Document and Entity Information
Document and Entity Information - shares | 3 Months Ended | |
Mar. 31, 2022 | Apr. 30, 2022 | |
Document Information [Line Items] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Mar. 31, 2022 | |
Document Fiscal Year Focus | 2022 | |
Document Fiscal Period Focus | Q1 | |
Trading Symbol | UHS | |
Entity Registrant Name | UNIVERSAL HEALTH SERVICES, INC. | |
Entity Central Index Key | 0000352915 | |
Current Fiscal Year End Date | --12-31 | |
Entity Filer Category | Large Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Current Reporting Status | Yes | |
Entity Shell Company | false | |
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 | 367 SOUTH GULPH ROAD | |
Entity Address, City or Town | KING OF PRUSSIA | |
Entity Address, State or Province | PA | |
Entity Address, Postal Zip Code | 19406 | |
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, $0.01 par value | |
Document Quarterly Report | true | |
Document Transition Report | false | |
Class A | ||
Document Information [Line Items] | ||
Entity Common Stock, Shares Outstanding | 6,577,100 | |
Class B | ||
Document Information [Line Items] | ||
Entity Common Stock, Shares Outstanding | 67,127,528 | |
Class C | ||
Document Information [Line Items] | ||
Entity Common Stock, Shares Outstanding | 661,688 | |
Class D | ||
Document Information [Line Items] | ||
Entity Common Stock, Shares Outstanding | 14,293 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Income Statement [Abstract] | ||
Net revenues | $ 3,292,956 | $ 3,012,987 |
Operating charges: | ||
Salaries, wages and benefits | 1,692,270 | 1,497,773 |
Other operating expenses | 820,934 | 709,708 |
Supplies expense | 371,073 | 347,110 |
Depreciation and amortization | 143,784 | 131,403 |
Lease and rental expense | 32,038 | 31,324 |
Operating Expenses, Total | 3,060,099 | 2,717,318 |
Income from operations | 232,857 | 295,669 |
Interest expense, net | 21,673 | 21,957 |
Other (income) expense, net | 11,201 | 835 |
Income before income taxes | 199,983 | 272,877 |
Provision for income taxes | 48,962 | 63,807 |
Net income | 151,021 | 209,070 |
Less: Net income (loss) attributable to noncontrolling interests | (2,892) | (21) |
Net income attributable to UHS | $ 153,913 | $ 209,091 |
Basic earnings per share attributable to UHS | $ 2.05 | $ 2.46 |
Diluted earnings per share attributable to UHS | $ 2.02 | $ 2.43 |
Weighted average number of common shares - basic | 75,030 | 84,782 |
Add: Other share equivalents | 1,011 | 1,014 |
Weighted average number of common shares and equivalents - diluted | 76,041 | 85,796 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Statement Of Income And Comprehensive Income [Abstract] | ||
Net income | $ 151,021 | $ 209,070 |
Other comprehensive income (loss): | ||
Foreign currency translation adjustment | (18,470) | (10,346) |
Other comprehensive income (loss) before tax | (18,470) | (10,346) |
Income tax expense (benefit) related to items of other comprehensive income (loss) | (944) | (1,466) |
Total other comprehensive income (loss), net of tax | (17,526) | (8,880) |
Comprehensive income | 133,495 | 200,190 |
Less: Comprehensive income (loss) attributable to noncontrolling interests | (2,892) | (21) |
Comprehensive income attributable to UHS | $ 136,387 | $ 200,211 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Current assets: | ||
Cash and cash equivalents | $ 105,999 | $ 115,301 |
Accounts receivable, net | 1,754,877 | 1,746,635 |
Supplies | 208,302 | 206,839 |
Other current assets | 232,724 | 194,781 |
Total current assets | 2,301,902 | 2,263,556 |
Property and equipment | 10,929,292 | 10,770,702 |
Less: accumulated depreciation | (5,010,825) | (4,896,427) |
Property, plant and equipment, net, Total | 5,918,467 | 5,874,275 |
Other assets: | ||
Goodwill | 3,949,788 | 3,962,624 |
Deferred income taxes | 47,549 | 45,707 |
Right of use assets-operating leases | 368,921 | 367,477 |
Deferred charges | 6,310 | 6,525 |
Other | 551,509 | 573,379 |
Total Assets | 13,144,446 | 13,093,543 |
Current liabilities: | ||
Current maturities of long-term debt | 48,486 | 48,409 |
Accounts payable and other liabilities | 1,976,389 | 1,860,496 |
Operating lease liabilities | 65,607 | 64,484 |
Federal and state taxes | 55,734 | 10,720 |
Total current liabilities | 2,146,216 | 1,984,109 |
Other noncurrent liabilities | 475,006 | 464,759 |
Operating lease liabilities noncurrent | 305,643 | 304,624 |
Long-term debt | 4,250,689 | 4,141,879 |
Redeemable noncontrolling interests | 4,314 | 5,119 |
Equity: | ||
UHS common stockholders’ equity | 5,867,872 | 6,089,664 |
Noncontrolling interest | 94,706 | 103,389 |
Total equity | 5,962,578 | 6,193,053 |
Total Liabilities and Stockholders’ Equity | $ 13,144,446 | $ 13,093,543 |
Condensed Consolidated Statem_3
Condensed 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, 2020 | $ 6,401,967 | $ 66 | $ 778 | $ 7 | $ 0 | $ (479,503) | $ 6,747,678 | $ 48,120 | $ 6,317,146 | $ 84,821 | |
Balance at Dec. 31, 2020 | $ 4,569 | ||||||||||
Common Stock | |||||||||||
Issued/(converted) | 3,360 | 4 | 3,356 | 3,360 | |||||||
Repurchased | (7,464) | (1) | (7,463) | (7,464) | |||||||
Restricted share-based compensation expense | 2,862 | 2,862 | 2,862 | ||||||||
Dividends paid and accrued | (17,018) | (17,018) | (17,018) | ||||||||
Stock option expense | 14,765 | 14,765 | 14,765 | ||||||||
Distributions to noncontrolling interests | (4,525) | (4,525) | |||||||||
Purchase (sale) of ownership interests by (from) minority members | 7,603 | 7,603 | |||||||||
Comprehensive income: | |||||||||||
Net income (loss) to UHS / noncontrolling interests | 209,169 | (99) | 209,091 | 209,091 | 78 | ||||||
Foreign currency translation adjustments, net of income tax | (8,880) | (8,880) | (8,880) | ||||||||
Subtotal - comprehensive income | 200,289 | 209,091 | (8,880) | 200,211 | 78 | ||||||
Subtotal attributable to redeemable noncontrolling interest | (99) | ||||||||||
Balance at Mar. 31, 2021 | 6,601,839 | 66 | 781 | 7 | 0 | (496,521) | 6,970,289 | 39,240 | 6,513,862 | 87,977 | |
Balance at Mar. 31, 2021 | 4,470 | ||||||||||
Balance at Dec. 31, 2021 | 6,193,053 | 66 | 698 | 7 | 0 | (545,487) | 6,604,089 | 30,291 | 6,089,664 | 103,389 | |
Balance at Dec. 31, 2021 | 5,119 | ||||||||||
Common Stock | |||||||||||
Issued/(converted) | 3,645 | 5 | 3,640 | 3,645 | |||||||
Repurchased | (365,505) | (27) | (365,478) | (365,505) | |||||||
Restricted share-based compensation expense | 3,442 | 3,442 | 3,442 | ||||||||
Dividends paid and accrued | (14,963) | (14,963) | (14,963) | ||||||||
Stock option expense | 15,202 | 15,202 | 15,202 | ||||||||
Distributions to noncontrolling interests | (4,639) | (650) | (4,639) | ||||||||
Purchase (sale) of ownership interests by (from) minority members | (1,307) | (1,307) | |||||||||
Comprehensive income: | |||||||||||
Net income (loss) to UHS / noncontrolling interests | 151,176 | (155) | 153,913 | 153,913 | (2,737) | ||||||
Foreign currency translation adjustments, net of income tax | (17,526) | (17,526) | (17,526) | ||||||||
Subtotal - comprehensive income | 133,650 | 153,913 | (17,526) | 136,387 | (2,737) | ||||||
Subtotal attributable to redeemable noncontrolling interest | (155) | ||||||||||
Balance at Mar. 31, 2022 | 5,962,578 | $ 66 | $ 676 | $ 7 | $ 0 | $ (560,450) | $ 6,414,808 | $ 12,765 | $ 5,867,872 | $ 94,706 | |
Balance at Mar. 31, 2022 | $ 4,000 | $ 4,314 |
Condensed Consolidated Statem_4
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Cash Flows from Operating Activities: | ||
Net income | $ 151,021 | $ 209,070 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||
Depreciation & amortization | 143,784 | 131,403 |
Loss on sale of assets and businesses | 1,084 | |
Stock-based compensation expense | 19,055 | 18,022 |
Changes in assets & liabilities, net of effects from acquisitions and dispositions: | ||
Accounts receivable | (15,073) | 56,851 |
Accrued interest | 180 | 10,133 |
Accrued and deferred income taxes | 47,548 | 53,769 |
Other working capital accounts | 63,308 | 82,663 |
Medicare accelerated payments and deferred CARES Act and other grants | 250 | (509,448) |
Other assets and deferred charges | 26,042 | (17) |
Other | (4,020) | 2,623 |
Accrued insurance expense, net of commercial premiums paid | 41,685 | 35,467 |
Payments made in settlement of self-insurance claims | (29,431) | (18,741) |
Net cash provided by operating activities | 445,433 | 71,795 |
Cash Flows from Investing Activities: | ||
Property and equipment additions | (200,002) | (247,459) |
Proceeds received from sales of assets and businesses | 10,232 | |
Inflows (outflows) from foreign exchange contracts that hedge our net U.K. investment | 20,710 | (14,264) |
Decrease in capital reserves of commercial insurance subsidiary | 100 | 100 |
Costs incurred for purchase of information technology applications, net of refunds | (575) | |
Investment in, and advances to, joint ventures and other | (129) | |
Net cash used in investing activities | (168,960) | (262,327) |
Cash Flows from Financing Activities: | ||
Repayments of long-term debt | (11,966) | (251,830) |
Additional borrowings | 117,400 | |
Repurchase of common shares | (365,505) | (7,464) |
Dividends paid | (14,875) | (17,018) |
Issuance of common stock | 3,503 | 3,357 |
Profit distributions to noncontrolling interests | (5,289) | (4,525) |
Purchase (sale) of ownership interests by (from) minority members | (1,307) | 7,603 |
Net cash used in financing activities | (278,039) | (269,877) |
Effect of exchange rate changes on cash, cash equivalents and restricted cash | (2,232) | 423 |
Decrease in cash, cash equivalents and restricted cash | (3,798) | (459,986) |
Cash, cash equivalents and restricted cash, beginning of period | 178,934 | 1,279,154 |
Cash, cash equivalents and restricted cash, end of period | 175,136 | 819,168 |
Supplemental Disclosures of Cash Flow Information: | ||
Interest paid | 20,388 | 11,421 |
Income taxes paid, net of refunds | 4,423 | 8,654 |
Noncash purchases of property and equipment | $ 90,730 | $ 60,124 |
General
General | 3 Months Ended |
Mar. 31, 2022 | |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
