract Relationships and Other | ||
Finite Lived Intangible Assets [Line Items] | ||
Net Intangible Assets | $ 15,576 | $ 17,107 |
Summary of Net Intangible Ass_2
Summary of Net Intangible Assets (Parenthetical) (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Goodwill And Intangible Assets Disclosure [Abstract] | ||
Intangible assets, net of accumulated amortization | $ 54,134 | $ 52,804 |
Amounts Recognized in AOCI (Det
Amounts Recognized in AOCI (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Accumulated Other Comprehensive Income Loss [Line Items] | |||
Beginning balance, net of income tax | $ 6,317,146 | ||
Other comprehensive income (loss), Pretax amount | (19,316) | $ 18,047 | $ 32,464 |
Other comprehensive income (loss), Income tax effect | 1,487 | (1,820) | (4,813) |
Total other comprehensive income (loss), net of tax | (17,829) | 16,227 | 27,651 |
Ending balance, net of income tax | 6,089,664 | 6,317,146 | |
Net Unrealized Gains (Losses) on Effective Cash Flow Hedges | |||
Accumulated Other Comprehensive Income Loss [Line Items] | |||
Beginning balance, net of income tax | (17) | (17) | |
Other comprehensive income (loss), Pretax amount | 0 | 0 | |
Other comprehensive income (loss), Income tax effect | 0 | 0 | |
Total other comprehensive income (loss), net of tax | 0 | 0 | |
Ending balance, net of income tax | (17) | (17) | (17) |
Foreign Currency Translation Adjustment | |||
Accumulated Other Comprehensive Income Loss [Line Items] | |||
Beginning balance, net of income tax | 52,438 | 39,568 | |
Other comprehensive income (loss), Pretax amount | (20,743) | 13,619 | |
Other comprehensive income (loss), Income tax effect | 1,829 | (749) | |
Total other comprehensive income (loss), net of tax | (18,914) | 12,870 | |
Ending balance, net of income tax | 33,524 | 52,438 | 39,568 |
Minimum Pension Liability | |||
Accumulated Other Comprehensive Income Loss [Line Items] | |||
Beginning balance, net of income tax | (4,301) | (7,658) | |
Other comprehensive income (loss), Pretax amount | 1,427 | 4,428 | |
Other comprehensive income (loss), Income tax effect | (342) | (1,071) | |
Total other comprehensive income (loss), net of tax | 1,085 | 3,357 | |
Ending balance, net of income tax | (3,216) | (4,301) | (7,658) |
Accumulated Other Comprehensive Income (Loss) | |||
Accumulated Other Comprehensive Income Loss [Line Items] | |||
Beginning balance, net of income tax | 48,120 | 31,893 | |
Ending balance, net of income tax | $ 30,291 | $ 48,120 | $ 31,893 |
Computation of Basic and Dilute
Computation of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Basic and diluted: | |||
Net Income | $ 987,632 | $ 952,790 | $ 827,543 |
Less: Net (income) loss attributable to noncontrolling interest | 3,958 | (8,837) | (12,689) |
Less: Net income attributable to unvested restricted share grants | (2,059) | (2,981) | (2,028) |
Net income attributable to UHS—basic and diluted | $ 989,531 | $ 940,972 | $ 812,826 |
Basic earnings per share attributable to UHS: | |||
Weighted average number of common shares—basic | 82,519 | 85,061 | 88,762 |
Total basic earnings per share | $ 11.99 | $ 11.06 | $ 9.16 |
Diluted earnings per share attributable to UHS: | |||
Weighted average number of common shares—basic | 82,519 | 85,061 | 88,762 |
Net effect of dilutive stock options and grants based on the treasury stock method | 1,173 | 526 | 278 |
Weighted average number of common shares and equivalents—diluted | 83,692 | 85,587 | 89,040 |
Total diluted earnings per share | $ 11.82 | $ 10.99 | $ 9.13 |
Acquisitions and Divestitures -
Acquisitions and Divestitures - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Business Acquisition [Line Items] | |||
Aggregate cash proceeds from divestiture of businesses | $ 25 | ||
2020 Divestiture of Assets and Businesses | |||
Business Acquisition [Line Items] | |||
Aggregate cash proceeds from divestiture of businesses | $ 8 | ||
2019 Divestiture of Assets | |||
Business Acquisition [Line Items] | |||
Aggregate cash proceeds from divestiture of businesses | $ 9 | ||
2019 Acquisitions of Assets and Businesses | |||
Business Acquisition [Line Items] | |||
Acquisition, cash paid | $ 8 | ||
Nevada | |||
Business Acquisition [Line Items] | |||
Acquisition, cash paid | $ 105 | ||
Nevada | 2020 Acquisitions of Assets and Businesses | |||
Business Acquisition [Line Items] | |||
Acquisition, cash paid | $ 52 |
Financial Instruments and Fai_3
Financial Instruments and Fair Value Measurement - Additional Information (Detail) | 12 Months Ended | ||
Dec. 31, 2021USD ($) | Dec. 31, 2020USD ($) | Dec. 31, 2019USD ($)Derivative | |
Financial Instruments And Fair Value Measurement [Line Items] | |||
Cash flow hedges | $ 0 | $ 0 | |
Cash and cash equivalents | 577,000,000 | ||
Other cash accounts | $ 581,000,000 | ||
Minimum | |||
Financial Instruments And Fair Value Measurement [Line Items] | |||
Other cash accounts, variable interest rates | 0.20% | ||
Maximum | |||
Financial Instruments And Fair Value Measurement [Line Items] | |||
Other cash accounts, variable interest rates | 0.25% | ||
One Point Three One Percent Forward Starting Interest Rate Swaps | |||
Financial Instruments And Fair Value Measurement [Line Items] | |||
Number of interest rate swaps outstanding | Derivative | 9 | ||
Maturity date of interest rate cash flow hedges | Apr. 15, 2019 | ||
Fixed rate payable on interest rate swap | 1.31% | ||
Foreign Currency Forward Exchange Contracts | |||
Financial Instruments And Fair Value Measurement [Line Items] | |||
Net cash (outflows) inflows | $ 1,000,000 | $ (22,000,000) | $ 20,000,000 |
Cash Flow Hedging | One Point Three One Percent Forward Starting Interest Rate Swaps | |||
Financial Instruments And Fair Value Measurement [Line Items] | |||
Notional amount of interest rate cash flow hedges | $ 1,000,000,000 |
Summary of Effects of Interest
Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | ||
Derivative Instruments Gain Loss [Line Items] | ||||
Gain/(Loss) recognized in AOCI | $ 0 | $ 0 | $ (3,925) | |
Designated As Hedging Instrument | Cash Flow Hedging | Interest Rate Swap | ||||
Derivative Instruments Gain Loss [Line Items] | ||||
Gain/(Loss) recognized in AOCI | [1] | 0 | 0 | (3,925) |
Designated As Hedging Instrument | Net Investment Hedge | Foreign Currency Foreign Exchange Contracts | ||||
Derivative Instruments Gain Loss [Line Items] | ||||
Gain/(Loss) recognized in AOCI | $ (7,272) | $ (22,097) | $ (18,328) | |
[1] | The amount of |
Summary of Effects of Interes_2
Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations (Parenthetical) (Detail) $ in Millions | 12 Months Ended |
Dec. 31, 2019USD ($) | |
Designated As Hedging Instrument | Interest Expense, Net | Cash Flow Hedging | Interest Rate Swap | |
Derivative Instruments Gain Loss [Line Items] | |
Gain reclassified out of AOCI into interest expenses | $ 3.4 |
Summary of Assets and Liabiliti
Summary of Assets and Liabilities Recorded at Fair Value on Recurring Basis (Detail) - Recurring - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Assets: | ||
Assets, fair value | $ 221,235 | $ 780,793 |
Liabilities: | ||
Liabilities, fair value | 45,759 | 42,044 |
Term Deposit | Cash and Cash Equivalents | ||
Assets: | ||
Assets, fair value | 540,000 | |
Money Market Mutual Funds | Cash and Cash Equivalents | ||
Assets: | ||
Assets, fair value | 37,100 | |
Money Market Mutual Funds | Other Assets | ||
Assets: | ||
Assets, fair value | 79,900 | 70,995 |
Certificates of Deposit | Other Assets | ||
Assets: | ||
Assets, fair value | 2,300 | 2,300 |
Equity Securities | Other Assets | ||
Assets: | ||
Assets, fair value | 91,919 | 78,367 |
Deferred Compensation Assets | Other Assets | ||
Assets: | ||
Assets, fair value | 45,759 | 42,044 |
Foreign Currency Foreign Exchange Contracts | Other Current Assets | ||
Assets: | ||
Assets, fair value | 1,357 | 9,987 |
Deferred Compensation Liability | Other Noncurrent Liabilities | ||
Liabilities: | ||
Liabilities, fair value | 45,759 | 42,044 |
Basis of Fair Value Measurement, Level 1 | ||
Assets: | ||
Assets, fair value | 217,578 | 228,506 |
Liabilities: | ||
Liabilities, fair value | 45,759 | 42,044 |
Basis of Fair Value Measurement, Level 1 | Money Market Mutual Funds | Cash and Cash Equivalents | ||
Assets: | ||
Assets, fair value | 37,100 | |
Basis of Fair Value Measurement, Level 1 | Money Market Mutual Funds | Other Assets | ||
Assets: | ||
Assets, fair value | 79,900 | 70,995 |
Basis of Fair Value Measurement, Level 1 | Equity Securities | Other Assets | ||
Assets: | ||
Assets, fair value | 91,919 | 78,367 |
Basis of Fair Value Measurement, Level 1 | Deferred Compensation Assets | Other Assets | ||
Assets: | ||
Assets, fair value | 45,759 | 42,044 |
Basis of Fair Value Measurement, Level 1 | Deferred Compensation Liability | Other Noncurrent Liabilities | ||
Liabilities: | ||
Liabilities, fair value | 45,759 | 42,044 |
Basis of Fair Value Measurement, Level 2 | ||
Assets: | ||
Assets, fair value | 3,657 | 552,287 |
Basis of Fair Value Measurement, Level 2 | Term Deposit | Cash and Cash Equivalents | ||
Assets: | ||
Assets, fair value | 540,000 | |
Basis of Fair Value Measurement, Level 2 | Certificates of Deposit | Other Assets | ||
Assets: | ||
Assets, fair value | 2,300 | 2,300 |
Basis of Fair Value Measurement, Level 2 | Foreign Currency Foreign Exchange Contracts | Other Current Assets | ||
Assets: | ||
Assets, fair value | $ 1,357 | $ 9,987 |
Summary of Long-Term Debt (Deta
Summary of Long-Term Debt (Detail) - USD ($) | Dec. 31, 2021 | Dec. 31, 2020 |
Debt Instrument [Line Items] | ||
Accounts receivable securitization program | $ 0 | |
Total debt before unamortized financing costs | 4,212,967,000 | $ 3,874,444,000 |
Less-Unamortized financing costs | (22,679,000) | (18,193,000) |
Total debt after unamortized financing costs | 4,190,288,000 | 3,856,251,000 |
Less-Amounts due within one year | (48,409,000) | (331,998,000) |
Long-term debt | 4,141,879,000 | 3,524,253,000 |
Tranche A Term Loan | ||
Debt Instrument [Line Items] | ||
Line of credit facility amount outstanding | 1,689,375,000 | 1,900,000,000 |
Revolving Credit Facility | ||
Debt Instrument [Line Items] | ||
Line of credit facility amount outstanding | 342,600,000 | |
Term Loan B | ||
Debt Instrument [Line Items] | ||
Line of credit facility amount outstanding | 490,000,000 | |
1.65% Senior Secured Notes due 2026 | ||
Debt Instrument [Line Items] | ||
Senior Notes | 699,187,000 | |
Accounts Receivable Securitization Program | ||
Debt Instrument [Line Items] | ||
Accounts receivable securitization program | 225,000,000 | |
2.65% Senior Secured Notes due 2032 | ||
Debt Instrument [Line Items] | ||
Senior Notes | 498,746,000 | |
5.00% Senior Secured Notes due 2026 | ||
Debt Instrument [Line Items] | ||
Senior Notes | 400,000,000 | |
2.65% Senior Secured Notes due 2030 | ||
Debt Instrument [Line Items] | ||
Senior Notes | 798,032,000 | 797,806,000 |
Notes And Mortgages Payable | ||
