0001564590-20-051981 | 10-Q | XBRL Viewer | Universal Health Services INC

Document and Entity Information - shares	9 Months Ended
Document and Entity Information - shares	Sep. 30, 2020	Oct. 31, 2020
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q3
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		77,724,494
Class C
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		661,688
Class D
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		18,251

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Statement [Abstract]
Net revenues	$ 2,912,541	$ 2,822,453	$ 8,471,962	$ 8,482,012
Operating charges:
Salaries, wages and benefits	1,406,348	1,408,226	4,147,027	4,157,253
Other operating expenses	666,665	762,174	1,982,202	2,079,518
Supplies expense	335,409	313,936	936,808	927,256
Depreciation and amortization	125,961	121,528	376,563	362,736
Lease and rental expense	28,488	27,660	84,967	80,320
Operating Expenses, Total	2,562,871	2,633,524	7,527,567	7,607,083
Income from operations	349,670	188,929	944,395	874,929
Interest expense, net	24,575	41,447	86,399	123,574
Other (income) expense, net	1,831	9,407	8,291	6,176
Income before income taxes	323,264	138,075	849,705	745,179
Provision for income taxes	79,172	37,205	204,649	165,646
Net income	244,092	100,870	645,056	579,533
Less: Net income attributable to noncontrolling interests	2,813	3,680	9,811	9,855
Net income attributable to UHS	$ 241,279	$ 97,190	$ 635,245	$ 569,678
Basic earnings per share attributable to UHS	$ 2.84	$ 1.10	$ 7.44	$ 6.36
Diluted earnings per share attributable to UHS	$ 2.82	$ 1.10	$ 7.40	$ 6.35
Weighted average number of common shares - basic	84,672	87,952	85,172	89,288
Add: Other share equivalents	575	403	415	231
Weighted average number of common shares and equivalents - diluted	85,247	88,355	85,587	89,519

Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 244,092	$ 100,870	$ 645,056	$ 579,533
Other comprehensive income (loss):
Unrealized derivative gains (losses) on cash flow hedges				(3,925)
Foreign currency translation adjustment	14,245	(10,089)	(18,280)	(19,192)
Other comprehensive income (loss) before tax	14,245	(10,089)	(18,280)	(23,117)
Income tax expense (benefit) related to items of other comprehensive income (loss)	302	174	(908)	(676)
Total other comprehensive income (loss), net of tax	13,943	(10,263)	(17,372)	(22,441)
Comprehensive income	258,035	90,607	627,684	557,092
Less: Comprehensive income attributable to noncontrolling interests	2,813	3,680	9,811	9,855
Comprehensive income attributable to UHS	$ 255,222	$ 86,927	$ 617,873	$ 547,237

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 1,101,230	$ 61,268
Accounts receivable, net	1,540,747	1,560,847
Supplies	176,105	159,889
Other current assets	143,072	133,930
Total current assets	2,961,154	1,915,934
Property and equipment	9,652,778	9,106,377
Less: accumulated depreciation	(4,403,941)	(4,089,679)
Property, plant and equipment, net, Total	5,248,837	5,016,698
Other assets:
Goodwill	3,854,265	3,869,760
Deferred income taxes	19,936	16,189
Right of use assets-operating leases	330,172	326,518
Deferred charges	5,136	6,373
Other	556,258	516,778
Total Assets	12,975,758	11,668,250
Current liabilities:
Current maturities of long-term debt	94,504	87,550
Accounts payable and other liabilities	1,591,258	1,272,374
Medicare accelerated payments and deferred CARES Act and other grants	878,480
Legal reserves	5,426	144,509
Operating lease liabilities	57,219	56,442
Federal and state taxes	7,335	2,515
Total current liabilities	2,634,222	1,563,390
Other noncurrent liabilities	488,457	329,932
Operating lease liabilities noncurrent	274,236	270,076
Long-term debt	3,514,673	3,896,577
Deferred income taxes	24,895	25,071
Redeemable noncontrolling interests	4,177	4,333
Equity:
UHS common stockholders’ equity	5,962,788	5,504,105
Noncontrolling interest	72,310	74,766
Total equity	6,035,098	5,578,871
Total Liabilities and Stockholders’ Equity	$ 12,975,758	$ 11,668,250