General | (1) General This Quarterly Report on Form 10-Q is for the quarterly period ended March 31, 2022. In this Quarterly Report, “we,” “us,” “our” “UHS” and the “Company” refer to Universal Health Services, Inc. and its subsidiaries. The condensed consolidated interim financial statements include the accounts of our majority-owned subsidiaries and partnerships and limited liability companies controlled by us, or our subsidiaries, as managing general partner or managing member. The condensed consolidated interim financial statements included herein have been prepared by us, without audit, pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) and reflect all adjustments (consisting only of normal recurring adjustments) which, in our opinion, are necessary to fairly state results for the interim periods. Certain information and footnote disclosures normally included in audited consolidated financial statements prepared in accordance with accounting principles generally accepted in the United States of America have been condensed or omitted pursuant to such rules and regulations, although we believe that the accompanying disclosures are adequate to make the information presented not misleading. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements, significant accounting policies and the notes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2021. The impact of the COVID-19 pandemic, which began during the second half of March, 2020, has had a material effect on our operations and financial results since that time. The COVID-19 vaccination process commenced during the first quarter of 2021. Since that time through the second quarter of 2021, we had generally experienced a decline in COVID-19 patients as well as a corresponding recovery in non-COVID patient activity. However, during the third and fourth quarters of 2021, and continuing into the early part of the first quarter of 2022, our facilities generally experienced an increase in COVID-19 patients resulting from the Delta and, more recently, the highly transmissible Omicron variants. COVID-19 related patient volumes at our facilities were generally declining during the latter part of the first quarter of 2022. We believe that the adverse impact that COVID-19 will have on our future operations and financial results will depend upon many factors, most of which are beyond our capability to control or predict. Our future operations and financial results may be materially impacted by developments related to COVID-19 including, but not limited to, the potential impact on future COVID-19 patient volumes resulting from new variants of the virus, the length of time and severity of the spread of the pandemic; the volume of cancelled or rescheduled elective procedures and the volume of COVID-19 patients treated at our hospitals and other healthcare facilities; measures we are taking to respond to the COVID-19 pandemic; the impact of government and administrative regulation and stimulus on the hospital industry and potential retrospective adjustment in future periods of CARES Act and other grant income revenues recorded as revenues in prior periods; the requirements that federal healthcare program participation is conditional upon facility employees being vaccinated; declining patient volumes and unfavorable changes in payer mix caused by deteriorating macroeconomic conditions (including increases in uninsured and underinsured patients as the result of business closings During 2021, we received approximately $189 million of additional funds from the federal government in connection with the CARES Act, substantially all of which was received during the first quarter of 2021. During the second quarter of 2021, we returned the $189 million to the appropriate government agencies utilizing a portion of our cash and cash equivalents held on deposit. T Also, in March of 2021, we made an early repayment of $695 million of funds received during 2020 pursuant to the Medicare Accelerated and Advance Payment Program. These funds were returned to the government utilizing a portion of our cash and cash equivalents held on deposit. |
Relationship with Universal Hea
Relationship with Universal Health Realty Income Trust and Other Related Party Transactions | 3 Months Ended |
Mar. 31, 2022 | |
Related Party Transactions [Abstract] | |
Relationship with Universal Health Realty Income Trust and Other Related Party Transactions | (2) Relationship with Universal Health Realty Income Trust and Other Related Party Transactions Relationship with Universal Health Realty Income Trust: At March 31, 2022, 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 opportunities. The advisory agreement was renewed by the Trust for 20 2 2 at the same rate as the prior three years, providing for an advisory fee computation at 0.70 % of the Trust’s average invested real estate assets. We earned an advisory fee from the Trust, which is included in net revenues in the accompanying consolidated statements of income, of approximately $ million and $ million during the three-month periods ended March 3 1 , 20 2 2 and 20 2 1 , respectively . 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, which is included in other income, net, on the accompanying consolidated statements of income for each period was approximately $300,000 during each of the three-month periods ended March 31, 2022 and 2021. We received dividends from the Trust amounting to $555,000 and $547,000 during the three-month periods ended March 31, 2022 and 2021, respectively. The carrying value of our investment in the Trust was approximately $9.1 million and $9.4 million at March 31, 2022 and December 31, 2021, respectively, and is included in other assets in the accompanying consolidated balance sheets. The market value of our investment in the Trust was $46.0 million at March 31, 2022 and $46.8 million at December 31, 2021, based on the closing price of the Trust’s stock on the respective dates. The Trust commenced operations in 1986 by purchasing certain properties from us and immediately leasing the properties back to our respective subsidiaries. The base rents are paid monthly and the bonus rents, which as of January 1, 2022 are applicable to only McAllen Medical Center, 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 the asset purchase and sale agreement, which was amended during the first quarter of 2022, a wholly-owned subsidiary of ours purchased from the Trust the real estate assets of the Inland Valley Campus of Southwest Healthcare System (at its fair market value of $79.6 million). Additionally, two wholly-owned subsidiaries of ours transferred to the Trust the real estate assets of Aiken Regional Medical Center (at its fair market value of $57.7 million) and Canyon Creek Behavioral Health (at its fair market value of $26.0 million). In connection with this transaction, since the $83.7 million aggregate fair market value of Aiken Regional Medical Center (“Aiken”) and Canyon Creek Behavioral Health (“Canyon Creek”) exceeded the $79.6 million fair market value of the Inland Valley Campus of Southwest Healthcare System, we received approximately $4.1 million in cash from the Trust. Pursuant to the leases, as amended, the aggregate annual rental during 2022 for Aiken and Canyon Creek aggregates to approximately $5.7 million ($3.9 million related to Aiken and $1.8 million related to Canyon Creek). There is no bonus rental component applicable to the leases for these two facilities. The asset purchase and sale transaction was accounted for 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 March 31, 2022 reflects a financial liability of $83.3 million, which is included in debt, related to this transaction. Our monthly lease payments payable to the Trust will be recorded to interest expense and as a reduction to the outstanding financial liability. The aggregate rental for the leases on the four wholly-owned hospital facilities with the Trust was approximately $5 million during the three months ended March 31, 2022. The aggregate rental for the leases on the three wholly-owned hospital facilities with the Trust was approximately $4 million during each the three months ended March 31, 2021. 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 pursuant to the lease terms as provided in the table below. The rental on this facility was approximately $657,000 and $568,000 for the three months ended March 31, 2022 and 2021, respectively. 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 March 31, 2022: Hospital Name Annual Minimum Rent End of Lease Term Renewal Term (years) McAllen Medical Center $ 5,485,000 December, 5 (a) Wellington Regional Medical Center $ 6,319,000 December, 5 (b) Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services $ 3,895,000 December, 35 (c) Canyon Creek Behavioral Health $ 1,670,000 December, 35 (c) Clive Behavioral Health Hospital $ 2,628,000 December, 50 (d) (a) We have one 5-year renewal option at existing lease rates (through 2031). (b) We have one 5-year renewal options 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 (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, a 170-bed a newly constructed acute care hospital owned and operated by a wholly-owned subsidiary of ours, was completed and opened in April, 2022. In connection with this MOB, a ground lease and a master flex lease was executed between a wholly-owned subsidiary of ours and the Trust, pursuant to the terms of which our subsidiary will master lease approximately 68% of the rentable square feet of the MOB at an initial minimum rent of $1.3 million annually. The master flex lease could be reduced during the term if certain conditions are met. 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 Alan B. Miller (our Executive Chairman of the Board) 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 Executive Chairman of the Board, 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 will pay/we paid approximately $1.0 million, net, in premium payments during each of the 2022 and 2021 years, respectively. 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 vested shares of Premier, the market value of which is included in other assets on our consolidated balance sheet. Based upon the closing price of Premier’s stock on each respective date, the market value of our shares of Premier was approximately $ million and $ 92 million as of March 3 1 , 20 2 2 and December 31, 20 2 1 , respectively . Any change in market value of our Premier shares since December 31, 20 2 1 was recorded as an unrealized gain/ loss and included in “Other (income) expense, net” i n our condensed consolidated statements of income for the three - month period ended March 3 1 , 20 2 2 . Additionally, Premier declared and paid quarterly cash dividends during each of the t hree months ended March 3 1 , 202 2 and 202 1 . Our share of the cash dividends amounted to approximately $ 400,000 for each of the three-month periods ended March 3 1 , 202 2 and 202 1 . The dividends are included in “Other (income) expense, net” in our condensed consolidated statements of income . 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. |