Debt Instrument [Line Items] | ||
Notes and Mortgages payable (including obligations under finance leases of $79,331 in 2021 and $52,905 in 2020) and term loans with varying maturities through 2099; weighted average interest rates of 5.6% in 2021 and 6.8% in 2020 (see Note 7 regarding finance leases) | $ 185,027,000 | $ 61,638,000 |
Summary of Long-Term Debt (Pare
Summary of Long-Term Debt (Parenthetical) (Detail) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2021 | Dec. 31, 2020 | |
Debt Instrument [Line Items] | ||
Obligations under finance leases | $ 79,331 | $ 52,905 |
2.65% Senior Secured Notes due 2030 | ||
Debt Instrument [Line Items] | ||
Debt instruments, maturity date | 2030 | 2030 |
Senior notes, interest rate | 2.65% | 2.65% |
Unamortized discount | $ 1,968 | $ 2,193 |
1.65% Senior Secured Notes due 2026 | ||
Debt Instrument [Line Items] | ||
Debt instruments, maturity date | 2026 | |
Senior notes, interest rate | 1.65% | |
Unamortized discount | $ 813 | |
2.65% Senior Secured Notes due 2032 | ||
Debt Instrument [Line Items] | ||
Debt instruments, maturity date | 2032 | |
Senior notes, interest rate | 2.65% | |
Unamortized discount | $ 1,254 | |
5.00% Senior Secured Notes due 2026 | ||
Debt Instrument [Line Items] | ||
Debt instruments, maturity date | 2026 | |
Senior notes, interest rate | 5.00% | |
Notes And Mortgages Payable | ||
Debt Instrument [Line Items] | ||
Obligations under finance leases | $ 79,331 | $ 52,905 |
Weighted average interest | 5.60% | 6.80% |
Term Loans With Varying Maturities | ||
Debt Instrument [Line Items] | ||
Debt instruments, maturity date | 2099 |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Detail) - USD ($) | Sep. 13, 2021 | Aug. 24, 2021 | Sep. 28, 2020 | Oct. 23, 2018 | Dec. 31, 2021 | Apr. 30, 2021 | Mar. 31, 2021 | Dec. 31, 2020 | Sep. 21, 2020 |
Debt Instrument [Line Items] | |||||||||
Line of credit facility, starting date | Aug. 24, 2021 | ||||||||
Rate adjustment to weighted average federal funds rate for credit facility borrowings | 0.50% | ||||||||
Rate adjustment to one month Eurodollar rate on credit facility borrowings | 1.00% | ||||||||
Accounts receivable securitization program credit facility, borrowing capacity | $ 450,000,000 | ||||||||
Accounts receivable securitization program credit facility, available borrowing capacity | $ 20,000,000 | ||||||||
Accounts receivable securitization program credit facility, amount outstanding | $ 0 | ||||||||
Initial lease terms of property | 12 years | ||||||||
Financial liability | $ 82,000 | ||||||||
Debt instrument carrying amount | 4,190,288,000 | $ 3,856,251,000 | |||||||
Fair value of debt | $ 4,200,000,000 | $ 3,900,000,000 | |||||||
1.65% Senior Secured Notes due 2026 | |||||||||
Debt Instrument [Line Items] | |||||||||
Senior notes, interest rate | 1.65% | ||||||||
2.65% Senior Secured Notes due 2032 | |||||||||
Debt Instrument [Line Items] | |||||||||
Senior notes, interest rate | 2.65% | ||||||||
5.00% Senior Secured Notes due 2026 | |||||||||
Debt Instrument [Line Items] | |||||||||
Senior notes, interest rate | 5.00% | ||||||||
Revolving Credit Facility | |||||||||
Debt Instrument [Line Items] | |||||||||
Line of credit facility, borrowing capacity | $ 1,200,000,000 | $ 1,000,000,000 | |||||||
Line of credit facility, maturity date | Aug. 24, 2026 | ||||||||
Line of credit facility increased (decreased) amount | $ 200,000,000 | ||||||||
Line of credit facility amount outstanding | $ 342,600,000 | ||||||||
Line of credit facility, available borrowing capacity | $ 854,000,000 | ||||||||
Revolving Credit Facility | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Current applicable margins | 1.25% | ||||||||
Revolving Credit Facility | ABR-based loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Current applicable margins | 0.25% | ||||||||
Revolving Credit Facility | Minimum | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Consolidated Leverage Ratio | 0.25% | ||||||||
Revolving Credit Facility | Minimum | One Three Six Month LIBOR Rate Plus Index Based Loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Consolidated Leverage Ratio | 1.25% | ||||||||
Revolving Credit Facility | Maximum | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Consolidated Leverage Ratio | 0.625% | ||||||||
Revolving Credit Facility | Maximum | One Three Six Month LIBOR Rate Plus Index Based Loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Consolidated Leverage Ratio | 1.625% | ||||||||
Revolving Credit Facility | Letter of Credit | |||||||||
Debt Instrument [Line Items] | |||||||||
Line of credit facility, borrowing capacity | $ 125,000,000 | ||||||||
Letters of credit, outstanding | 4,000,000 | ||||||||
Tranche A Term Loan | |||||||||
Debt Instrument [Line Items] | |||||||||
Line of credit facility, borrowing capacity | $ 1,850,000,000 | ||||||||
Line of credit facility, maturity date | Aug. 24, 2026 | ||||||||
Line of credit facility increased (decreased) amount | $ (150,000,000) | ||||||||
Line of credit facility amount outstanding | $ 1,689,375,000 | $ 1,900,000,000 | |||||||
Tranche A Term Loan | Quarterly Payment Beginning on December 31,2021 Through September 2023 | |||||||||
Debt Instrument [Line Items] | |||||||||
Scheduled principal payments per quarter | $ 10,625,000 | ||||||||
Debt instrument payment, description | beginning on December 31, 2021 through September 30, 2023 | ||||||||
Tranche A Term Loan | Quarterly Payment Beginning on December 31,2023 Through June 30, 2026 | |||||||||
Debt Instrument [Line Items] | |||||||||
Scheduled principal payments per quarter | $ 21,250,000 | ||||||||
Debt instrument payment, description | beginning on December 31, 2023 through June 30, 2026 | ||||||||
Tranche B Term Loan | |||||||||
Debt Instrument [Line Items] | |||||||||
Line of credit facility amount outstanding | $ 488,000,000 | ||||||||
Term Loan A | |||||||||
Debt Instrument [Line Items] | |||||||||
Current applicable margins | 1.25% | ||||||||
Term Loan A | ABR-based loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Current applicable margins | 0.25% | ||||||||
Term Loan A | Minimum | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Consolidated Leverage Ratio | 0.25% | ||||||||
Term Loan A | Minimum | One Three Six Month LIBOR Rate Plus Index Based Loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Consolidated Leverage Ratio | 1.25% | ||||||||
Term Loan A | Maximum | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Consolidated Leverage Ratio | 0.625% | ||||||||
Term Loan A | Maximum | One Three Six Month LIBOR Rate Plus Index Based Loans | |||||||||
Debt Instrument [Line Items] | |||||||||
Consolidated Leverage Ratio | 1.625% | ||||||||
New Senior Secured Notes | |||||||||
Debt Instrument [Line Items] | |||||||||
Senior notes, issued | $ 2,000,000,000 | ||||||||
New Senior Secured Notes | Maximum | |||||||||
Debt Instrument [Line Items] | |||||||||
Number of days to complete exchange offer | 60 days | ||||||||
New Senior Secured Notes | 1.65% Senior Secured Notes due 2026 | |||||||||
Debt Instrument [Line Items] | |||||||||
Line of credit facility, maturity date | Sep. 1, 2026 | ||||||||
Senior notes, issued | $ 700,000,000 | ||||||||
Senior notes, interest rate | 1.65% | ||||||||
New Senior Secured Notes | 2.65% Senior Secured Notes due 2032 | |||||||||
Debt Instrument [Line Items] | |||||||||
Line of credit facility, maturity date | Jan. 15, 2032 | ||||||||
Senior notes, issued | $ 500,000,000 | ||||||||
Senior notes, interest rate | 2.65% | ||||||||
New Senior Secured Notes | 5.00% Senior Secured Notes due 2026 | |||||||||
Debt Instrument [Line Items] | |||||||||
Senior notes, interest rate | 5.00% | 4.75% | |||||||
Senior notes, redeemed | $ 400,000,000 | $ 700,000,000 | |||||||
Redemption price, percentage | 102.50% | 100.00% | |||||||
Senior notes, redemption price | $ 410,000,000 | ||||||||
New Senior Secured Notes | 2.65% Senior Secured Notes due 2030 | |||||||||
Debt Instrument [Line Items] | |||||||||
Line of credit facility, maturity date | Oct. 15, 2030 | ||||||||
Senior notes, issued | $ 800,000,000 | ||||||||
Senior notes, interest rate | 2.65% | ||||||||
New Senior Secured Notes | 5.00% Senior Secured Notes due 2026 | |||||||||
Debt Instrument [Line Items] | |||||||||
Line of credit facility, maturity date | Sep. 1, 2026 |
Aggregate Scheduled Maturities
Aggregate Scheduled Maturities of Debt Outstanding (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Debt Disclosure [Abstract] | ||
2022 | $ 48,409 | |
2023 | 59,648 | |
2024 | 92,012 | |
2025 | 91,274 | |
2026 | 2,472,172 | |
Later | 1,449,452 | |
Total debt before unamortized financing costs | 4,212,967 | $ 3,874,444 |
Less-Unamortized financing costs | (22,679) | (18,193) |
Total debt after unamortized financing costs | $ 4,190,288 | $ 3,856,251 |
Common Stock - Additional Infor
Common Stock - Additional Information (Detail) - USD ($) | 3 Months Ended | 12 Months Ended | |||
Mar. 31, 2020 | Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | Jul. 31, 2021 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Dividends declared and paid, per share | $ 0.20 | $ 0.80 | $ 0.60 | ||
Stock repurchase programs authorized to purchase, value | $ 3,700,000,000 | $ 1,000,000,000 | |||
Stock repurchased, value | 1,220,875,000 | $ 206,719,000 | $ 753,927,000 | ||
Compensation cost recognized | $ 73,686,000 | 65,837,000 | 69,431,000 | ||
Restricted stock units granted | 2,401,402 | ||||
Weighted-average grant date fair value | $ 39.66 | ||||
Forfeitures utilization term | 5 years | ||||
Total in-the-money value of all stock options exercised during the year | $ 52,000,000 | $ 22,200,000 | 126,700,000 | ||
Weighted average grant-date fair value of restricted stock units | $ 28.93 | $ 22.74 | |||
ASU 2016-09 | Revision of Prior Period, Accounting Standards Update, Adjustment | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
New accounting adoption impact on income taxes and net income | $ 2,400,000 | $ 7,400,000 | 12,200,000 | ||
Stock Options | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Share-based compensation cost recognized, pre-tax charge | 59,300,000 | 54,700,000 | 60,100,000 | ||
Restricted Stock | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Share-based compensation cost recognized, after-tax | 14,400,000 | $ 11,200,000 | $ 9,300,000 | ||
Unrecognized compensation cost | $ 126,000,000 | ||||
Unrecognized compensation cost vesting period | 2 years 7 months 6 days | ||||
Unvested Stock option | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Unrecognized compensation cost | $ 126,000,000 | ||||
Unrecognized compensation cost vesting period | 2 years 7 months 6 days | ||||
Income Tax Withholding Obligations | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Stock repurchased, shares | 134,464 | 81,057 | 336,943 | ||
Stock repurchased, value | $ 19,500,000 | $ 10,200,000 | $ 47,700,000 | ||