Condensed Consolidated Statements of Changes in Equity - USD ($) $ in Thousands	Total	Redeemable Noncontrolling Interest	Class A	Class B	Class C	Class D	Cumulative Dividends	Retained Earnings	Accumulated Other Comprehensive Income (Loss)	UHS Common Stockholders' Equity	Noncontrolling Interest
Balance at Dec. 31, 2018	$ 5,465,793		$ 66	$ 841	$ 7	$ 0	$ (409,156)	$ 5,793,262	$ 4,242	$ 5,389,262	$ 76,531
Balance at Dec. 31, 2018		$ 4,292
Common Stock
Issued/(converted)	8,383			10				8,373		8,383
Repurchased	(571,399)			(44)				(571,355)		(571,399)
Restricted share-based compensation expense	5,950							5,950		5,950
Dividends paid	(35,556)						(35,556)			(35,556)
Stock option expense	45,338							45,338		45,338
Distributions to noncontrolling interests	(11,555)	(500)									(11,555)
Purchase of noncontrolling interest	168										168
Comprehensive income:
Net income to UHS / noncontrolling interests	579,264							569,678		569,678	9,586
Net income attributable to redeemable noncontrolling interest		269
Foreign currency translation adjustments, net of income tax	(19,444)								(19,444)	(19,444)
Unrealized derivative gains on cash flow hedges, net of income tax	(2,997)								(2,997)	(2,997)
Subtotal - comprehensive income	556,823							569,678	(22,441)	547,237	9,586
Subtotal attributable to redeemable noncontrolling interest		269
Balance at Sep. 30, 2019	5,463,945		66	807	7	0	(444,712)	5,851,246	(18,199)	5,389,215	74,730
Balance at Sep. 30, 2019		4,061
Balance at Jun. 30, 2019	5,464,451		66	810	7	0	(427,109)	5,827,251	(7,936)	5,393,089	71,362
Balance at Jun. 30, 2019		3,986
Common Stock
Issued/(converted)	2,978			4				2,974		2,978
Repurchased	(93,327)			(7)				(93,320)		(93,327)
Restricted share-based compensation expense	2,291							2,291		2,291
Dividends paid	(17,603)						(17,603)			(17,603)
Stock option expense	14,860							14,860		14,860
Distributions to noncontrolling interests	(405)										(405)
Purchase of noncontrolling interest	168										168
Comprehensive income:
Net income to UHS / noncontrolling interests	100,795							97,190		97,190	3,605
Net income attributable to redeemable noncontrolling interest		75
Foreign currency translation adjustments, net of income tax	(10,263)								(10,263)	(10,263)
Subtotal - comprehensive income	90,532							97,190	(10,263)	86,927	3,605
Subtotal attributable to redeemable noncontrolling interest		75
Balance at Sep. 30, 2019	5,463,945		66	807	7	0	(444,712)	5,851,246	(18,199)	5,389,215	74,730
Balance at Sep. 30, 2019		4,061
Balance at Dec. 31, 2019	5,578,871		66	794	7	0	(462,159)	5,933,504	31,893	5,504,105	74,766
Balance at Dec. 31, 2019		4,333
Common Stock
Issued/(converted)	9,729			3				9,726		9,729
Repurchased	(200,098)			(20)				(200,078)		(200,098)
Restricted share-based compensation expense	6,958							6,958		6,958
Dividends paid	(17,344)						(17,344)			(17,344)
Stock option expense	41,565							41,565		41,565
Distributions to noncontrolling interests	(14,675)	(500)									(14,675)
Purchase of noncontrolling interest	(547)										(547)
Other	3,300										3,300
Comprehensive income:
Net income to UHS / noncontrolling interests	644,711							635,245		635,245	9,466
Net income attributable to redeemable noncontrolling interest		344
Foreign currency translation adjustments, net of income tax	(17,372)								(17,372)	(17,372)
Subtotal - comprehensive income	627,339							635,245	(17,372)	617,873	9,466
Subtotal attributable to redeemable noncontrolling interest		344
Balance at Sep. 30, 2020	6,035,098		66	777	7	0	(479,503)	6,426,920	14,521	5,962,788	72,310
Balance at Sep. 30, 2020	4,000	4,177
Balance at Jun. 30, 2020	5,761,572		66	777	7	0	(479,503)	6,166,722	578	5,688,647	72,925
Balance at Jun. 30, 2020		4,287
Common Stock
Issued/(converted)	3,766							3,766		3,766
Repurchased	(44)							(44)		(44)
Restricted share-based compensation expense	2,209							2,209		2,209
Stock option expense	12,988							12,988		12,988
Distributions to noncontrolling interests	(6,290)										(6,290)
Purchase of noncontrolling interest	(547)										(547)
Other	3,300										3,300
Comprehensive income:
Net income to UHS / noncontrolling interests	244,201							241,279		241,279	2,922
Net income attributable to redeemable noncontrolling interest		(110)
Foreign currency translation adjustments, net of income tax	13,943								13,943	13,943
Subtotal - comprehensive income	258,144							241,279	13,943	255,222	2,922
Subtotal attributable to redeemable noncontrolling interest		(110)
Balance at Sep. 30, 2020	6,035,098		$ 66	$ 777	$ 7	$ 0	$ (479,503)	$ 6,426,920	$ 14,521	$ 5,962,788	$ 72,310
Balance at Sep. 30, 2020	$ 4,000	$ 4,177