Other Noncurrent liabilities an
Other Noncurrent liabilities and Redeemable/Noncontrolling Interests | 3 Months Ended |
Mar. 31, 2022 | |
Noncontrolling Interest [Abstract] | |
Other Noncurrent liabilities and Redeemable/Noncontrolling Interests | (3) Other Noncurrent liabilities and Redeemable/Noncontrolling Interests Other noncurrent liabilities include the long-term portion of our professional and general liability, workers’ compensation reserves, pension and deferred compensation liabilities, and liabilities incurred in connection with split-dollar life insurance agreements on the lives of our chief executive officer and his wife. As of March 31, 2022, outside owners held noncontrolling, minority ownership interests of: (i) 20% in an acute care facility located in Washington, D.C.; (ii) approximately 7% 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 $95 million and $4 million, respectively, as of March 31, 2022, 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 Condensed 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 Condensed Consolidated Balance Sheet reflects the estimated fair market value of these ownership interests. |
Treasury
Treasury | 3 Months Ended |
Mar. 31, 2022 | |
Equity [Abstract] | |
Treasury | (4) Treasury 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 March 31, 2022, this facility had $460 million of borrowings outstanding and $736 million of available borrowing capacity, net of $4 million of outstanding letters of credit; o a $1.7 billion initial 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 $1.679 billion of borrowings outstanding as of March 31, 2022, 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 March 31, 2022, the applicable margins were 0.375% for ABR-based loans and 1.375% 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 March 31, 2022 and December 31, 2021. 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. In April, 2022, the Securitization was amended (the ninth amendment) to extend the maturity date to July 22, 2022. Substantially all other material terms and conditions remained unchanged. There were no borrowings outstanding pursuant to the Securitization as of March 31, 2022. 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 March 31, 2022, 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 2 to the Consolidated Financial Statements-Relationship with Universal Health Realty Income Trust and Other Related Party Transactions As a result of our purchase option within the Aiken and Canyon Creek 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 Sheets at March 31, 2022 and December 31, 2021 reflect financial liabilities of approximately $83 million and $82 million, respectively, which is included in debt. At March 31, 2022, the carrying value and fair value of our debt were approximately $4.3 billion and $4.0 billion, respectively. At December 31, 2021, the carrying value and fair value of our debt were each approximately $4.2 billion. The fair value of our debt was computed based upon quotes received from financial institutions. We consider these to be “level 2” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with debt instruments. Cash Flow Hedges: During the three-month period ended March 31, 2022 and the year ended December 31, 2021, we had no cash flow hedges outstanding. 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 $21 million during the three-month period ended March 31, 2022 and net cash outflows of $14 million during the three-month period ended March 31, 2021. Derivatives Hedging Relationships: The following table presents the effects of our foreign currency foreign exchange contracts on our results of operations for the three-month periods ended March 31, 2022 and 2021 (in thousands): Gain/(Loss) recognized in AOCI Three months ended March 31, March 31, 2022 2021 Net Investment Hedge relationships Foreign currency foreign exchange contracts $ 17,112 $ (21,114 ) No other gains or losses were recognized in income related to derivatives in Subtopic 815-20. Cash, Cash Equivalents and Restricted Cash: Cash, cash equivalents, and restricted cash as reported in the condensed consolidated statements of cash flows are presented separately on our condensed consolidated balance sheets as follows (in thousands): March 31, March 31, December 31, 2022 2021 2021 Cash and cash equivalents $ 105,999 $ 764,502 $ 115,301 Restricted cash (a) 69,137 54,666 63,633 Total cash, cash equivalents and restricted cash $ 175,136 $ 819,168 $ 178,934 (a) Restricted cash is included in other assets on the accompanying consolidated balance sheet. |
Fair Value Measurement
Fair Value Measurement | 3 Months Ended |
Mar. 31, 2022 | |
Fair Value Disclosures [Abstract] | |
Fair Value Measurement | (5) 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) March 31, 2022 Location Level 1 Level 2 Level 3 Assets: Money market mutual funds $ 3,000 Cash and cash equivalents $ 3,000 Money market mutual funds 85,029 Other assets 85,029 Certificates of deposit 2,200 Other assets 2,200 Equity securities 79,461 Other assets 79,461 Deferred compensation assets 43,925 Other assets 43,925 Foreign currency exchange contracts 2,241 Other current assets 2,241 $ 215,856 $ 211,415 $ 4,441 - Liabilities: Deferred compensation liability 43,925 Other noncurrent liabilities 43,925 $ 43,925 $ 43,925 - - 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 - - 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 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. |
Commitments and Contingencies
Commitments and Contingencies | 3 Months Ended |
Mar. 31, 2022 | |
Commitments And Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | (6) 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 million for professional liability and $3 million for general liability per occurrence in 2022 and 2021; (ii) $10 million and $3 million per occurrence in 2020 (professional liability claims are also subject to an additional annual aggregate self-insured retention of $2.5 million for claims in excess of $10 million for 2020); (iii) $5 million and $3 million per occurrence, respectively, during 2019, 2018 and 2017, and; (iv) $10 million and $3 million per occurrence, respectively, prior to 2017. 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 2014 through 2020. As of March 31, 2022, the total net accrual for our professional and general liability claims was $358 million, of which $74 million was included in current liabilities. 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 a result of unfavorable trends experienced during 2021, included in our results of operations was a pre-tax increase of $ 52 million ($ 36 million, $ 5 million and $ 11 million recorded during the second, third and fourth quarters of 2021, respectively), to increase our reserves for self-insured 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 March 31, 2022, the total accrual for our workers’ compensation liability claims was $118 million, $55 million of which was included in current liabilities. 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. 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 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. 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: Knight v. Miller, et. al. 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 filed a motion to dismiss the complaint and the court granted part and denied part of our motion. 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 million in the aggregate. Since that time, certain of our behavioral health care hospitals in Pennsylvania have received similar requests for repayment for alleged DSH overpayments for FFYs 2012 through 2015. For FFY 2012, the claimed overpayment amounts to approximately $4 million. For FY 2013, FY 2014 and FY 2015 the initial claimed overpayments and attempted recoupment by the Department were approximately $7 million, $8 million and $7 million, respectively. The Department has agreed to a change in methodology which, upon confirmation of the underlying data being accepted by the Department, could reduce the initial claimed overpayments for FY 2013, FY 2014 and FY 2015 to approximately $2 million, $2 million and $3 million, respectively. We filed administrative appeals for all of our facilities contesting the recoupment efforts for FFYs 2011 through 2015 as we believe the Department’s calculation methodology is inaccurate and conflicts with applicable federal and state laws and regulations. The Department has agreed to postpone the recoupment of the state’s share for FY 2011 to 2013 until all hospital appeals are resolved but started recoupment of the federal share. For FY 2014 and FY 2015, the Department has initiated the recoupment of the alleged overpayments. Starting in FFY 2016, the first full fiscal year after the January 1, 2015 effective date of Medicaid expansion in Pennsylvania, the Department no longer characterized managed care payments received by the hospitals as DSH payments. We can provide no assurance that we will ultimately be successful in our legal and administrative appeals related to the Department’s repayment demands. If our legal and administrative appeals are unsuccessful, our future consolidated results of operations and financial condition could be adversely impacted by these repayments. 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. |
Segment Reporting
Segment Reporting | 3 Months Ended |
Mar. 31, 2022 | |
Segment Reporting [Abstract] | |