Stock Repurchase Programs Twenty Twenty One | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Stock repurchase programs authorized to purchase, value | $ 1,000,000,000 | ||||
Stock repurchased, shares | 8,409,721 | ||||
Stock repurchased, value | $ 1,200,000,000 | ||||
Total number of shares cancelled | 15,761 | ||||
Stock Repurchase Programs Twenty Twenty | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Stock repurchased, shares | 1,951,899 | ||||
Stock repurchased, value | $ 196,600,000 | ||||
Total number of shares cancelled | 17,779 | ||||
Stock Repurchase Programs Twenty Nineteen | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Stock repurchase programs authorized to purchase, value | $ 1,000,000,000 | ||||
Stock repurchased, shares | 5,397,753 | ||||
Stock repurchased, value | $ 706,200,000 | ||||
Total number of shares cancelled | 27,713 | ||||
Stock Incentive Plan | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Weighted-average grant date fair value of option granted, number of shares | 2,400,000 | 2,100,000 | |||
Additional stock options granted | 0 | ||||
2020 Stock Incentive Plan | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Weighted-average grant date fair value of option granted, number of shares | 2,300,000 | 44,000 | |||
Total number of shares cancelled | 0 | ||||
2020 Stock Incentive Plan | Restricted Stock Units (RSUs) | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Restricted stock units granted | 138,114 | 3,000 | |||
Weighted average grant-date fair value of restricted stock units | $ 138.80 | $ 109.72 | |||
2010 Employees' Restricted Stock Purchase Plan | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Additional stock options granted | 0 | ||||
Number of shares issued | 0 | ||||
2010 Employees' Restricted Stock Purchase Plan | Restricted Stock | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Restricted stock units granted | 111,554 | 122,336 | |||
Weighted-average grant date fair value | $ 68.06 | $ 133.98 | |||
2010 Employees' Restricted Stock Purchase Plan | Restricted Stock | Maximum | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Shares vesting period | 5 years | 5 years | |||
Stock Incentive Plan | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Weighted-average grant date fair value | $ 39.66 | $ 14.60 | $ 30.40 | ||
Options are exercisable, in period | 4 years | ||||
Exercise price percentage | 10.00% | ||||
Employee Stock Purchase Plan Twenty Zero Five | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Restricted stock units granted | 96,179 | 115,008 | 82,449 | ||
Common Stock remain available for issuance | 400,000 | ||||
Stock issued during period, net of cancellations | 1,600,000 | ||||
Class B | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Stock repurchase programs authorized to purchase, value | $ 358,200,000 | ||||
Common Stock, shares issued | 69,834,320 | 77,805,530 | |||
Issuance upon conversion of shares | 20,034,442 | ||||
Class B | Stock Incentive Plan | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Shares reserved | 35,600,000 | ||||
Class B | 2020 Stock Incentive Plan | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Common Stock, shares issued | 6,100,000 | ||||
Common Stock remain available for issuance | 3,200,000 | ||||
Class B | 2010 Employees' Restricted Stock Purchase Plan | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Shares reserved | 600,000 | ||||
Class B | Employee Stock Purchase Plan Twenty Zero Five | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Shares reserved | 2,000,000 | ||||
Special Dividend | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Dividends declared and paid | $ 17,300,000 | $ 65,900,000 | $ 53,000,000 |
Schedule of Information Related
Schedule of Information Related to Stock Repurchase Programs (Detail) - USD ($) | 12 Months Ended | |||||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | Jul. 31, 2021 | Dec. 31, 2018 | ||
Class of Stock [Line Items] | ||||||
Additional dollars authorized for repurchase | $ 3,700,000,000 | $ 1,000,000,000 | ||||
Aggregate purchase price paid for shares purchased as part of publicly announced program | $ 1,220,875,000 | $ 206,719,000 | $ 753,927,000 | |||
Stock Repurchase Program | ||||||
Class of Stock [Line Items] | ||||||
Total number of shares purchased as part of publicly announced programs | 15,759,373 | |||||
Average price paid per share for shares purchased as part of publicly announced program | $ 133.51 | |||||
Aggregate purchase price paid for shares purchased as part of publicly announced program | $ 2,104,111,000 | |||||
Stock Repurchase Programs Twenty Eighteen | ||||||
Class of Stock [Line Items] | ||||||
Maximum number of dollars that may yet be purchased under the program | $ 462,344,000 | |||||
Stock Repurchase Programs Twenty Nineteen | ||||||
Class of Stock [Line Items] | ||||||
Additional dollars authorized for repurchase | $ 1,000,000,000 | |||||
Total number of shares purchased | [1] | 5,762,409 | ||||
Total number of shares cancelled | 27,713 | |||||
Average price paid per share for forfeited restricted shares | $ 0.01 | |||||
Total number of shares purchased as part of publicly announced programs | 5,397,753 | |||||
Aggregate purchase price paid | $ 753,928,000 | |||||
Aggregate purchase price paid for shares purchased as part of publicly announced program | 706,200,000 | |||||
Maximum number of dollars that may yet be purchased under the program | $ 756,123,000 | |||||
Stock Repurchase Programs Twenty Nineteen | Stock Repurchase Program | ||||||
Class of Stock [Line Items] | ||||||
Total number of shares purchased as part of publicly announced programs | 5,397,753 | |||||
Average price paid per share for shares purchased as part of publicly announced program | $ 130.84 | |||||
Aggregate purchase price paid for shares purchased as part of publicly announced program | $ 706,221,000 | |||||
Stock Repurchase Programs Twenty Twenty | ||||||
Class of Stock [Line Items] | ||||||
Total number of shares purchased | [1] | 2,050,735 | ||||
Total number of shares cancelled | 17,779 | |||||
Average price paid per share for forfeited restricted shares | $ 0.01 | |||||
Total number of shares purchased as part of publicly announced programs | 1,951,899 | |||||
Aggregate purchase price paid | $ 206,719,000 | |||||
Aggregate purchase price paid for shares purchased as part of publicly announced program | 196,600,000 | |||||
Maximum number of dollars that may yet be purchased under the program | $ 559,563,000 | |||||
Stock Repurchase Programs Twenty Twenty | Stock Repurchase Program | ||||||
Class of Stock [Line Items] | ||||||
Total number of shares purchased as part of publicly announced programs | 1,951,899 | |||||
Average price paid per share for shares purchased as part of publicly announced program | $ 100.70 | |||||
Aggregate purchase price paid for shares purchased as part of publicly announced program | $ 196,560,000 | |||||
Stock Repurchase Programs Twenty Twenty One | ||||||
Class of Stock [Line Items] | ||||||
Additional dollars authorized for repurchase | $ 1,000,000,000 | |||||
Total number of shares purchased | [1] | 8,559,946 | ||||
Total number of shares cancelled | 15,761 | |||||
Average price paid per share for forfeited restricted shares | $ 0.01 | |||||
Total number of shares purchased as part of publicly announced programs | 8,409,721 | |||||
Aggregate purchase price paid | $ 1,220,876,000 | |||||
Aggregate purchase price paid for shares purchased as part of publicly announced program | 1,200,000,000 | |||||
Maximum number of dollars that may yet be purchased under the program | $ 358,233,000 | |||||
Stock Repurchase Programs Twenty Twenty One | Stock Repurchase Program | ||||||
Class of Stock [Line Items] | ||||||
Total number of shares purchased as part of publicly announced programs | 8,409,721 | |||||
Average price paid per share for shares purchased as part of publicly announced program | $ 142.85 | |||||
Aggregate purchase price paid for shares purchased as part of publicly announced program | $ 1,201,330,000 | |||||
Stock Repurchase Programs Twenty Nineteen to Twenty Twenty One | ||||||
Class of Stock [Line Items] | ||||||
Additional dollars authorized for repurchase | $ 2,000,000,000 | |||||
Total number of shares purchased | [1] | 16,373,090 | ||||
Total number of shares cancelled | 61,253 | |||||
Average price paid per share for forfeited restricted shares | $ 0.01 | |||||
Aggregate purchase price paid | $ 2,181,523,000 | |||||
[1] | Includes 15,761, 17,779 and, 27,713 |
Schedule of Information Relat_2
Schedule of Information Related to Stock Repurchase Programs (Parenthetical) (Detail) - shares | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Class of Stock [Line Items] | |||
Restricted shares forfeited by former employee | 339,996 | ||
Restricted Stock Purchase Plan | |||
Class of Stock [Line Items] | |||
Restricted shares forfeited by former employee | 15,761 | 17,779 | 27,713 |
Assumptions Used in Black-Schol
Assumptions Used in Black-Scholes Model to Determine Fair Value for Stock Option Awards Granted (Detail) | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |||
Expected volatility | 31.00% | 28.00% | 27.00% |
Risk free Interest rate | 2.00% | 2.00% | 2.00% |
Expected life (years) | 3 years 6 months | 3 years 6 months | 3 years 4 months 24 days |
Forfeiture rate | 8.00% | 8.00% | 9.00% |
Dividend yield | 0.50% | 0.50% | 0.30% |
Summary of Option Activities (D
Summary of Option Activities (Detail) - $ / shares | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |||
Outstanding Options, Number of shares, beginning balance | 8,238,966 | ||
Granted, Number of Shares | 2,401,402 | ||
Exercised, Number of Shares | (1,737,286) | ||
Cancelled, Number of Shares | (346,967) | ||
Outstanding Options, Number of shares, ending balance | 8,556,115 | ||
Outstanding options vested and exercisable, Number of Shares | 2,997,296 | 2,522,906 | 2,551,267 |
Outstanding Options, Average Option Price, beginning balance | $ 109.47 | ||
Granted, Average Option Price | 141.08 | ||
Exercised, Average Option Price | 116.38 | ||
Cancelled, Average Option Price | 112.84 | ||
Outstanding Options, Average Option Price, ending balance | 116.80 | ||
Outstanding options vested and exercisable, Average Option Price | $ 119 | $ 124.62 | $ 119.86 |
Schedule of Information about U
Schedule of Information about Unvested Options (Detail) | 12 Months Ended |
Dec. 31, 2021$ / sharesshares | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
Unvested options, Shares, beginning balance | shares | 5,716,060 |
Granted, Shares | shares | 2,401,402 |
Vested, Shares | shares | (2,218,647) |
Cancelled, Shares | shares | (339,996) |
Unvested options, Shares, ending balance | shares | 5,558,819 |
Unvested options, Weighted Average Grant Date Fair Value, beginning balance | $ / shares | $ 22.74 |
Granted, Weighted Average Grant Date Fair Value | $ / shares | 39.66 |
Vested, Weighted Average Grant Date Fair Value | $ / shares | 24.61 |