Segment Reporting | (7) 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 President and 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 our Annual Report on Form 10-K for the year ended December 31, 20 2 1 . The corporate overhead allocations, as reflected below, are utilized for internal reporting purposes and are comprised of each period’s projected corporate-level operating expenses (excluding interest expense). The overhead expenses are captured and allocated directly to each segment to the extent possible, and overhead expenses incurred on behalf of both segments are captured and allocated to each segment based upon each segment’s respective percentage of total operating expenses. Three months ended March 31, 2022 Acute Care Hospital Services Behavioral Health Services (a) Other Total Consolidated (Amounts in thousands) Gross inpatient revenues $ 10,239,231 $ 2,436,474 $ - $ 12,675,705 Gross outpatient revenues $ 5,775,539 $ 257,113 $ - $ 6,032,652 Total net revenues $ 1,912,316 $ 1,366,467 $ 14,173 $ 3,292,956 Income/(loss) before allocation of corporate overhead and income taxes $ 148,680 $ 205,787 $ (154,484 ) $ 199,983 Allocation of corporate overhead $ (62,284 ) $ (45,001 ) $ 107,285 $ 0 Income/(loss) after allocation of corporate overhead and before income taxes $ 86,396 $ 160,786 $ (47,199 ) $ 199,983 Total assets as of March 31, 2022 $ 5,645,352 $ 7,260,870 $ 238,224 $ 13,144,446 Three months ended March 31, 2021 Acute Care Hospital Services Behavioral Health Services (a) Other Total Consolidated (Amounts in thousands) Gross inpatient revenues $ 9,119,184 $ 2,473,565 $ 0 $ 11,592,749 Gross outpatient revenues $ 4,580,720 $ 246,764 $ 0 $ 4,827,484 Total net revenues $ 1,694,542 $ 1,315,337 $ 3,108 $ 3,012,987 Income/(loss) before allocation of corporate overhead and income taxes $ 173,118 $ 231,325 $ (131,566 ) $ 272,877 Allocation of corporate overhead $ (58,107 ) $ (42,950 ) $ 101,057 $ 0 Income/(loss) after allocation of corporate overhead and before income taxes $ 115,011 $ 188,375 $ (30,509 ) $ 272,877 Total assets as of March 31, 2021 $ 4,957,253 $ 7,090,291 $ 1,048,785 $ 13,096,329 (a) Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $176 million and $165 million for the three-month periods ended March 31, 2022 and 2021, respectively. Total assets at our U.K. behavioral health care facilities were approximately $1.320 billion and $1.355 billion as of March 31, 2022 and 2021, respectively. |
Earnings Per Share Data ("EPS")
Earnings Per Share Data ("EPS") and Stock Based Compensation | 3 Months Ended |
Mar. 31, 2022 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
Earnings Per Share Data ("EPS") and Stock Based Compensation | (8) Earnings Per Share Data (“EPS”) and Stock Based Compensation Basic earnings per share are based on the weighted average number of common shares outstanding during the period. Diluted earnings per share are based on the weighted average number of common shares outstanding during the period 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 (in thousands, except per share data): Three months ended March 31, 2022 2021 Basic and Diluted: Net income attributable to UHS $ 153,913 $ 209,091 Less: Net income attributable to unvested restricted share grants (249 ) (552 ) Net income attributable to UHS – basic and diluted $ 153,664 $ 208,539 Weighted average number of common shares - basic 75,030 84,782 Net effect of dilutive stock options and grants based on the treasury stock method 1,011 1,014 Weighted average number of common shares and equivalents - diluted 76,041 85,796 Earnings per basic share attributable to UHS: $ 2.05 $ 2.46 Earnings per diluted share attributable to UHS: $ 2.02 $ 2.43 The “Net effect of dilutive stock options and grants based on the treasury stock method”, for all periods presented above, excludes certain outstanding stock options applicable to each period since the effect would have been anti-dilutive. The excluded weighted-average stock options totaled 5.7 million for the three months ended March 31, 2022 and 4.6 million for the three months ended March 31, 2021. All classes of our common stock have the same dividend rights. Stock-Based Compensation: During the three-month periods ended March 31, 2022 and 2021, pre-tax compensation cost of $15.2 million and $14.8 million, respectively, was recognized related to outstanding stock options. In addition, during the three-month periods ended March 31, 2022 and 2021, pre-tax compensation cost of approximately $3.4 million and $2.9 million, respectively, was recognized related to restricted stock awards, restricted stock units and performance based restricted stock units. As of March 31, 2022 there was approximately $212.1 million of unrecognized compensation cost related to unvested options, restricted stock awards, restricted stock units and performance based restricted stock units which is expected to be recognized over the remaining weighted average vesting period of 3.2 years. There were 1,813,573 stock options granted during the first three months of 2022 with a weighted-average grant date fair value of $45.70 per option. There were an aggregate of 240,284 restricted units granted during the first three months of 2022, including 73,782 performance based restricted stock units, with a weighted-average grant date fair value of $143.81 per share. The expense associated with stock-based compensation arrangements is a non-cash charge. In the Condensed 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 $19.1 million and $18.0 million during the three-month periods ended March 31, 2022 and 2021. |
Dispositions and acquisitions
Dispositions and acquisitions | 3 Months Ended |
Mar. 31, 2022 | |
Business Combinations [Abstract] | |
Dispositions and acquisitions | (9) Dispositions and acquisitions Three-month period ended March 31, 2022: Acquisitions: During the first three months of 2022, there were no acquisitions. Divestitures: During the first three months of 2022, we received $10 million from the sales of assets and businesses. Three-month period ended March 31, 2021: Acquisitions: During the first three months of 2021, there were no acquisitions. Divestitures: During the first three months of 2021, there were no divestitures. |
Dividends
Dividends | 3 Months Ended |
Mar. 31, 2022 | |
Earnings Per Share [Abstract] | |
Dividends | (10) Dividends We declared and paid dividends of $15.0 million, or $.20 per share, during the first quarter of 2022 and $17.0 million, or $.20 per share, during the first quarter of 2021. Included in the amounts above were dividend equivalents applicable to unvested restricted stock units which were accrued during 2022 and 2021 and will be paid upon vesting of the restricted stock unit. |
Income Taxes
Income Taxes | 3 Months Ended |
Mar. 31, 2022 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | (11) Income Taxes Our effective income tax rates were 24.5% and 23.4% during the three month periods ended March 31, 2022 and 2021, respectively. The increase in our effective tax rate during the three months ended March 31, 2022, compared with the same period in 2021, was primarily due to a $1 million increase in our provision for income taxes attributable to employee share-based payments. The global intangible low-taxed income (“GILTI”) provisions from the TCJA-17 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 three months ended March 31, 2022 and 2021. As of January 1, 2022, our unrecognized tax benefits were approximately $2 million. The amount, if recognized, that would favorably affect the effective tax rate is approximately $2 million. During the three months ended March 31, 2022, changes to the estimated liabilities for uncertain tax positions (including accrued interest) relating to tax positions taken during prior and current periods did not have a material impact on our financial statements. We recognize accrued interest and penalties associated with uncertain tax positions as part of the tax provision. As of March 31, 2022, we have less than $1 million of accrued interest and penalties. The U.S. federal statute of limitations remains open for 2018 and subsequent years. Foreign and U.S. state and local jurisdictions have statutes of limitations generally ranging from 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 uncertain 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. 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. |
Revenue
Revenue | 3 Months Ended |
Mar. 31, 2022 | |
Revenue From Contract With Customer [Abstract] | |
Revenue | (12) Revenue 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 three-month periods ended March 31, 2022 and 2021 (in thousands): For the three months ended March 31, 2022 Acute Care Behavioral Health Other Total Medicare $ 337,109 18 % $ 79,512 6 % $ 416,621 13 % Managed Medicare 332,248 17 % 63,850 5 % 396,098 12 % Medicaid 155,836 8 % 175,403 13 % 331,239 10 % Managed Medicaid 171,637 9 % 334,165 24 % 505,802 15 % Managed Care (HMO and PPOs) 638,895 33 % 365,205 27 % 1,004,100 30 % UK Revenue 0 0 % 176,092 13 % 176,092 5 % Other patient revenue and adjustments, net 92,110 5 % 120,733 9 % 212,843 6 % Other non-patient revenue 184,481 10 % 51,507 4 % 14,173 250,161 8 % Total Net Revenue $ 1,912,316 100 % $ 1,366,467 100 % $ 14,173 3,292,956 100 % For the three months ended March 31, 2021 Acute Care Behavioral Health Other Total Medicare $ 335,513 20 % $ 88,492 7 % $ 424,005 14 % Managed Medicare 275,560 16 % 57,542 4 % 333,102 11 % Medicaid 111,641 7 % 153,140 12 % 264,781 9 % Managed Medicaid 135,498 8 % 334,758 25 % 470,256 16 % Managed Care (HMO and PPOs) 598,810 35 % 348,744 27 % 947,554 31 % UK Revenue 0 0 % 164,666 13 % 164,666 5 % Other patient revenue and adjustments, net 94,250 6 % 120,283 9 % 214,533 7 % Other non-patient revenue 143,270 8 % 47,712 4 % 3,108 194,090 6 % Total Net Revenue $ 1,694,542 100 % $ 1,315,337 100 % $ 3,108 $ 3,012,987 100 % |
Lease Accounting
Lease Accounting | 3 Months Ended |
Mar. 31, 2022 | |
Leases [Abstract] | |
Lease Accounting | (13) Lease Accounting 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 ten years. These real estate leases may include one or more options to renew, with renewals that can extend the lease term from five to ten 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 2 for additional disclosure). We are also the lessee of the real property of certain facilities from unrelated third parties. Supplemental cash flow information related to leases for the three-month periods ended March 31, 2022 and 2021 are as follows (in thousands): Three months ended March 31, 2022 2021 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 31,325 $ 31,043 Operating cash flows from finance leases $ 1,006 $ 1,184 Financing cash flows from finance leases $ 803 $ 697 Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 19,037 $ 5,907 Finance leases $ 1,066 $ 7,690 |
Recent Accounting Standards
Recent Accounting Standards | 3 Months Ended |
Mar. 31, 2022 | |
Accounting Changes And Error Corrections [Abstract] | |
Recent Accounting Standards | (14) Recent Accounting Standards In November 2021, the Financial Accounting Standards Board (the “FASB”) issued Accounting Standards Update (“ASU”) 2021-10, “Government Assistance (Topic 832)” (“ASU 2021-10”). ASU 2021-10 provides guidance to increase the transparency of government assistance including the disclosure of (1) the types of assistance, (2) an entity’s accounting for the assistance, and (3) the effect of the assistance on an entity’s financial statements. ASU 2021-10 applies to all business entities except for not-for-profit entities within the scope of Topic 958, Not-for-Profit Entities, and employee benefit plans within the scope of Topic 960, Plan Accounting—Defined Benefit Pension Plans, Topic 962, Plan Accounting—Defined Contribution Pension Plans, and Topic 965, Plan Accounting—Health and Welfare Benefit Plans that account for a transaction with a government by applying a grant or contribution accounting model by analogy to other accounting guidance (for example, a grant model within IAS 20, Accounting for Government Grants and Disclosure of Government Assistance, or Subtopic 958-605, Not-For-Profit Entities—Revenue Recognition). ASU 2021-10 is effective for fiscal years beginning after December 15, 2021. Early adoption is permitted. The Company is evaluating the impact of ASU 2021-10 on the Company’s consolidated financial statements. 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. The pronouncement is effective immediately and can be applied to contract modifications through December 31, 2022. To the extent that, prior to December 31, 2022, the Company enters into any contract modifications for which the optional expedients are applied, the adoption of this standard is not expected to have a material impact 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. |
Relationship with Universal H_2
Relationship with Universal Health Realty Income Trust and Other Related Party Transactions (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
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 March 31, 2022: Hospital Name Annual Minimum Rent End of Lease Term Renewal Term (years) McAllen Medical Center $ 5,485,000 December, 5 (a) Wellington Regional Medical Center $ 6,319,000 December, 5 (b) Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services $ 3,895,000 December, 35 (c) Canyon Creek Behavioral Health $ 1,670,000 December, 35 (c) Clive Behavioral Health Hospital $ 2,628,000 December, 50 (d) (a) We have one 5-year renewal option at existing lease rates (through 2031). (b) We have one 5-year renewal options 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 (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. |
Treasury (Tables)
Treasury (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Equity [Abstract] | |
Summary of Effects of Foreign Currency Foreign Exchange Contracts on Result of Operations | The following table presents the effects of our foreign currency foreign exchange contracts on our results of operations for the three-month periods ended March 31, 2022 and 2021 (in thousands): Gain/(Loss) recognized in AOCI Three months ended March 31, March 31, 2022 2021 Net Investment Hedge relationships Foreign currency foreign exchange contracts $ 17,112 $ (21,114 ) |
Summary of Cash, Cash Equivalents and Restricted Cash Reported In Condensed Consolidated Statements of Cash Flows | Cash, cash equivalents, and restricted cash as reported in the condensed consolidated statements of cash flows are presented separately on our condensed consolidated balance sheets as follows (in thousands): March 31, March 31, December 31, 2022 2021 2021 Cash and cash equivalents $ 105,999 $ 764,502 $ 115,301 Restricted cash (a) 69,137 54,666 63,633 Total cash, cash equivalents and restricted cash $ 175,136 $ 819,168 $ 178,934 (a) Restricted cash is included in other assets on the accompanying consolidated balance sheet. |
Fair Value Measurement (Tables)
Fair Value Measurement (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Fair Value Disclosures [Abstract] | |
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) March 31, 2022 Location Level 1 Level 2 Level 3 Assets: Money market mutual funds $ 3,000 Cash and cash equivalents $ 3,000 Money market mutual funds 85,029 Other assets 85,029 Certificates of deposit 2,200 Other assets 2,200 Equity securities 79,461 Other assets 79,461 Deferred compensation assets 43,925 Other assets 43,925 Foreign currency exchange contracts 2,241 Other current assets 2,241 $ 215,856 $ 211,415 $ 4,441 - Liabilities: Deferred compensation liability 43,925 Other noncurrent liabilities 43,925 $ 43,925 $ 43,925 - - 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 - - |
Segment Reporting (Tables)
Segment Reporting (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Segment Reporting [Abstract] | |
Segment Reporting | Three months ended March 31, 2022 Acute Care Hospital Services Behavioral Health Services (a) Other Total Consolidated (Amounts in thousands) Gross inpatient revenues $ 10,239,231 $ 2,436,474 $ - $ 12,675,705 Gross outpatient revenues $ 5,775,539 $ 257,113 $ - $ 6,032,652 Total net revenues $ 1,912,316 $ 1,366,467 $ 14,173 $ 3,292,956 Income/(loss) before allocation of corporate overhead and income taxes $ 148,680 $ 205,787 $ (154,484 ) $ 199,983 Allocation of corporate overhead $ (62,284 ) $ (45,001 ) $ 107,285 $ 0 Income/(loss) after allocation of corporate overhead and before income taxes $ 86,396 $ 160,786 $ (47,199 ) $ 199,983 Total assets as of March 31, 2022 $ 5,645,352 $ 7,260,870 $ 238,224 $ 13,144,446 Three months ended March 31, 2021 Acute Care Hospital Services Behavioral Health Services (a) Other Total Consolidated (Amounts in thousands) Gross inpatient revenues $ 9,119,184 $ 2,473,565 $ 0 $ 11,592,749 Gross outpatient revenues $ 4,580,720 $ 246,764 $ 0 $ 4,827,484 Total net revenues $ 1,694,542 $ 1,315,337 $ 3,108 $ 3,012,987 Income/(loss) before allocation of corporate overhead and income taxes $ 173,118 $ 231,325 $ (131,566 ) $ 272,877 Allocation of corporate overhead $ (58,107 ) $ (42,950 ) $ 101,057 $ 0 Income/(loss) after allocation of corporate overhead and before income taxes $ 115,011 $ 188,375 $ (30,509 ) $ 272,877 Total assets as of March 31, 2021 $ 4,957,253 $ 7,090,291 $ 1,048,785 $ 13,096,329 (a) Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $176 million and $165 million for the three-month periods ended March 31, 2022 and 2021, respectively. Total assets at our U.K. behavioral health care facilities were approximately $1.320 billion and $1.355 billion as of March 31, 2022 and 2021, respectively. |
Earnings Per Share Data ("EPS_2
Earnings Per Share Data ("EPS") and Stock Based Compensation (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
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 (in thousands, except per share data): Three months ended March 31, 2022 2021 Basic and Diluted: Net income attributable to UHS $ 153,913 $ 209,091 Less: Net income attributable to unvested restricted share grants (249 ) (552 ) Net income attributable to UHS – basic and diluted $ 153,664 $ 208,539 Weighted average number of common shares - basic 75,030 84,782 Net effect of dilutive stock options and grants based on the treasury stock method 1,011 1,014 Weighted average number of common shares and equivalents - diluted 76,041 85,796 Earnings per basic share attributable to UHS: $ 2.05 $ 2.46 Earnings per diluted share attributable to UHS: $ 2.02 $ 2.43 |
Revenue (Tables)
Revenue (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Revenue From Contract With Customer [Abstract] | |
Schedule of Disaggregates Revenue by Major Source | The following table disaggregates our revenue by major source for the three-month periods ended March 31, 2022 and 2021 (in thousands): For the three months ended March 31, 2022 Acute Care Behavioral Health Other Total Medicare $ 337,109 18 % $ 79,512 6 % $ 416,621 13 % Managed Medicare 332,248 17 % 63,850 5 % 396,098 12 % Medicaid 155,836 8 % 175,403 13 % 331,239 10 % Managed Medicaid 171,637 9 % 334,165 24 % 505,802 15 % Managed Care (HMO and PPOs) 638,895 33 % 365,205 27 % 1,004,100 30 % UK Revenue 0 0 % 176,092 13 % 176,092 5 % Other patient revenue and adjustments, net 92,110 5 % 120,733 9 % 212,843 6 % Other non-patient revenue 184,481 10 % 51,507 4 % 14,173 250,161 8 % Total Net Revenue $ 1,912,316 100 % $ 1,366,467 100 % $ 14,173 3,292,956 100 % For the three months ended March 31, 2021 Acute Care Behavioral Health Other Total Medicare $ 335,513 20 % $ 88,492 7 % $ 424,005 14 % Managed Medicare 275,560 16 % 57,542 4 % 333,102 11 % Medicaid 111,641 7 % 153,140 12 % 264,781 9 % Managed Medicaid 135,498 8 % 334,758 25 % 470,256 16 % Managed Care (HMO and PPOs) 598,810 35 % 348,744 27 % 947,554 31 % UK Revenue 0 0 % 164,666 13 % 164,666 5 % Other patient revenue and adjustments, net 94,250 6 % 120,283 9 % 214,533 7 % Other non-patient revenue 143,270 8 % 47,712 4 % 3,108 194,090 6 % Total Net Revenue $ 1,694,542 100 % $ 1,315,337 100 % $ 3,108 $ 3,012,987 100 % |
Lease Accounting (Tables)
Lease Accounting (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Leases [Abstract] | |
Supplemental Cash Flow Information Related to Leases | Supplemental cash flow information related to leases for the three-month periods ended March 31, 2022 and 2021 are as follows (in thousands): Three months ended March 31, 2022 2021 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 31,325 $ 31,043 Operating cash flows from finance leases $ 1,006 $ 1,184 Financing cash flows from finance leases $ 803 $ 697 Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 19,037 $ 5,907 Finance leases $ 1,066 $ 7,690 |
General - Additional Informatio
General - Additional Information (Detail) - USD ($) $ in Millions | 1 Months Ended | 3 Months Ended | |
Mar. 31, 2021 | Jun. 30, 2021 | Mar. 31, 2021 | |
Disclosure of General Information [Line Items] | |||
Additional funds received from government by CARES Act | $ 189 | ||
Return of funds by CARES Act to government | $ 189 | ||
Medicare Accelerated and Advance Payment Program | |||
Disclosure of General Information [Line Items] | |||
Medicare accelerated payments received | $ 695 |
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 ($)BedSquareFoot | Mar. 31, 2022USD ($)FacilityHospitalBed | Mar. 31, 2021USD ($)Hospital | Dec. 31, 2013 | Dec. 31, 2022USD ($) | Dec. 31, 2021USD ($) | Dec. 31, 2020 | Dec. 31, 2019 | |
Related Party Transaction [Line Items] | ||||||||
Net revenues | $ 3,292,956,000 | $ 3,012,987,000 | ||||||
Lease and rental expense | $ 32,038,000 | $ 31,324,000 | ||||||
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 | |||||||
Chief Executive Officer | Scenario Forecast | ||||||||
Related Party Transaction [Line Items] | ||||||||
Payments to acquire life insurance policies, net | $ 1,000,000 | |||||||
Chief Executive Officer | Trust Owned by CEO | ||||||||
Related Party Transaction [Line Items] | ||||||||
Estimated payments to acquire life insurance policies | 9,000,000 | |||||||
Minimum | Chief Executive Officer | ||||||||
Related Party Transaction [Line Items] | ||||||||
Estimated death benefit proceeds | $ 37,000,000 | |||||||
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% | 0.70% | 0.70% | |||
Pre-tax share of income from the Trust | $ 300,000 | $ 300,000 | ||||||