Cancelled, Weighted Average Grant Date Fair Value | $ / shares | 28.70 |
Unvested options, Weighted Average Grant Date Fair Value, ending balance | $ / shares | $ 28.93 |
Schedule of Information about A
Schedule of Information about All Outstanding Options (Detail) - USD ($) | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |||
Number, Options Outstanding | 8,556,115 | 8,238,966 | 8,133,176 |
Weighted average exercise price, Options Outstanding | $ 116.80 | $ 109.47 | $ 124.52 |
Aggregate intrinsic value, Options Outstanding | $ 144,921,069 | ||
Weighted average remaining contractual life, Options Outstanding | 2 years 7 months 6 days | 2 years 10 months 24 days | 2 years 8 months 12 days |
Number, Options Exercisable | 2,997,296 | 2,522,906 | 2,551,267 |
Weighted Average Exercise Price, Options Exercisable | $ 119 | $ 124.62 | $ 119.86 |
Aggregate intrinsic value, Options Exercisable | $ 35,394,928 | ||
Weighted average remaining contractual life, Options Exercisable | 1 year 4 months 24 days |
Schedule of Weighted Average Re
Schedule of Weighted Average Remaining Contractual Life for Options Outstanding and Weighted Average Exercise Price Per Share for Exercisable Options (Detail) - $ / shares | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |||
Options Outstanding, Shares | 8,556,115 | 8,238,966 | 8,133,176 |
Options Outstanding, Weighted Average Exercise Price Per Share | $ 116.80 | $ 109.47 | $ 124.52 |
Options Outstanding, Weighted Average Remaining Contractual Life (in Years) | 2 years 7 months 6 days | 2 years 10 months 24 days | 2 years 8 months 12 days |
Number, Options Exercisable | 2,997,296 | 2,522,906 | 2,551,267 |
Weighted Average Exercise Price, Options Exercisable | $ 119 | $ 124.62 | $ 119.86 |
Expected to Vest Options , Shares | 5,005,113 | 5,099,823 | 5,073,423 |
Expected to Vest Options, Weighted Average Exercise Price Per Share | $ 116.94 | $ 110.47 | $ 126.62 |
Components of Income Tax Expens
Components of Income Tax Expense Benefit (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Income Tax Disclosure [Abstract] | |||
Current, Federal | $ 276,471 | $ 268,974 | $ 225,663 |
Current, Foreign | 13,754 | 13,978 | 9,284 |
Current, State | 44,993 | 43,333 | 40,152 |
Current, Total | 335,218 | 326,285 | 275,099 |
Deferred, Federal | (26,638) | (20,382) | (27,073) |
Deferred, Foreign | 1,521 | (2,496) | 1,874 |
Deferred, State | (4,420) | (4,114) | (11,106) |
Deferred, Total | (29,537) | (26,992) | (36,305) |
Provision for income taxes | $ 305,681 | $ 299,293 | $ 238,794 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) | 12 Months Ended | |||
Dec. 31, 2021USD ($) | Dec. 31, 2020USD ($) | Dec. 31, 2019USD ($) | Dec. 31, 2018Provision | |
Income Taxes [Line Items] | ||||
Number of anti-base erosion tax provisions | Provision | 2 | |||
Provisional deferred tax - GILTI | $ 0 | $ 0 | $ 0 | |
Foreign pre-tax earnings | 79,000,000 | 72,000,000 | 69,000,000 | |
Qualified dividend received deduction | 116,000,000 | |||
Tax expense (benefit) from employee share-based payments | $ (2,000,000) | $ 7,000,000 | $ (12,000,000) | |
Effective tax rates | 23.60% | 23.90% | 22.40% | |
Deferred federal state and foreign tax benefit | $ 6,000,000 | $ 11,000,000 | ||
Future taxable income, amount | 891,000,000 | |||
Deferred state tax benefit (net of the federal benefit) | (4,420,000) | (4,114,000) | $ (11,106,000) | |
Deferred foreign tax benefit | 13,000,000 | |||
Deferred federal tax benefits | 26,638,000 | 20,382,000 | 27,073,000 | |
State tax benefits | (44,993,000) | (43,333,000) | $ (40,152,000) | |
Valuation allowances | 62,356,000 | 68,003,000 | ||
Increase in estimated liabilities for uncertain tax positions | 1,000,000 | 1,000,000 | ||
Impact of unrecognized tax benefits if recognized | $ 2,000,000 | 2,000,000 | ||
Period of expiration of the statute of limitations for certain jurisdictions | within the next twelve months | |||
Jurisdictions statutes of limitations expiration period | 12 months | |||
Maximum | ||||
Income Taxes [Line Items] | ||||
Accrued interest and penalties | $ 1,000,000 | 1,000,000 | ||
Foreign and U.S. state and local jurisdictions have statutes of limitations, in years | 4 years | |||
Minimum | ||||
Income Taxes [Line Items] | ||||
Foreign and U.S. state and local jurisdictions have statutes of limitations, in years | 3 years | |||
Allowance in relation to state tax benefit | ||||
Income Taxes [Line Items] | ||||
Valuation allowances | $ 57,000,000 | 64,000,000 | ||
Net Operating Losses Not Realized | ||||
Income Taxes [Line Items] | ||||
Decrease in valuation allowance | 7,000,000 | |||
Foreign Net Operating Losses and Credit Carryforwards | ||||
Income Taxes [Line Items] | ||||
Decrease in valuation allowance | 5,000,000 | $ 4,000,000 | ||
State and Local Jurisdiction | ||||
Income Taxes [Line Items] | ||||
Deferred state tax benefit (net of the federal benefit) | 60,000,000 | |||
Interest expense carryforwards | 158,000,000 | |||
Interest expense, deferred tax benefit | 5,000,000 | |||
Foreign Tax Authority | ||||
Income Taxes [Line Items] | ||||
Net operating losses and interest expense | 51,000,000 | |||
Riverside Medical Clinic Patient Services, LLC | ||||
Income Taxes [Line Items] | ||||
Operating loss carry forward federal and state | 11,000,000 | |||
Operating loss carry forward state | 10,000,000 | |||
Deferred federal tax benefits | 2,000,000 | |||
State tax benefits | $ 1,000,000 |
Reconciliation between Federal
Reconciliation between Federal Statutory Rate and Effective Tax Rate (Detail) | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Income Tax Disclosure [Abstract] | |||
Federal statutory rate | 21.00% | 21.00% | 21.00% |
State taxes, net of federal income tax benefit | 2.50% | 2.50% | 2.20% |
Tax effects of foreign operations | (0.10%) | (0.30%) | (0.30%) |
Tax benefit from settlement of employee equity awards | (0.20%) | 0.50% | (1.00%) |
Other items | 0.30% | 0.40% | 0.80% |
Impact of income attributable to noncontrolling interests | 0.10% | (0.20%) | (0.30%) |
Effective tax rate | 23.60% | 23.90% | 22.40% |
Components of Deferred Taxes (D
Components of Deferred Taxes (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Income Tax Disclosure [Abstract] | ||
Self-insurance reserves | $ 97,024 | $ 75,648 |
Compensation accruals | 77,917 | 71,054 |
Doubtful accounts and other reserves | 127,876 | 94,295 |
Other currently non-deductible accrued liabilities | 31,240 | 61,634 |
Operating lease liabilities | 86,652 | 89,865 |
State and foreign net operating loss carryforwards and other state and foreign deferred tax assets | 79,499 | 81,036 |
Net pension liabilities – OCI only | 1,014 | 1,356 |
Deferred income tax assets, Gross | 501,222 | 474,888 |
Valuation Allowance | (62,356) | (68,003) |
Total deferred income taxes | 438,866 | 406,885 |
Depreciable and amortizable assets | 303,079 | 296,588 |
Right of use assets-operating leases | 86,269 | 89,493 |
Other liabilities | 3,811 | 3,697 |
Deferred income tax liabilities, Gross | $ 393,159 | $ 389,778 |
Reconciliation of Unrecognized
Reconciliation of Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Income Tax Disclosure [Abstract] | |||
Balance at January 1, | $ 2,806 | $ 2,164 | $ 1,553 |
Additions based on tax positions related to the current year | 500 | 500 | 500 |
Additions for tax positions of prior years | 213 | 142 | 113 |
Reductions for tax positions of prior years | (261) | 0 | 0 |
Settlements | (714) | 0 | (2) |
Balance at December 31, | $ 2,544 | $ 2,806 | $ 2,164 |
Lease Commitments - Additional
Lease Commitments - Additional Information (Detail) | 12 Months Ended | ||
Dec. 31, 2021USD ($)Hospital | Dec. 31, 2020USD ($) | Dec. 31, 2019USD ($) | |
Lessee Lease Description [Line Items] | |||
Lessee, operating lease, existence of option to extend [true false] | true | ||
Number of hospital facilities | Hospital | 5 | ||
Right-of-use assets obtained in exchange for operating lease obligations | $ 95,805,000 | $ 69,678,000 | $ 383,857,000 |
Finance lease obligations | $ 29,000,000 | $ 37,000,000 | 0 |
New Operating Leases | |||
Lessee Lease Description [Line Items] | |||
Right-of-use assets obtained in exchange for operating lease obligations | $ 29,300,000 | ||
Two Hospital Facilities | |||
Lessee Lease Description [Line Items] | |||
Lease expiration term | 2026 | ||
Third and Fourth Hospital Facilities | |||
Lessee Lease Description [Line Items] | |||
Lease expiration term | 2033 | ||
Fifth Hospital Facility | |||
Lessee Lease Description [Line Items] | |||
Lease expiration term | 2040 | ||
Minimum | |||
Lessee Lease Description [Line Items] | |||
Initial term of real estate lease | 5 years | ||
Real estate leases option to extend lease term | 5 years | ||
Maximum | |||
Lessee Lease Description [Line Items] | |||
Initial term of real estate lease | 10 years | ||
Real estate leases option to extend lease term | 10 years |
Components of Lease Expense (De
Components of Lease Expense (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | ||
Leases [Abstract] | ||||
Operating lease cost | $ 77,420 | $ 73,841 | $ 72,098 | |
Variable and short term lease cost | [1] | 41,443 | 42,218 | 35,711 |
Total lease and rental expense | 118,863 | 116,059 | 107,809 | |
Finance lease cost: | ||||
Amortization of property under capital lease | 3,626 | 1,985 | 1,877 | |
Interest on debt of property under capital lease | 4,124 | 1,763 | 1,876 | |
Total finance lease cost | $ 7,750 | $ 3,748 | $ 3,753 | |
[1] | Includes equipment, month-to-month and leases with a maturity of less than 12 months. |
Supplemental Cash Flow Informat
Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Cash paid for amounts included in the measurement of lease liabilities: | |||
Operating cash flows from operating leases | $ 118,433 | $ 115,270 | $ 107,239 |
Operating cash flows from finance leases | 4,612 | 1,885 | 2,078 |
Financing cash flows from finance leases | 2,849 | 2,586 | 1,959 |
Right-of-use assets obtained in exchange for lease obligations: | |||
Operating leases | 95,805 | 69,678 | $ 383,857 |
Finance leases | $ 28,600 | $ 37,029 |
Supplemental Balance Sheet Info
Supplemental Balance Sheet Information Related to Leases (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Operating Leases | ||
Right of use assets-operating leases | $ 367,477 | $ 336,513 |
Operating lease liabilities | 64,484 | 59,796 |
Operating lease liabilities noncurrent | 304,624 | 278,303 |
Total operating lease liabilities | 369,108 | 338,099 |
Finance Leases | ||
Accumulated depreciation | (4,896,427) | (4,512,764) |
Property, plant and equipment, net, Total | 5,874,275 | 5,373,124 |
Current maturities of long-term debt | $ 2,740 | $ 2,060 |
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] | us-gaap:DebtCurrent | us-gaap:DebtCurrent |
Long-term debt | $ 76,591 | $ 50,845 |
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration] | us-gaap:LongTermDebtAndCapitalLeaseObligations | us-gaap:LongTermDebtAndCapitalLeaseObligations |