Dividends received from the Trust | 555,000 | 547,000 | ||||||
Carrying value of investment in Trust | 9,100,000 | $ 9,400,000 | ||||||
Market value of investment in Trust | 46,000,000 | 46,800,000 | ||||||
Financial liability included in debt | 83,300,000 | |||||||
Lease and rental expense | $ 5,000,000 | $ 4,000,000 | ||||||
Number of hospital facilities | Hospital | 4 | 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 | |||||||
Number of square feet to be constructed | SquareFoot | 86,000 | |||||||
Number of beds available in acute care hospital | Bed | 170 | |||||||
Percentage of master lease rentable square feet | 68.00% | |||||||
Relationship with Universal Health Realty Income Trust | Minimum | ||||||||
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 | Limited Liability Companies | ||||||||
Related Party Transaction [Line Items] | ||||||||
Non-controlling ownership interests by subsidiaries | 100.00% | |||||||
Relationship with Universal Health Realty Income Trust | Aiken, South Carolina | Behavioral Health Care Facility | ||||||||
Related Party Transaction [Line Items] | ||||||||
Lease and rental expense | $ 657,000 | $ 568,000 | ||||||
Notice period on renewal of lease | 270 days | |||||||
Period of rights of refusal to leased facilities | 30 days | |||||||
Number of bed available in behavioral health care facility | Bed | 100 | |||||||
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 | 1,800,000 | |||||||
Relationship with Universal Health Realty Income Trust | Aiken Regional Medical Center and Canyon Creek Behavioral Health | ||||||||
Related Party Transaction [Line Items] | ||||||||
Lease rent receivable | $ 5,700,000 | |||||||
Number of facilities leased | Facility | 2 | |||||||
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 | 4,100,000 | |||||||
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 | Canyon Creek Behavioral Health | Temple, Texas | ||||||||
Related Party Transaction [Line Items] | ||||||||
Fair market value of real estate assets sold | 26,000,000 | |||||||
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 | 83,700,000 | |||||||
Relationship with Universal Health Realty Income Trust | Advisory Fee | ||||||||
Related Party Transaction [Line Items] | ||||||||
Net revenues | 1,200,000 | 1,100,000 | ||||||
Premier, Inc. | Other (Income) Expense, Net | ||||||||
Related Party Transaction [Line Items] | ||||||||
Dividend | 400,000 | $ 400,000 | ||||||
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 | $ 79,000,000 | $ 92,000,000 |
Summary of Details of Hospitals
Summary of Details of Hospitals Leased from Trust (Detail) - USD ($) | 3 Months Ended | ||
Mar. 31, 2022 | Mar. 31, 2021 | ||
Property Subject to or Available for Operating Lease [Line Items] | |||
Lease and rental expense | $ 32,038,000 | $ 31,324,000 | |
McAllen Medical Center | |||
Property Subject to or Available for Operating Lease [Line Items] | |||
Lease and rental expense | $ 5,485,000 | ||
End of Lease Term | 2026-12 | ||
Renewal Term (years) | [1] | 5 years | |
Wellington Regional Medical Center | |||
Property Subject to or Available for Operating Lease [Line Items] | |||
Lease and rental expense | $ 6,319,000 | ||
End of Lease Term | 2026-12 | ||
Renewal Term (years) | [2] | 5 years | |
Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services | |||
Property Subject to or Available for Operating Lease [Line Items] | |||
Lease and rental expense | $ 3,895,000 | ||
End of Lease Term | 2033-12 | ||
Renewal Term (years) | 35 years | ||
Canyon Creek Behavioral Health | |||
Property Subject to or Available for Operating Lease [Line Items] | |||
Lease and rental expense | $ 1,670,000 | ||
End of Lease Term | 2033-12 | ||
Renewal Term (years) | 35 years | ||
Clive Behavioral Health Hospital | |||
Property Subject to or Available for Operating Lease [Line Items] | |||
Lease and rental expense | $ 2,628,000 | ||
End of Lease Term | 2040-12 | ||
Renewal Term (years) | 50 years | ||
[1] | We have one 5-year renewal option at existing lease rates (through 2031). | ||
[2] | We have one 5-year renewal options 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 |
Summary of Details of Hospita_2
Summary of Details of Hospitals Leased from Trust (Parenthetical) (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2022USD ($)RenewalOption | |
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 |
McAllen Medical Center | |
Property Subject to or Available for Operating Lease [Line Items] | |
Renewal options term at existing lease rates | 5 years |
McAllen Medical Center | Maximum | |
Property Subject to or Available for Operating Lease [Line Items] | |
Renewal options at existing lease rates expiration year | 2031 |
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% |
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 |
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 |
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 |
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 |
Canyon Creek Behavioral Health | |
Property Subject to or Available for Operating Lease [Line Items] | |
Renewal options term at fair market lease rates | 5 years |
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 |
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 |
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 |
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 |
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 |
Other Noncurrent Liabilities _2
Other Noncurrent Liabilities and Redeemable/Noncontrolling Interests - Additional Information (Detail) $ in Millions | Mar. 31, 2022USD ($)Facility |
Minority Interest [Line Items] | |
Behavioral health care facilities with outside owners holding non-controlling minority interest | Facility | 5 |
Non-controlling interest balances | $ 95 |
Redeemable non-controlling interest balances | $ 4 |
Outside Owners | Acute Care Facility | Washington, District of Columbia | |
Minority Interest [Line Items] | |
Percentage of non-controlling, minority ownership interests held by outside owners | 20.00% |
Outside Owners | Acute Care Facility | Texas | |
Minority Interest [Line Items] | |
Percentage of non-controlling, minority ownership interests held by outside owners | 7.00% |
Outside Owners | Acute Care Facility | Nevada | |
Minority Interest [Line Items] | |
Percentage of non-controlling, minority ownership interests held by outside owners | 5.00% |
Outside Owners | Behavioral Health Care Facility | Pennsylvania | |
Minority Interest [Line Items] | |
Percentage of non-controlling, minority ownership interests held by outside owners | 20.00% |
Outside Owners | Behavioral Health Care Facility | Ohio | |
Minority Interest [Line Items] | |
Percentage of non-controlling, minority ownership interests held by outside owners | 30.00% |
Outside Owners | Behavioral Health Care Facility | Washington | |
Minority Interest [Line Items] | |
Percentage of non-controlling, minority ownership interests held by outside owners | 20.00% |
Outside Owners | Behavioral Health Care Facility | Missouri | |
Minority Interest [Line Items] | |
Percentage of non-controlling, minority ownership interests held by outside owners | 25.00% |
Outside Owners | Behavioral Health Care Facility | Iowa | |
Minority Interest [Line Items] | |
Percentage of non-controlling, minority ownership interests held by outside owners | 48.00% |
Treasury - Additional Informati
Treasury - Additional Information (Detail) - USD ($) | Sep. 13, 2021 | Aug. 24, 2021 | Sep. 28, 2020 | Mar. 31, 2022 | Mar. 31, 2021 | Dec. 31, 2021 | Apr. 30, 2021 | Sep. 21, 2020 | Oct. 23, 2018 |
Equity Class Of Treasury Stock [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 | ||||||||
Securitized extended maturity date | Jul. 22, 2022 | ||||||||
Accounts receivable securitization program credit facility, amount outstanding | $ 0 | ||||||||
Debt instrument carrying amount | 4,300,000,000 | $ 4,200,000,000 | |||||||
Fair value of debt | 4,000,000,000 | 4,200,000,000 | |||||||
Cash flow hedges | 0 | 0 | |||||||
Foreign Currency Forward Exchange Contracts | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Net cash (outflows) inflows | 21,000,000 | $ (14,000,000) | |||||||
Debt | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Financial liabilities | $ 83,000,000 | $ 82,000,000 | |||||||
Revolving Credit Facility | |||||||||
Equity Class Of Treasury Stock [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 | $ 460,000,000 | ||||||||
Line of credit facility, available borrowing capacity | $ 736,000,000 | ||||||||
Revolving Credit Facility | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Current applicable margins | 1.375% | ||||||||
Revolving Credit Facility | ABR-based loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Current applicable margins | 0.375% | ||||||||
Revolving Credit Facility | Letter of Credit | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Line of credit facility, borrowing capacity | $ 125,000,000 | ||||||||
Letters of credit, outstanding | 4,000,000 | ||||||||
Tranche A Term Loan | |||||||||
Equity Class Of Treasury Stock [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 | 1,679,000,000 | ||||||||
Tranche A Term Loan | Quarterly Payment Beginning on December 31,2021 Through September 2023 | |||||||||
Equity Class Of Treasury Stock [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 | |||||||||
Equity Class Of Treasury Stock [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 | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Line of credit facility amount outstanding | $ 488,000,000 | ||||||||
New Senior Secured Notes | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Senior notes, issued | 2,000,000,000 | ||||||||
New Senior Secured Notes | 5.00% Senior Secured Notes due 2026 | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Senior notes, interest rate | 5.00% | ||||||||
Senior notes, redeemed | $ 400,000,000 | ||||||||
Redemption price, percentage | 102.50% | ||||||||
Senior notes, redemption price | $ 410,000,000 | ||||||||
New Senior Secured Notes | 1.65% Senior Secured Notes due 2026 | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Line of credit facility, maturity date | Sep. 1, 2026 | ||||||||
Senior notes, issued | $ 700,000,000 | $ 700,000,000 | |||||||
Senior notes, interest rate | 1.65% | 1.65% | |||||||
New Senior Secured Notes | 2.65% Senior Secured Notes due 2032 | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Line of credit facility, maturity date | Jan. 15, 2032 | ||||||||
Senior notes, issued | $ 500,000,000 | $ 500,000,000 | |||||||
Senior notes, interest rate | 2.65% | 2.65% | |||||||