Total finance lease liabilities | $ 79,331 | $ 52,905 |
Weighted Average remaining lease term, years | ||
Operating leases | 9 years 1 month 6 days | 10 years 10 months 24 days |
Finance leases | 20 years 9 months 18 days | 8 years 1 month 6 days |
Weighted Average discount rate | ||
Operating leases | 3.80% | 4.40% |
Finance leases | 7.10% | 9.70% |
Finance Lease | ||
Finance Leases | ||
Property and equipment | $ 102,940 | $ 75,611 |
Accumulated depreciation | (30,949) | (28,595) |
Property, plant and equipment, net, Total | $ 71,991 | $ 47,016 |
Future Maturities of Lease Liab
Future Maturities of Lease Liabilities (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Operating Leases | ||
2022 | $ 75,790 | |
2023 | 67,994 | |
2024 | 59,354 | |
2025 | 52,098 | |
2026 | 43,193 | |
Later years | 150,024 | |
Total lease payments | 448,453 | |
less imputed interest | (79,345) | |
Total | 369,108 | $ 338,099 |
Finance Leases | ||
2022 | 6,809 | |
2023 | 6,993 | |
2024 | 7,162 | |
2025 | 6,047 | |
2026 | 6,057 | |
Later years | 110,263 | |
Total lease payments | 143,331 | |
less imputed interest | (64,000) | |
Total | $ 79,331 | $ 52,905 |
Commitments and Contingencies -
Commitments and Contingencies - Additional Information (Detail) £ in Millions | 12 Months Ended | ||||||||||||||
Dec. 31, 2021USD ($) | Dec. 31, 2021GBP (£) | Dec. 31, 2020USD ($) | Dec. 31, 2015USD ($) | Dec. 31, 2014USD ($) | Dec. 31, 2013USD ($) | Dec. 31, 2012USD ($) | Dec. 31, 2011USD ($) | Dec. 31, 2022USD ($) | Dec. 31, 2021GBP (£) | Jun. 01, 2020USD ($) | Dec. 31, 2019USD ($) | Dec. 31, 2018USD ($) | Dec. 31, 2017USD ($) | Dec. 31, 2016USD ($) | |
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | $ 463,678,000 | $ 368,964,000 | $ 322,824,000 | $ 314,941,000 | |||||||||||
Self-insured for professional and general liability, current | 74,000,000 | 74,000,000 | |||||||||||||
Compensation liability claims | 115,000,000 | 105,000,000 | |||||||||||||
Compensation and related benefits | 55,000,000 | 55,000,000 | |||||||||||||
Impact of information technology incident on revenue | 45,000,000 | ||||||||||||||
Proceeds from commercial cyber insurance | 28,000,000 | ||||||||||||||
Revenues reserved | 17,000,000 | ||||||||||||||
Combined estimated future purchase obligations | 367,000,000 | ||||||||||||||
Defined benefit pension plan estimated payments through 2089 | 156,000,000 | ||||||||||||||
Other retirement plan liabilities | 23,000,000 | ||||||||||||||
Department of Human Services | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Repayment of legal settlement amount on demand | $ 4,000,000 | $ 4,000,000 | $ 4,000,000 | $ 4,000,000 | $ 4,000,000 | ||||||||||
Amount claimed from over payments of legal settlements | 7,000,000 | 8,000,000 | 7,000,000 | $ 4,000,000 | |||||||||||
Amount claimed from over payments of legal settlements due to change in calculations | 3,000,000 | 2,000,000 | $ 2,000,000 | ||||||||||||
Construction Commitment | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Combined estimated future purchase obligations | 21,000,000 | ||||||||||||||
Revenue Cycle Data Processing Services | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Combined estimated future purchase obligations | 63,000,000 | ||||||||||||||
Electronic Health Records And Revenue Cycle Application | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Combined estimated future purchase obligations | 208,000,000 | ||||||||||||||
Other Software Applications | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Combined estimated future purchase obligations | 21,000,000 | ||||||||||||||
Related to Certain Equipment | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Combined estimated future purchase obligations | 179,000,000 | ||||||||||||||
Commercial Health Insurer and Self-insured Employee Benefit Plans | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Combined estimated future purchase obligations | 114,000,000 | ||||||||||||||
Healthcare Infrastructure | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Combined estimated future purchase obligations | 75,000,000 | ||||||||||||||
Wind Storms | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Maximum insurance deductible | $ 2,500,000 | ||||||||||||||
Cygnet Health Care Limited | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Property insurance | £ | £ 1,500 | ||||||||||||||
Maximum | Wind Storms | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Commercial property insurance policies covering catastrophic losses | $ 1,000,000,000 | ||||||||||||||
Percentage of insurance deductible | 5.00% | 5.00% | |||||||||||||
Maximum | Earthquake | LAS VEGAS, NEVADA | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Commercial property insurance policies covering catastrophic losses | $ 200,000,000 | ||||||||||||||
Maximum | Earthquake | CALIFORNIA | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Commercial property insurance policies covering catastrophic losses | 150,000,000 | ||||||||||||||
Maximum | Earthquake | OTHER STATES | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Commercial property insurance policies covering catastrophic losses | 250,000,000 | ||||||||||||||
Maximum | Earthquake | Faulty Zones of UNITED STATES | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Commercial property insurance policies covering catastrophic losses | 100,000,000 | ||||||||||||||
Maximum | Earthquake | PUERTO RICO | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Commercial property insurance policies covering catastrophic losses | 40,000,000 | ||||||||||||||
Maximum | Flood | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Commercial property insurance policies covering catastrophic losses | 100,000,000 | ||||||||||||||
Maximum | Flood | Texas | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Commercial property insurance policies covering catastrophic losses | 10,000,000 | ||||||||||||||
Maximum | Flood | PUERTO RICO | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Commercial property insurance policies covering catastrophic losses | $ 1,000,000 | ||||||||||||||
Minimum | Wind Storms | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Percentage of insurance deductible | 3.00% | 3.00% | |||||||||||||
General And Professional Liability Insurance Policies | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | $ 52,000,000 | 25,000,000 | |||||||||||||
General and Professional Liability | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | 348,693,000 | 263,779,000 | 241,820,000 | 243,051,000 | |||||||||||
Workers’ Compensation Liability Insurance Policies | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | 20,000,000 | ||||||||||||||
Subsidiaries | Professional Liability | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Purchased several excess policies through commercial insurance carriers per occurrence | 2,500,000 | ||||||||||||||
Purchased several excess policies through commercial insurance carriers per occurrence excess claim amount | 10,000,000 | ||||||||||||||
Subsidiaries | Professional Liability | Cygnet Health Care Limited | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | £ | £ 16 | ||||||||||||||
Subsidiaries | Professional Liability | Maximum | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | 20,000,000 | 10,000,000 | 5,000,000 | 5,000,000 | $ 5,000,000 | $ 10,000,000 | |||||||||
Subsidiaries | Professional Liability | Maximum | Forecast | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | $ 20,000,000 | ||||||||||||||
Subsidiaries | General Liability | Cygnet Health Care Limited | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | £ | £ 25 | ||||||||||||||
Subsidiaries | General Liability | Maximum | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | 3,000,000 | 3,000,000 | 3,000,000 | 3,000,000 | 3,000,000 | 3,000,000 | |||||||||
Subsidiaries | General Liability | Maximum | Forecast | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Self-insured for professional and general liability | 3,000,000 | ||||||||||||||
Subsidiaries | General And Professional Liability Insurance Policies | Maximum | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Purchased several excess policies through commercial insurance carriers per occurrence | $ 155,000,000 | $ 250,000,000 | $ 250,000,000 | $ 250,000,000 | $ 250,000,000 | $ 250,000,000 | $ 250,000,000 | $ 250,000,000 | |||||||
Subsidiaries | General And Professional Liability Insurance Policies | Maximum | Forecast | |||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||
Purchased several excess policies through commercial insurance carriers per occurrence | $ 162,500,000 |
Commitments and Contingencies_2
Commitments and Contingencies - Schedule of Changes in General and Professional Liability and Workers Compensation Reserves (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Commitments and Contingencies Disclosure [Line Items] | |||
Beginning balance | $ 368,964 | $ 322,824 | $ 314,941 |
Plus: Accrued insurance expense, net of commercial premiums paid | 186,215 | 159,223 | 105,672 |
Less: Payments made in settlement of self-insured claims | (91,501) | (113,083) | (97,789) |
Ending balance | 463,678 | 368,964 | 322,824 |
General and Professional Liability | |||
Commitments and Contingencies Disclosure [Line Items] | |||
Beginning balance | 263,779 | 241,820 | 243,051 |
Plus: Accrued insurance expense, net of commercial premiums paid | 129,690 | 91,518 | 56,452 |
Less: Payments made in settlement of self-insured claims | (44,776) | (69,559) | (57,683) |
Ending balance | 348,693 | 263,779 | 241,820 |
Workers’ Compensation | |||
Commitments and Contingencies Disclosure [Line Items] | |||
Beginning balance | 105,185 | 81,004 | 71,890 |
Plus: Accrued insurance expense, net of commercial premiums paid | 56,525 | 67,705 | 49,220 |
Less: Payments made in settlement of self-insured claims | (46,725) | (43,524) | (40,106) |
Ending balance | $ 114,985 | $ 105,185 | $ 81,004 |
Relationship with Universal H_3
Relationship with Universal Health Realty Income Trust and Other Related Party Transactions - Additional Information (Detail) | 1 Months Ended | 3 Months Ended | 12 Months Ended | ||||
Jan. 31, 2022USD ($)BedSquareFoot | Dec. 31, 2020USD ($)$ / shares | Sep. 30, 2020$ / shares | Dec. 31, 2013 | Dec. 31, 2021USD ($)HospitalFacilityBed$ / shares | Dec. 31, 2020USD ($)Hospital | Dec. 31, 2019USD ($)Hospital | |
Related Party Transaction [Line Items] | |||||||
Net revenues | $ 12,642,117,000 | $ 11,558,897,000 | $ 11,378,259,000 | ||||
Lessee, operating lease, existence of option to extend [true false] | true | ||||||
Lease and rental expense | $ 118,863,000 | 116,059,000 | 107,809,000 | ||||
Number of hospital facilities | Hospital | 5 | ||||||
Chief Executive Officer | |||||||
Related Party Transaction [Line Items] | |||||||
Estimated payments to acquire life insurance policies | $ 28,000,000 | ||||||