New Senior Secured Notes | 2.65% Senior Secured Notes due 2030 | |||||||||
Equity Class Of Treasury Stock [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 | 4.75% Senior Secured Notes due 2022 | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Senior notes, interest rate | 4.75% | ||||||||
Senior notes, redeemed | $ 700,000,000 | ||||||||
Redemption price, percentage | 100.00% | ||||||||
New Senior Secured Notes | 5.00% Senior Secured Notes due 2026 | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Line of credit facility, maturity date | Sep. 1, 2026 | ||||||||
Term Loan A | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Current applicable margins | 1.375% | ||||||||
Term Loan A | ABR-based loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Current applicable margins | 0.375% | ||||||||
Minimum | Revolving Credit Facility | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Consolidated Leverage Ratio | 0.25% | ||||||||
Minimum | Revolving Credit Facility | One Three Six Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Consolidated Leverage Ratio | 1.25% | ||||||||
Minimum | Term Loan A | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Consolidated Leverage Ratio | 0.25% | ||||||||
Minimum | Term Loan A | One Three Six Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Consolidated Leverage Ratio | 1.25% | ||||||||
Maximum | Revolving Credit Facility | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Consolidated Leverage Ratio | 0.625% | ||||||||
Maximum | Revolving Credit Facility | One Three Six Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Consolidated Leverage Ratio | 1.625% | ||||||||
Maximum | New Senior Secured Notes | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Number of days to complete exchange offer | 60 days | ||||||||
Maximum | Term Loan A | One Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Consolidated Leverage Ratio | 0.625% | ||||||||
Maximum | Term Loan A | One Three Six Month LIBOR Rate Plus Index Based Loans | |||||||||
Equity Class Of Treasury Stock [Line Items] | |||||||||
Consolidated Leverage Ratio | 1.625% |
Summary of Effects of Foreign C
Summary of Effects of Foreign Currency Foreign Exchange Contracts on Result of Operations (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Designated As Hedging Instrument | Net Investment Hedge | Foreign Currency Foreign Exchange Contracts | ||
Derivative Instruments Gain Loss [Line Items] | ||
Gain/(Loss) recognized in AOCI | $ 17,112 | $ (21,114) |
Summary of Cash, Cash Equivalen
Summary of Cash, Cash Equivalents and Restricted Cash Reported In Condensed Consolidated Statements of Cash Flows (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 | Mar. 31, 2021 | |
Cash And Cash Equivalents Period Increase Decrease [Abstract] | ||||
Cash and cash equivalents | $ 105,999 | $ 115,301 | $ 764,502 | |
Restricted cash | [1] | $ 69,137 | $ 63,633 | $ 54,666 |
Restricted Cash, Statement of Financial Position [Extensible Enumeration] | us-gaap:OtherAssetsNoncurrent | us-gaap:OtherAssetsNoncurrent | us-gaap:OtherAssetsNoncurrent | |
Total cash, cash equivalents and restricted cash | $ 175,136 | $ 178,934 | $ 819,168 | |
[1] | Restricted cash is included in other assets on the accompanying consolidated balance sheet. |
Summary of Assets and Liabiliti
Summary of Assets and Liabilities Recorded at Fair Value on Recurring Basis (Detail) - Recurring - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Assets: | ||
Assets, fair value | $ 215,856 | $ 221,235 |
Liabilities: | ||
Liabilities, fair value | 43,925 | 45,759 |
Money Market Mutual Funds | Cash and Cash Equivalents | ||
Assets: | ||
Assets, fair value | 3,000 | |
Money Market Mutual Funds | Other Assets | ||
Assets: | ||
Assets, fair value | 85,029 | 79,900 |
Certificates of Deposit | Other Assets | ||
Assets: | ||
Assets, fair value | 2,200 | 2,300 |
Equity Securities | Other Assets | ||
Assets: | ||
Assets, fair value | 79,461 | 91,919 |
Deferred Compensation Assets | Other Assets | ||
Assets: | ||
Assets, fair value | 43,925 | 45,759 |
Foreign Currency Foreign Exchange Contracts | Other Current Assets | ||
Assets: | ||
Assets, fair value | 2,241 | 1,357 |
Deferred Compensation Liability | Other Noncurrent Liabilities | ||
Liabilities: | ||
Liabilities, fair value | 43,925 | 45,759 |
Basis of Fair Value Measurement, Level 1 | ||
Assets: | ||
Assets, fair value | 211,415 | 217,578 |
Liabilities: | ||
Liabilities, fair value | 43,925 | 45,759 |
Basis of Fair Value Measurement, Level 1 | Money Market Mutual Funds | Cash and Cash Equivalents | ||
Assets: | ||
Assets, fair value | 3,000 | |
Basis of Fair Value Measurement, Level 1 | Money Market Mutual Funds | Other Assets | ||
Assets: | ||
Assets, fair value | 85,029 | 79,900 |
Basis of Fair Value Measurement, Level 1 | Equity Securities | Other Assets | ||
Assets: | ||
Assets, fair value | 79,461 | 91,919 |
Basis of Fair Value Measurement, Level 1 | Deferred Compensation Assets | Other Assets | ||
Assets: | ||
Assets, fair value | 43,925 | 45,759 |
Basis of Fair Value Measurement, Level 1 | Deferred Compensation Liability | Other Noncurrent Liabilities | ||
Liabilities: | ||
Liabilities, fair value | 43,925 | 45,759 |
Basis of Fair Value Measurement, Level 2 | ||
Assets: | ||
Assets, fair value | 4,441 | 3,657 |
Basis of Fair Value Measurement, Level 2 | Certificates of Deposit | Other Assets | ||
Assets: | ||
Assets, fair value | 2,200 | 2,300 |
Basis of Fair Value Measurement, Level 2 | Foreign Currency Foreign Exchange Contracts | Other Current Assets | ||
Assets: | ||
Assets, fair value | $ 2,241 | $ 1,357 |
Commitments and Contingencies -
Commitments and Contingencies - Additional Information (Detail) £ in Millions | 3 Months Ended | 12 Months Ended | |||||||||||||||||
Mar. 31, 2022GBP (£) | Dec. 31, 2021USD ($) | Sep. 30, 2021USD ($) | Jun. 30, 2021USD ($) | Dec. 31, 2021USD ($) | Dec. 31, 2015USD ($) | Dec. 31, 2014USD ($) | Dec. 31, 2013USD ($) | Dec. 31, 2012USD ($) | Dec. 31, 2011USD ($) | Mar. 31, 2022USD ($) | Mar. 31, 2022GBP (£) | Dec. 31, 2020USD ($) | Jun. 01, 2020USD ($) | Mar. 31, 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, current | $ 74,000,000 | $ 74,000,000 | $ 74,000,000 | ||||||||||||||||
Compensation liability claims | 115,000,000 | 115,000,000 | 118,000,000 | ||||||||||||||||
Compensation and related benefits | 55,000,000 | 55,000,000 | $ 55,000,000 | ||||||||||||||||
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 | ||||||||||||||||
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 | 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 | Earthquake | OTHER STATES | |||||||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||||||
Commercial property insurance policies covering catastrophic losses | 250,000,000 | ||||||||||||||||||
Maximum | Flood | |||||||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||||||
Commercial property insurance policies covering catastrophic losses | 100,000,000 | ||||||||||||||||||
Maximum | Flood | PUERTO RICO | |||||||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||||||
Commercial property insurance policies covering catastrophic losses | 1,000,000 | ||||||||||||||||||
Maximum | Flood | Texas | |||||||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||||||
Commercial property insurance policies covering catastrophic losses | $ 10,000,000 | ||||||||||||||||||
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 | 36,000,000 | $ 5,000,000 | $ 11,000,000 | 52,000,000 | |||||||||||||||
General and Professional Liability | |||||||||||||||||||
Commitments and Contingencies Disclosure [Line Items] | |||||||||||||||||||
Self-insured for professional and general liability | 349,000,000 | 349,000,000 | $ 358,000,000 | ||||||||||||||||
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 | 20,000,000 | 20,000,000 | 10,000,000 | $ 5,000,000 | $ 5,000,000 | $ 5,000,000 | $ 10,000,000 | |||||||||||
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 | 3,000,000 | 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 | $ 155,000,000 | $ 250,000,000 | $ 250,000,000 | $ 162,500,000 | $ 250,000,000 | $ 250,000,000 | $ 250,000,000 | $ 250,000,000 | $ 250,000,000 |
Segment Reporting (Detail)
Segment Reporting (Detail) - USD ($) $ in Thousands | 3 Months Ended | |||
Mar. 31, 2022 | Mar. 31, 2021 | Dec. 31, 2021 | ||
Segment Reporting Information [Line Items] | ||||
Gross inpatient revenues | $ 12,675,705 | $ 11,592,749 | ||
Gross outpatient revenues | 6,032,652 | 4,827,484 | ||
Total net revenues | 3,292,956 | 3,012,987 | ||
Income/(loss) before allocation of corporate overhead and income taxes | 199,983 | 272,877 | ||
Allocation of corporate overhead | 0 | 0 | ||
Income before income taxes | 199,983 | 272,877 | ||
Total assets | 13,144,446 | 13,096,329 | $ 13,093,543 | |
Acute Care Hospital Services | ||||
Segment Reporting Information [Line Items] | ||||
Gross inpatient revenues | 10,239,231 | 9,119,184 | ||
Gross outpatient revenues | 5,775,539 | 4,580,720 | ||
Total net revenues | 1,912,316 | 1,694,542 | ||
Income/(loss) before allocation of corporate overhead and income taxes | 148,680 | 173,118 | ||
Allocation of corporate overhead | (62,284) | (58,107) | ||
Income before income taxes | 86,396 | 115,011 | ||
Total assets | 5,645,352 | 4,957,253 | ||
Behavioral Health Services | ||||
Segment Reporting Information [Line Items] | ||||
Gross inpatient revenues | [1] | 2,436,474 | 2,473,565 | |
Gross outpatient revenues | [1] | 257,113 | 246,764 | |
Total net revenues | [1] | 1,366,467 | 1,315,337 | |
Income/(loss) before allocation of corporate overhead and income taxes | [1] | 205,787 | 231,325 | |
Allocation of corporate overhead | [1] | (45,001) | (42,950) | |
Income before income taxes | [1] | 160,786 | 188,375 | |
Total assets | [1] | 7,260,870 | 7,090,291 | |
Other | ||||
Segment Reporting Information [Line Items] | ||||
Gross inpatient revenues | 0 | |||
Gross outpatient revenues | 0 | |||
Total net revenues | 14,173 | 3,108 | ||
Income/(loss) before allocation of corporate overhead and income taxes | (154,484) | (131,566) | ||
Allocation of corporate overhead | 107,285 | 101,057 | ||
Income before income taxes | (47,199) | (30,509) | ||
Total assets | $ 238,224 | $ 1,048,785 | ||
[1] | Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $176 million and $165 million for the three-month periods ended March 31, 2022 and 2021, respectively. Total assets at our U.K. behavioral health care facilities were approximately $1.320 billion and $1.355 billion as of March 31, 2022 and 2021, respectively. |
Segment Reporting (Parenthetica