Payments to acquire life insurance policies, net | 1,000,000 | 1,100,000 | 1,100,000 | ||||
Chief Executive Officer | Trust Owned by CEO | |||||||
Related Party Transaction [Line Items] | |||||||
Estimated payments to acquire life insurance policies | 9,000,000 | ||||||
Acute Care Hospital Services | |||||||
Related Party Transaction [Line Items] | |||||||
Net revenues | 7,108,254,000 | $ 6,337,304,000 | $ 6,164,560,000 | ||||
Asset Purchase and Sale Agreement | Subsidiaries | |||||||
Related Party Transaction [Line Items] | |||||||
Gain on sale of real estate assets | $ 4,000,000 | ||||||
Minimum | |||||||
Related Party Transaction [Line Items] | |||||||
Lease initial terms | 5 years | ||||||
Real estate leases option to extend lease term | 5 years | ||||||
Minimum | Chief Executive Officer | |||||||
Related Party Transaction [Line Items] | |||||||
Estimated death benefit proceeds | $ 37,000,000 | ||||||
Maximum | |||||||
Related Party Transaction [Line Items] | |||||||
Lease initial terms | 10 years | ||||||
Real estate leases option to extend lease term | 10 years | ||||||
Relationship with Universal Health Realty Income Trust | |||||||
Related Party Transaction [Line Items] | |||||||
Trust outstanding shares held, percentage | 5.70% | ||||||
Percentage of advisory fee on average invested real estate assets | 0.70% | 0.70% | 0.70% | ||||
Pre-tax share of income from the Trust | $ 6,200,000 | $ 1,100,000 | $ 1,100,000 | ||||
Dividends received from the Trust | 2,200,000 | 2,200,000 | $ 2,100,000 | ||||
Proceeds from transactions including asset purchase and sale transaction | 5,000,000 | ||||||
Carrying value of investment in Trust | $ 5,400,000 | 9,400,000 | 5,400,000 | ||||
Market value of investment in Trust | $ 50,600,000 | $ 46,800,000 | $ 50,600,000 | ||||
Lease renewal period, years | 5 years | ||||||
Financial liability included in debt | $ 82,400,000 | ||||||
Number of hospital facilities | Hospital | 3 | 3 | 3 | ||||
Notice period on renewal of lease | 90 days | ||||||
Period of rights of refusal to leased facilities | 180 days | ||||||
Number of free-standing emergency departments to be acquired | Facility | 2 | ||||||
Relationship with Universal Health Realty Income Trust | Subsequent Event | |||||||
Related Party Transaction [Line Items] | |||||||
Number of beds available in acute care hospital | Bed | 170 | ||||||
Number of square feet to be constructed | SquareFoot | 86,000 | ||||||
Percentage of master lease rentable square feet | 68.00% | ||||||
Relationship with Universal Health Realty Income Trust | McAllen Medical Center, Wellington Regional Medical Center and Inland Valley Campus of Southwest Healthcare System | |||||||
Related Party Transaction [Line Items] | |||||||
Lease and rental expense | $ 17,700,000 | $ 17,100,000 | $ 16,400,000 | ||||
Relationship with Universal Health Realty Income Trust | Aiken, South Carolina | Behavioral Health Care Facility | |||||||
Related Party Transaction [Line Items] | |||||||
Number of bed available in behavioral health care facility | Bed | 100 | ||||||
Lease and rental expense | $ 2,500,000 | ||||||
Notice period on renewal of lease | 270 days | ||||||
Period of rights of refusal to leased facilities | 30 days | ||||||
Relationship with Universal Health Realty Income Trust | Aiken Regional Medical Center | |||||||
Related Party Transaction [Line Items] | |||||||
Lease rent receivable | $ 3,900,000 | ||||||
Relationship with Universal Health Realty Income Trust | Canyon Creek Behavioral Health | |||||||
Related Party Transaction [Line Items] | |||||||
Lease rent receivable | $ 1,700,000 | ||||||
Relationship with Universal Health Realty Income Trust | Aiken Regional Medical Center and Canyon Creek Behavioral Health | |||||||
Related Party Transaction [Line Items] | |||||||
Lease initial terms | 5 years | ||||||
Initial lease term on property | 12 years | ||||||
Lease expiration date | Dec. 31, 2033 | ||||||
Lessee, operating lease, existence of option to extend [true false] | true | ||||||
Real estate leases option to extend lease term | 7 years | ||||||
Number of facilities leased | Facility | 2 | ||||||
Lease rent receivable | $ 5,600,000 | ||||||
Percentage of annual rental increase on cumulative and compound basis | 2.25% | ||||||
Relationship with Universal Health Realty Income Trust | Aiken Regional Medical Center and Canyon Creek Behavioral Health | Bonus Rental | |||||||
Related Party Transaction [Line Items] | |||||||
Lease revenue | $ 0 | ||||||
Relationship with Universal Health Realty Income Trust | Asset Purchase and Sale Agreement | Subsidiaries | |||||||
Related Party Transaction [Line Items] | |||||||
Cash received for sale of real estate asset | 2,800,000 | ||||||
Gain on sale of real estate assets | 68,400,000 | ||||||
Relationship with Universal Health Realty Income Trust | Asset Purchase and Sale Agreement | Subsidiaries | Inland Valley Campus of Southwest Healthcare System | Wildomar, California | |||||||
Related Party Transaction [Line Items] | |||||||
Fair market value of real estate assets received | 79,600,000 | ||||||
Relationship with Universal Health Realty Income Trust | Asset Purchase and Sale Agreement | Subsidiaries | Aiken Regional Medical Center | Aiken South Carolina | |||||||
Related Party Transaction [Line Items] | |||||||
Fair market value of real estate assets sold | $ 57,700,000 | ||||||
Relationship with Universal Health Realty Income Trust | Asset Purchase and Sale Agreement | Subsidiaries | Aiken Regional Medical Center | Aiken South Carolina | Acute Care Hospital Services | |||||||
Related Party Transaction [Line Items] | |||||||
Number of beds available in acute care hospital | Bed | 211 | ||||||
Relationship with Universal Health Realty Income Trust | Asset Purchase and Sale Agreement | Subsidiaries | Aiken Regional Medical Center | Aiken South Carolina | Behavioral Health Care Facility | |||||||
Related Party Transaction [Line Items] | |||||||
Number of bed available in behavioral health care facility | Bed | 62 | ||||||
Relationship with Universal Health Realty Income Trust | Asset Purchase and Sale Agreement | Subsidiaries | Canyon Creek Behavioral Health | Temple, Texas | |||||||
Related Party Transaction [Line Items] | |||||||
Fair market value of real estate assets sold | $ 24,700,000 | ||||||
Relationship with Universal Health Realty Income Trust | Asset Purchase and Sale Agreement | Subsidiaries | Aiken Regional Medical Center and Canyon Creek Behavioral Health | |||||||
Related Party Transaction [Line Items] | |||||||
Fair market value of real estate assets sold | $ 82,400,000 | ||||||
Relationship with Universal Health Realty Income Trust | Minimum | |||||||
Related Party Transaction [Line Items] | |||||||
Lease initial terms | 13 years | ||||||
Relationship with Universal Health Realty Income Trust | Minimum | Subsequent Event | |||||||
Related Party Transaction [Line Items] | |||||||
Lease and rental expense | $ 1,300,000 | ||||||
Relationship with Universal Health Realty Income Trust | Minimum | Limited Liability Companies | |||||||
Related Party Transaction [Line Items] | |||||||
Non-controlling ownership interests by subsidiaries | 95.00% | ||||||
Relationship with Universal Health Realty Income Trust | Maximum | |||||||
Related Party Transaction [Line Items] | |||||||
Lease initial terms | 15 years | ||||||
Relationship with Universal Health Realty Income Trust | Maximum | Limited Liability Companies | |||||||
Related Party Transaction [Line Items] | |||||||
Non-controlling ownership interests by subsidiaries | 100.00% | ||||||
Relationship with Universal Health Realty Income Trust | Advisory Fee | |||||||
Related Party Transaction [Line Items] | |||||||
Net revenues | $ 4,400,000 | 4,100,000 | $ 4,000,000 | ||||
Premier, Inc. | |||||||
Related Party Transaction [Line Items] | |||||||
Cash dividend declared per share | $ / shares | $ 0.19 | $ 0.19 | $ 0.78 | ||||
Premier, Inc. | Other (Income) Expense, Net | |||||||
Related Party Transaction [Line Items] | |||||||
Dividend | $ 1,700,000 | 800,000 | |||||
Premier, Inc. | Other (Income) Expense, Net | Accounting Standards Update 2016-01 | |||||||
Related Party Transaction [Line Items] | |||||||
Unrealized gain (loss) | 14,000,000 | ||||||
Premier, Inc. | Group Purchasing Organization Agreement | Restricted Stock | |||||||
Related Party Transaction [Line Items] | |||||||
Shares vesting period | 7 years | ||||||
Shares vesting period start year | 2014 | ||||||
Shares vesting period end year | 2020 | ||||||
Market value of retained vested shares | $ 92,000,000 | $ 78,000,000 |
Summary of Details of Hospitals
Summary of Details of Hospitals Leased from Trust (Detail) - USD ($) | Jan. 01, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Property Subject to or Available for Operating Lease [Line Items] | |||||
Annual Minimum Rent | $ 118,863,000 | $ 116,059,000 | $ 107,809,000 | ||
Subsequent Event | McAllen Medical Center | |||||
Property Subject to or Available for Operating Lease [Line Items] | |||||
Annual Minimum Rent | $ 5,485,000 | ||||
End of Lease Term | 2026-12 | ||||
Renewal Term (years) | [1] | 5 years | |||
Subsequent Event | Wellington Regional Medical Center | |||||
Property Subject to or Available for Operating Lease [Line Items] | |||||
Annual Minimum Rent | $ 6,319,000 | ||||
End of Lease Term | 2026-12 | ||||
Renewal Term (years) | [2] | 5 years | |||
Subsequent Event | Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services | |||||
Property Subject to or Available for Operating Lease [Line Items] | |||||
Annual Minimum Rent | $ 3,895,000 | ||||
End of Lease Term | 2033-12 | ||||
Renewal Term (years) | [3] | 35 years | |||
Subsequent Event | Canyon Creek Behavioral Health | |||||
Property Subject to or Available for Operating Lease [Line Items] | |||||
Annual Minimum Rent | $ 1,670,000 | ||||
End of Lease Term | 2033-12 | ||||
Renewal Term (years) | [3] | 35 years | |||
Subsequent Event | Clive Behavioral Health Hospital | |||||
Property Subject to or Available for Operating Lease [Line Items] | |||||
Annual Minimum Rent | $ 2,628,000 | ||||
End of Lease Term | 2040-12 | ||||
Renewal Term (years) | [4] | 50 years | |||
[1] | We have one 5-year renewal option at existing lease rates (through 2031). | ||||
[2] | We have one 5-year renewal option at fair market value lease rates ( through 2031 ). Upon the December 31, 2021 expiration of the lease on Wellington Regional Medical Center, a wholly-owned subsidiary of ours exercised its fair market value renewal option and renewed the lease for a 5-year term scheduled to expire on December 31, 2026 . Effective January 1, 2022, the annual fair market value lease rate for this hospital is $ 6.3 million (there is no longer a bonus rental component of the lease payment). Beginning on January 1, 2023, and thereafter on each January 1 st through 2026, the annual rent will increase by 2.50 % on a cumulative and compounded basis. | ||||
[3] | We have seven 5-year | ||||
[4] | This facility is operated by a joint venture in which we are the managing, majority member and an unrelated third-party holds a minority ownership interest. The joint venture has three, 10-year renewal options at computed lease rates as stipulated in the lease (2041 through 2070) and two additional, 10-year renewal options at fair market values lease rates (2071 through 2090). Beginning in January, 2022, and thereafter in each January through 2040 (and potentially through 2070 if three, 10-year renewal options are exercised), the annual rental will increase by 2.75% on a cumulative and compounded basis. |
Summary of Details of Hospita_2
Summary of Details of Hospitals Leased from Trust (Parenthetical) (Detail) $ in Millions | Jan. 01, 2022USD ($)RenewalOption | Dec. 31, 2021 |
Maximum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Real estate leases option to extend lease term | 10 years | |
Minimum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Real estate leases option to extend lease term | 5 years | |
Subsequent Event | McAllen Medical Center | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options term at existing lease rates | 5 years | |
Subsequent Event | McAllen Medical Center | Maximum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options at existing lease rates expiration year | 2031 | |
Subsequent Event | Wellington Regional Medical Center | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options term at fair market lease rates | 5 years | |
Real estate leases option to extend lease term | 5 years | |
Lease expiration date | Dec. 31, 2026 | |
Lease rent receivable | $ | $ 6.3 | |
Percentage of annual rental increase on cumulative and compound basis | 2.50% | |
Subsequent Event | Wellington Regional Medical Center | Maximum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options at fair market value lease rates expiration year | 2031 | |
Subsequent Event | Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options term at fair market lease rates | 5 years | |
Subsequent Event | Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services | Maximum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options at fair market value lease rates expiration year | 2068 | |
Subsequent Event | Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services | Minimum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options at fair market value lease rates expiration year | 2034 | |
Subsequent Event | Canyon Creek Behavioral Health | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options term at fair market lease rates | 5 years | |
Subsequent Event | Canyon Creek Behavioral Health | Maximum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options at fair market value lease rates expiration year | 2068 | |
Subsequent Event | Canyon Creek Behavioral Health | Minimum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options at fair market value lease rates expiration year | 2034 | |
Subsequent Event | Clive Behavioral Health Hospital | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options term at fair market lease rates | 10 years | |
Percentage of annual rental increase on cumulative and compound basis | 2.75% | |
Operating leases additional renewal options term at fair market value lease rates | 10 years | |
Number of lease renewal option exercised | RenewalOption | 3 | |
Subsequent Event | Clive Behavioral Health Hospital | Maximum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options at fair market value lease rates expiration year | 2070 | |
Operating leases additional renewal options at fair market value lease rates expiration year | 2090 | |
Subsequent Event | Clive Behavioral Health Hospital | Minimum | ||
Property Subject to or Available for Operating Lease [Line Items] | ||
Renewal options at fair market value lease rates expiration year | 2041 | |
Operating leases additional renewal options at fair market value lease rates expiration year | 2071 |
Schedule of Disaggregates Reven
Schedule of Disaggregates Revenue by Major Source (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | ||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 12,642,117 | $ 11,558,897 | $ 11,378,259 | |
Percentage of Net Revenue | 100.00% | 100.00% | 100.00% | |
Medicare | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 1,654,119 | $ 1,690,591 | $ 1,889,245 | |
Percentage of Net Revenue | 13.00% | 15.00% | 17.00% | |
Managed Medicare | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 1,362,962 | $ 1,104,930 | $ 1,047,759 | |
Percentage of Net Revenue | 11.00% | 10.00% | 9.00% | |
Medicaid | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 1,291,692 | $ 1,202,632 | $ 1,207,649 | |
Percentage of Net Revenue | 10.00% | 10.00% | 11.00% | |
Managed Medicaid | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 1,947,263 | $ 1,715,439 | $ 1,678,641 | |
Percentage of Net Revenue | 15.00% | 15.00% | 15.00% | |
Managed Care (HMO and PPOs) | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 3,957,027 | $ 3,426,937 | $ 3,634,817 | |
Percentage of Net Revenue | 31.00% | 30.00% | 32.00% | |
UK Revenue | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 687,725 | $ 584,000 | $ 553,831 | |
Percentage of Net Revenue | 5.00% | 5.00% | 5.00% | |
Other Patient Revenue and Adjustments, Net | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 843,200 | $ 745,344 | $ 696,566 | |
Percentage of Net Revenue | 7.00% | 6.00% | 6.00% | |
Other Non-patient Revenue | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 898,129 | $ 1,089,024 | $ 669,751 | |
Percentage of Net Revenue | 7.00% | 9.00% | 6.00% | |
Acute Care Hospital Services | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 7,108,254 | $ 6,337,304 | $ 6,164,560 | |
Percentage of Net Revenue | 100.00% | 100.00% | 100.00% | |
Acute Care Hospital Services | Medicare | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 1,292,205 | $ 1,242,268 | $ 1,336,200 | |
Percentage of Net Revenue | 18.00% | 20.00% | 22.00% | |
Acute Care Hospital Services | Managed Medicare | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 1,118,901 | $ 869,488 | $ 827,216 | |
Percentage of Net Revenue | 16.00% | 14.00% | 13.00% | |
Acute Care Hospital Services | Medicaid | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 539,741 | $ 551,551 | $ 519,508 | |
Percentage of Net Revenue | 8.00% | 9.00% | 8.00% | |
Acute Care Hospital Services | Managed Medicaid | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 618,727 | $ 491,234 | $ 560,029 | |
Percentage of Net Revenue | 9.00% | 8.00% | 9.00% | |
Acute Care Hospital Services | Managed Care (HMO and PPOs) | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 2,521,089 | $ 2,146,018 | $ 2,271,002 | |
Percentage of Net Revenue | 35.00% | 34.00% | 37.00% | |
Acute Care Hospital Services | UK Revenue | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 0 | $ 0 | $ 0 | |
Percentage of Net Revenue | 0.00% | 0.00% | 0.00% | |
Acute Care Hospital Services | Other Patient Revenue and Adjustments, Net | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 358,458 | $ 248,047 | $ 191,422 | |
Percentage of Net Revenue | 5.00% | 4.00% | 3.00% | |
Acute Care Hospital Services | Other Non-patient Revenue | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 659,133 | $ 788,698 | $ 459,183 | |
Percentage of Net Revenue | 9.00% | 12.00% | 7.00% | |
Behavioral Health Services | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | [1] | $ 5,503,644 | $ 5,208,722 | $ 5,210,063 |
Percentage of Net Revenue | 100.00% | 100.00% | 100.00% | |
Behavioral Health Services | Medicare | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 361,914 | $ 448,323 | $ 553,045 | |
Percentage of Net Revenue | 7.00% | 9.00% | 11.00% | |
Behavioral Health Services | Managed Medicare | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 244,061 | $ 235,442 | $ 220,543 | |
Percentage of Net Revenue | 4.00% | 5.00% | 4.00% | |
Behavioral Health Services | Medicaid | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 751,951 | $ 651,081 | $ 688,141 | |
Percentage of Net Revenue | 14.00% | 12.00% | 13.00% | |
Behavioral Health Services | Managed Medicaid | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 1,328,536 | $ 1,224,205 | $ 1,118,612 | |
Percentage of Net Revenue | 24.00% | 24.00% | 21.00% | |
Behavioral Health Services | Managed Care (HMO and PPOs) | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 1,435,938 | $ 1,280,919 | $ 1,363,815 | |
Percentage of Net Revenue | 26.00% | 25.00% | 26.00% | |
Behavioral Health Services | UK Revenue | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 687,725 | $ 584,000 | $ 553,831 | |
Percentage of Net Revenue | 12.00% | 11.00% | 11.00% | |
Behavioral Health Services | Other Patient Revenue and Adjustments, Net | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 484,742 | $ 497,297 | $ 505,144 | |
Percentage of Net Revenue | 9.00% | 10.00% | 10.00% | |
Behavioral Health Services | Other Non-patient Revenue | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 208,777 | $ 287,455 | $ 206,932 | |
Percentage of Net Revenue | 4.00% | 6.00% | 4.00% | |
Other | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 30,219 | $ 12,871 | $ 3,636 | |
Other | Other Non-patient Revenue | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 30,219 | $ 12,871 | $ 3,636 | |
[1] | Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $688 million in 2021, $584 million in 2020 and $554 million in 2019. Total assets at our U.K. behavioral health care facilities were approximately $1.351 billion as of December 31, 2021, $1.334 billion as of December 31, 2020 and $1.270 billion as of December 31, 2019. In addition, included in our 2019 Behavioral Health Services operating segment Income (loss) before allocation of corporate overhead and income taxes is a pre-tax $98 million provision for asset impairment to reduce the carrying value of a tradename intangible asset and real property assets. |
Schedule of Disaggregates Rev_2
Schedule of Disaggregates Revenue by Major Source (Parenthetical) (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | ||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 12,642,117 | $ 11,558,897 | $ 11,378,259 | |
Acute Care Hospital Services | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | 7,108,254 | 6,337,304 | 6,164,560 | |
Acute Care Hospital Services | CARES Act and Other Grant Revenue | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | 316,000 | |||
Behavioral Health Services | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | [1] | $ 5,503,644 | 5,208,722 | $ 5,210,063 |
Behavioral Health Services | CARES Act and Other Grant Revenue | ||||
Disaggregation Of Revenue [Line Items] | ||||
Net revenues | $ 97,000 | |||