Segment Reporting (Parenthetical) (Detail) - USD ($) $ in Thousands | 3 Months Ended | |||
Mar. 31, 2022 | Mar. 31, 2021 | Dec. 31, 2021 | ||
Segment Reporting Information [Line Items] | ||||
Net revenues | $ 3,292,956 | $ 3,012,987 | ||
Total assets | 13,144,446 | 13,096,329 | $ 13,093,543 | |
Behavioral Health Services | ||||
Segment Reporting Information [Line Items] | ||||
Net revenues | [1] | 1,366,467 | 1,315,337 | |
Total assets | [1] | 7,260,870 | 7,090,291 | |
Behavioral Health Services | Located in U.K. | ||||
Segment Reporting Information [Line Items] | ||||
Net revenues | 176,000 | 165,000 | ||
Total assets | $ 1,320,000 | $ 1,355,000 | ||
[1] | Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $176 million and $165 million for the three-month periods ended March 31, 2022 and 2021, respectively. Total assets at our U.K. behavioral health care facilities were approximately $1.320 billion and $1.355 billion as of March 31, 2022 and 2021, respectively. |
Computation of Basic and Dilute
Computation of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Basic and Diluted: | ||
Net income attributable to UHS | $ 153,913 | $ 209,091 |
Less: Net income attributable to unvested restricted share grants | (249) | (552) |
Net income attributable to UHS – basic and diluted | $ 153,664 | $ 208,539 |
Weighted average number of common shares - basic | 75,030 | 84,782 |
Net effect of dilutive stock options and grants based on the treasury stock method | 1,011 | 1,014 |
Weighted average number of common shares and equivalents - diluted | 76,041 | 85,796 |
Earnings per basic share attributable to UHS: | $ 2.05 | $ 2.46 |
Earnings per diluted share attributable to UHS: | $ 2.02 | $ 2.43 |
Earnings Per Share Data ("EPS_3
Earnings Per Share Data ("EPS") and Stock Based Compensation - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Anti-dilutive weighted average stock options excluded from computation of earnings per share | 5,700,000 | 4,600,000 |
Stock options granted during period | 1,813,573 | |
Weighted-average grant date fair value, per option | $ 45.70 | |
Compensation cost recognized | $ 19,055 | $ 18,022 |
Stock Options | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Compensation cost recognized, pre-tax charge | 15,200 | 14,800 |
Restricted Stock Awards, Restricted Stock Units and Performance Based Restricted Stock Units | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Compensation cost recognized, pre-tax charge | $ 3,400 | $ 2,900 |
Unrecognized compensation cost vesting period | 3 years 2 months 12 days | |
Unvested Stock option | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Unrecognized compensation cost related to unvested options and restricted stock | $ 212,100 | |
Restricted Stock | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Restricted shares and restricted units granted during period | 240,284 | |
Weighted-average grant date fair value, per share | $ 143.81 | |
Performance Based Restricted Stock Units | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Restricted shares and restricted units granted during period | 73,782 |
Dispositions and Acquisitions -
Dispositions and Acquisitions - Additional Information (Detail) - USD ($) | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Business Combinations [Abstract] | ||
Acquisition, cash paid | $ 0 | $ 0 |
Aggregate cash proceeds from divestiture of businesses | $ 10,000,000 | $ 0 |
Dividends - Additional Informat
Dividends - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Dividends [Abstract] | ||
Dividends declared and paid | $ 15 | $ 17 |
Dividends declared and paid, per share | $ 0.20 | $ 0.20 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) | 3 Months Ended | ||
Mar. 31, 2022 | Mar. 31, 2021 | Jan. 31, 2022 | |
Income Taxes [Line Items] | |||
Effective income tax rate | 24.50% | 23.40% | |
Tax provision from employee share-based payments | $ 1,000,000 | ||
Provisional deferred tax - GILTI | $ 0 | $ 0 | |
Unrecognized tax benefits | $ 2,000,000 | ||
Impact of unrecognized tax benefits if recognized | $ 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 | ||
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 |
Schedule of Disaggregates Reven
Schedule of Disaggregates Revenue by Major Source (Detail) - USD ($) $ in Thousands | 3 Months Ended | ||
Mar. 31, 2022 | Mar. 31, 2021 | ||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 3,292,956 | $ 3,012,987 | |
Percentage of Net Revenue | 100.00% | 100.00% | |
Medicare | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 416,621 | $ 424,005 | |
Percentage of Net Revenue | 13.00% | 14.00% | |
Managed Medicare | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 396,098 | $ 333,102 | |
Percentage of Net Revenue | 12.00% | 11.00% | |
Medicaid | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 331,239 | $ 264,781 | |
Percentage of Net Revenue | 10.00% | 9.00% | |
Managed Medicaid | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 505,802 | $ 470,256 | |
Percentage of Net Revenue | 15.00% | 16.00% | |
Managed Care (HMO and PPOs) | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 1,004,100 | $ 947,554 | |
Percentage of Net Revenue | 30.00% | 31.00% | |
UK Revenue | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 176,092 | $ 164,666 | |
Percentage of Net Revenue | 5.00% | 5.00% | |
Other Patient Revenue and Adjustments, Net | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 212,843 | $ 214,533 | |
Percentage of Net Revenue | 6.00% | 7.00% | |
Other Non-patient Revenue | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 250,161 | $ 194,090 | |
Percentage of Net Revenue | 8.00% | 6.00% | |
Acute Care Hospital Services | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 1,912,316 | $ 1,694,542 | |
Percentage of Net Revenue | 100.00% | 100.00% | |
Acute Care Hospital Services | Medicare | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 337,109 | $ 335,513 | |
Percentage of Net Revenue | 18.00% | 20.00% | |
Acute Care Hospital Services | Managed Medicare | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 332,248 | $ 275,560 | |
Percentage of Net Revenue | 17.00% | 16.00% | |
Acute Care Hospital Services | Medicaid | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 155,836 | $ 111,641 | |
Percentage of Net Revenue | 8.00% | 7.00% | |
Acute Care Hospital Services | Managed Medicaid | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 171,637 | $ 135,498 | |
Percentage of Net Revenue | 9.00% | 8.00% | |
Acute Care Hospital Services | Managed Care (HMO and PPOs) | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 638,895 | $ 598,810 | |
Percentage of Net Revenue | 33.00% | 35.00% | |
Acute Care Hospital Services | UK Revenue | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 0 | $ 0 | |
Percentage of Net Revenue | 0.00% | 0.00% | |
Acute Care Hospital Services | Other Patient Revenue and Adjustments, Net | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 92,110 | $ 94,250 | |
Percentage of Net Revenue | 5.00% | 6.00% | |
Acute Care Hospital Services | Other Non-patient Revenue | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 184,481 | $ 143,270 | |
Percentage of Net Revenue | 10.00% | 8.00% | |
Behavioral Health Services | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | [1] | $ 1,366,467 | $ 1,315,337 |
Percentage of Net Revenue | 100.00% | 100.00% | |
Behavioral Health Services | Medicare | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 79,512 | $ 88,492 | |
Percentage of Net Revenue | 6.00% | 7.00% | |
Behavioral Health Services | Managed Medicare | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 63,850 | $ 57,542 | |
Percentage of Net Revenue | 5.00% | 4.00% | |
Behavioral Health Services | Medicaid | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 175,403 | $ 153,140 | |
Percentage of Net Revenue | 13.00% | 12.00% | |
Behavioral Health Services | Managed Medicaid | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 334,165 | $ 334,758 | |
Percentage of Net Revenue | 24.00% | 25.00% | |
Behavioral Health Services | Managed Care (HMO and PPOs) | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 365,205 | $ 348,744 | |
Percentage of Net Revenue | 27.00% | 27.00% | |
Behavioral Health Services | UK Revenue | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 176,092 | $ 164,666 | |
Percentage of Net Revenue | 13.00% | 13.00% | |
Behavioral Health Services | Other Patient Revenue and Adjustments, Net | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 120,733 | $ 120,283 | |
Percentage of Net Revenue | 9.00% | 9.00% | |
Behavioral Health Services | Other Non-patient Revenue | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 51,507 | $ 47,712 | |
Percentage of Net Revenue | 4.00% | 4.00% | |
Other | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 14,173 | $ 3,108 | |
Other | Other Non-patient Revenue | |||
Disaggregation Of Revenue [Line Items] | |||
Net revenues | $ 14,173 | $ 3,108 | |
[1] | Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $176 million and $165 million for the three-month periods ended March 31, 2022 and 2021, respectively. Total assets at our U.K. behavioral health care facilities were approximately $1.320 billion and $1.355 billion as of March 31, 2022 and 2021, respectively. |
Lease Accounting - Additional I
Lease Accounting - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2022Hospital | |
Lessee Lease Description [Line Items] | |
Lessee, operating lease, existence of option to extend [true false] | true |
Number of hospital facilities | 5 |
Two Hospital Facilities | |
Lessee Lease Description [Line Items] | |
Lease expiration term | 2026 |
Another Two Hospital Facilities | |
Lessee Lease Description [Line Items] | |
Lease expiration term | 2033 |
One Hospital Facility | |
Lessee Lease Description [Line Items] | |
Lease expiration term | 2040 |
Minimum | |
Lessee Lease Description [Line Items] | |
Initial term of real estate lease | 5 years |
Real estate leases option to extend lease term | 5 years |
Maximum | |
Lessee Lease Description [Line Items] | |
Initial term of real estate lease | 10 years |
Real estate leases option to extend lease term | 10 years |
Supplemental Cash Flow Informat
Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Cash paid for amounts included in the measurement of lease liabilities: | ||
Operating cash flows from operating leases | $ 31,325 | $ 31,043 |
Operating cash flows from finance leases | 1,006 | 1,184 |
Financing cash flows from finance leases | 803 | 697 |
Right-of-use assets obtained in exchange for lease obligations: | ||
Operating leases | 19,037 | 5,907 |
Finance leases | $ 1,066 | $ 7,690 |