[1] | Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $688 million in 2021, $584 million in 2020 and $554 million in 2019. Total assets at our U.K. behavioral health care facilities were approximately $1.351 billion as of December 31, 2021, $1.334 billion as of December 31, 2020 and $1.270 billion as of December 31, 2019. In addition, included in our 2019 Behavioral Health Services operating segment Income (loss) before allocation of corporate overhead and income taxes is a pre-tax $98 million provision for asset impairment to reduce the carrying value of a tradename intangible asset and real property assets. |
Pension Plan - Additional Infor
Pension Plan - Additional Information (Detail) - USD ($) | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Compensation And Retirement Disclosure [Abstract] | |||
Amount of contributions to contributory plan | $ 69,800,000 | $ 67,100,000 | $ 56,300,000 |
Accumulated benefit obligation | 116,000,000 | 123,200,000 | |
Fair value of plan assets exceeded accumulated benefit obligation | 11,300,000 | $ 8,400,000 | |
Estimated net loss that will be amortized from accumulated other comprehensive income over the next fiscal year | 0 | ||
Estimated prior service cost that will be amortized from accumulated other comprehensive income over the next fiscal year | $ 0 |
Schedule of Reconciliation of D
Schedule of Reconciliation of Defined Benefit Pension Plan (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Compensation And Retirement Disclosure [Abstract] | |||
Fair value of plan assets at beginning of year | $ 131,685 | $ 120,287 | |
Actual return (loss) on plan assets | 2,771 | 18,169 | |
Benefits paid | (6,389) | (6,260) | |
Administrative expenses | (707) | (511) | |
Fair value of plan assets at end of year | 127,360 | 131,685 | $ 120,287 |
Benefit obligation at beginning of year | 123,237 | 117,556 | |
Service cost | 546 | 615 | 725 |
Interest cost | 2,493 | 3,357 | 4,237 |
Benefits paid | (6,389) | (6,260) | |
Actuarial (gain) loss | (3,853) | 7,969 | |
Benefit obligation at end of year | 116,034 | 123,237 | $ 117,556 |
Other non-current assets | 11,327 | 8,449 | |
Total amounts recognized at end of year | $ 11,327 | $ 8,449 |
Components of Net Periodic Pens
Components of Net Periodic Pension Cost Benefit (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Compensation And Retirement Disclosure [Abstract] | |||
Service cost | $ 546 | $ 615 | $ 725 |
Interest cost | 2,493 | 3,357 | 4,237 |
Expected return on plan assets | (4,490) | (5,261) | (4,558) |
Amortization of actuarial loss | 1,533 | ||
Net periodic cost | $ (1,451) | $ (1,289) | $ 1,937 |
Schedule of Measurement Dates (
Schedule of Measurement Dates (Detail) | 12 Months Ended | |
Dec. 31, 2021 | Dec. 31, 2020 | |
Benefit Obligation | ||
Defined Benefit Plan Disclosure [Line Items] | ||
Measurement Dates | Dec. 31, 2021 | Dec. 31, 2020 |
Fair Value Of Plan Assets | ||
Defined Benefit Plan Disclosure [Line Items] | ||
Measurement Dates | Dec. 31, 2021 | Dec. 31, 2020 |
Schedule of Weighted Average As
Schedule of Weighted Average Assumptions (Detail) | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Compensation And Retirement Disclosure [Abstract] | |||
Discount rate | 2.52% | 2.08% | |
Rate of compensation increase | 4.00% | 4.00% | |
Discount rate | 2.08% | 2.94% | 4.03% |
Expected long-term rate of return on plan assets | 3.50% | 4.50% | 4.50% |
Rate of compensation increase | 4.00% | 4.00% | 4.00% |
Schedule of Market Values of Pe
Schedule of Market Values of Pension Plan Assets (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 |
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | $ 127,360 | $ 131,685 | $ 120,287 |
Equity Securities U.S. Large Cap | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | 7,306 | 10,946 | |
Equity Securities U.S. Mid Cap | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | 2,014 | 3,403 | |
Equity Securities U.S. Small Cap | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | 1,913 | 3,581 | |
Equity Securities International Developed | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | 5,062 | 8,315 | |
Equity Securities Emerging Markets | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | 3,152 | 5,631 | |
Fixed Income Securities Core Fixed Income | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | 22,904 | 27,782 | |
Fixed Income Securities Long Duration Fixed Income | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | 84,277 | 68,886 | |
Real Estate REIT Fund | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | 2,474 | ||
Cash Cash Equivalents | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Fair value of plan assets | $ 732 | $ 667 |
Schedule of Estimated Future Be
Schedule of Estimated Future Benefit Payments (Detail) $ in Thousands | Dec. 31, 2021USD ($) |
Compensation And Retirement Disclosure [Abstract] | |
2022 | $ 6,994 |
2023 | 7,056 |
2024 | 7,057 |
2025 | 7,029 |
2026 | 6,973 |
2027-2031 | 33,438 |
Total | $ 68,547 |
Schedule of Plan Assets Categor
Schedule of Plan Assets Category (Detail) | Dec. 31, 2021 | Dec. 31, 2020 |
Defined Benefit Plan Disclosure [Line Items] | ||
Asset Allocation | 100.00% | 100.00% |
Equity Securities | ||
Defined Benefit Plan Disclosure [Line Items] | ||
Asset Allocation | 15.00% | 24.00% |
Fixed Income Securities | ||
Defined Benefit Plan Disclosure [Line Items] | ||
Asset Allocation | 84.00% | 73.00% |
Other | ||
Defined Benefit Plan Disclosure [Line Items] | ||
Asset Allocation | 1.00% | 3.00% |
Schedule of Asset Allocation Po
Schedule of Asset Allocation Policy and Ranges for Overall Risk and Return Objectives of Portfolio (Detail) | Dec. 31, 2021 | Dec. 31, 2020 |
Defined Benefit Plan Disclosure [Line Items] | ||
Assets allocation | 100.00% | 100.00% |
Equity Funds | ||
Defined Benefit Plan Disclosure [Line Items] | ||
Assets allocation | 15.00% | 24.00% |
Permitted Range, minimum | 10.00% | |
Permitted Range, maximum | 30.00% | |
Fixed Income Funds | ||
Defined Benefit Plan Disclosure [Line Items] | ||
Assets allocation | 84.00% | 73.00% |
Permitted Range, minimum | 70.00% | |
Permitted Range, maximum | 90.00% | |
Other | ||
Defined Benefit Plan Disclosure [Line Items] | ||
Assets allocation | 1.00% | 3.00% |
Permitted Range, minimum | 0.00% | |
Permitted Range, maximum | 10.00% |
Segment Reporting (Detail)
Segment Reporting (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | ||
Segment Reporting Information [Line Items] | ||||
Gross inpatient revenues | $ 46,449,556 | $ 40,281,027 | $ 38,531,825 | |
Gross outpatient revenues | 21,647,468 | 17,236,319 | 18,733,333 | |
Total net revenues | 12,642,117 | 11,558,897 | 11,378,259 | |
Income (loss) before allocation of corporate overhead and income taxes | 1,293,313 | 1,252,083 | 1,066,337 | |
Allocation of corporate overhead | 0 | 0 | 0 | |
Income before income taxes | 1,293,313 | 1,252,083 | 1,066,337 | |
Total assets | 13,093,543 | 13,476,879 | 11,668,250 | |
Acute Care Hospital Services | ||||
Segment Reporting Information [Line Items] | ||||
Gross inpatient revenues | 36,522,155 | 30,562,093 | 28,430,922 | |
Gross outpatient revenues | 20,633,921 | 16,272,520 | 17,666,629 | |
Total net revenues | 7,108,254 | 6,337,304 | 6,164,560 | |
Income (loss) before allocation of corporate overhead and income taxes | 734,666 | 693,427 | 713,410 | |
Allocation of corporate overhead | (233,298) | (223,921) | (230,166) | |
Income before income taxes | 501,368 | 469,506 | 483,244 | |
Total assets | 5,534,912 | 4,927,456 | 4,405,643 | |
Behavioral Health Services | ||||
Segment Reporting Information [Line Items] | ||||
Gross inpatient revenues | [1] | 9,927,401 | 9,718,934 | 10,100,903 |
Gross outpatient revenues | [1] | 1,013,547 | 963,799 | 1,066,704 |
Total net revenues | [1] | 5,503,644 | 5,208,722 | 5,210,063 |
Income (loss) before allocation of corporate overhead and income taxes | [1] | 1,025,557 | 1,023,257 | 900,965 |
Allocation of corporate overhead | [1] | (172,512) | (170,849) | (166,571) |
Income before income taxes | [1] | 853,045 | 852,408 | 734,394 |
Total assets | [1] | 7,250,427 | 7,044,617 | 6,910,790 |
Other | ||||
Segment Reporting Information [Line Items] | ||||
Total net revenues | 30,219 | 12,871 | 3,636 | |
Income (loss) before allocation of corporate overhead and income taxes | (466,910) | (464,601) | (548,038) | |
Allocation of corporate overhead | 405,810 | 394,770 | 396,737 | |
Income before income taxes | (61,100) | (69,831) | (151,301) | |
Total assets | $ 308,204 | $ 1,504,806 | $ 351,817 | |
[1] | Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $688 million in 2021, $584 million in 2020 and $554 million in 2019. Total assets at our U.K. behavioral health care facilities were approximately $1.351 billion as of December 31, 2021, $1.334 billion as of December 31, 2020 and $1.270 billion as of December 31, 2019. In addition, included in our 2019 Behavioral Health Services operating segment Income (loss) before allocation of corporate overhead and income taxes is a pre-tax $98 million provision for asset impairment to reduce the carrying value of a tradename intangible asset and real property assets. |
Segment Reporting (Parenthetica
Segment Reporting (Parenthetical) (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | ||
Segment Reporting Information [Line Items] | ||||
Net revenues | $ 12,642,117 | $ 11,558,897 | $ 11,378,259 | |
Total assets | 13,093,543 | 13,476,879 | 11,668,250 | |
Provision for asset impairment | 14,391 | 0 | 97,631 | |
Behavioral Health Services | ||||
Segment Reporting Information [Line Items] | ||||
Net revenues | [1] | 5,503,644 | 5,208,722 | 5,210,063 |
Total assets | [1] | 7,250,427 | 7,044,617 | 6,910,790 |
Behavioral Health Services | Located in U.K. | ||||
Segment Reporting Information [Line Items] | ||||
Net revenues | 688,000 | 584,000 | 554,000 | |
Total assets | $ 1,351,000 | 1,334,000 | $ 1,270,000 | |
Trade Names | Real Property Assets | Behavioral Health Services | ||||
Segment Reporting Information [Line Items] | ||||
Provision for asset impairment | $ 98,000 | |||
[1] | Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $688 million in 2021, $584 million in 2020 and $554 million in 2019. Total assets at our U.K. behavioral health care facilities were approximately $1.351 billion as of December 31, 2021, $1.334 billion as of December 31, 2020 and $1.270 billion as of December 31, 2019. In addition, included in our 2019 Behavioral Health Services operating segment Income (loss) before allocation of corporate overhead and income taxes is a pre-tax $98 million provision for asset impairment to reduce the carrying value of a tradename intangible asset and real property assets. |
Valuation and Qualifying Accoun
Valuation and Qualifying Accounts (Detail) - Valuation Allowance for Deferred Tax Assets - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Valuation and Qualifying Accounts Disclosure [Line Items] | |||
Balance at beginning of period | $ 68,003 | $ 75,277 | $ 79,264 |
Charges to costs and expenses (income) | (5,647) | (7,274) | (3,987) |
Balance at end of period | $ 62,356 | $ 68,003 | $ 75,277 |