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash Flows from Operating Activities:
Net income	$ 645,056	$ 579,533
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	376,563	362,736
(Gain) loss on sale of assets and businesses	2,124	(5,982)
Stock-based compensation expense	49,928	52,167
Costs related to extinguishment of debt	1,365
Provision for asset impairment		97,631
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	45,435	(37,332)
Accrued interest	(10,526)	(2,962)
Accrued and deferred income taxes	(2,095)	(53,714)
Other working capital accounts	85,944	90,262
Medicare accelerated payments and deferred CARES Act and other grants	878,480
Other assets and deferred charges	1,271	15,237
Other	115,431	(663)
Accrued insurance expense, net of commercial premiums paid	113,571	76,245
Payments made in settlement of self-insurance claims	(84,390)	(68,046)
Net cash provided by operating activities	2,218,157	1,105,112
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(546,656)	(480,247)
Proceeds received from sales of assets and businesses	7,851	7,497
Acquisition of businesses and property	(52,009)
Inflows from foreign exchange contracts that hedge our net U.K. investment	22,453	34,484
Costs incurred for purchase and implementation of information technology applications	(5,345)	(18,240)
Investment in, and advances to, joint ventures and other	(997)	(11,949)
Net cash used in investing activities	(574,703)	(468,455)
Cash Flows from Financing Activities:
Reduction of long-term debt	(1,173,590)	(68,175)
Additional borrowings	803,197	15,100
Financing costs	(8,256)
Repurchase of common shares	(200,098)	(587,976)
Dividends paid	(17,344)	(35,556)
Issuance of common stock	9,288	8,248
Profit distributions to noncontrolling interests	(15,175)	(11,887)
Purchase of ownership interests from minority members	(548)
Net cash used in financing activities	(602,526)	(680,246)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(706)	(1,259)
Increase (decrease) in cash, cash equivalents and restricted cash	1,040,222	(44,848)
Cash, cash equivalents and restricted cash, beginning of period	105,667	199,685
Cash, cash equivalents and restricted cash, end of period	1,145,889	154,837
Supplemental Disclosures of Cash Flow Information:
Interest paid	93,579	122,699
Income taxes paid, net of refunds	208,460	221,298
Noncash purchases of property and equipment	76,402	83,552
Right-of-use assets obtained in exchange for lease obligations	$ 47,679	$ 364,453

General

9 Months Ended

Sep. 30, 2020

Organization Consolidation And Presentation Of Financial Statements [Abstract]

General

(1) General

This Quarterly Report on Form 10-Q is for the quarterly period ended September 30, 2020. 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, 2019.

In March, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic and the federal government declared COVID-19 a national emergency. The impact of the COVID-19 pandemic has had a material unfavorable effect on our operations and financial results since that time, before giving effect to the revenues recorded in connection with the CARES Act and other governmental grants as discussed herein. Patient volumes at both our acute care and behavioral health care facilities were most significantly reduced in March and April. Our acute care and behavioral health facilities began experiencing gradual and continued improvement in patient volumes since May as various states eased stay-at-home restrictions and acute care hospitals were permitted to resume elective surgeries and procedures. Although many of our acute care and behavioral health facilities are located in states that have continued to experience intermittent increases in COVID-19 infections, non-COVID-19 patient volumes at our hospitals have not been as dramatically impacted in recent months by increases experienced from time-to-time in COVID-19 patient volumes.

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. Such factors include, but are not limited to, the scope and duration of stay-at-home policies and business closures and restrictions, government imposed or recommended suspensions of elective surgeries and procedures, continued declines in patient volumes for an indeterminable length of time, increases in the number of uninsured and underinsured patients as a result of higher sustained rates of unemployment, incremental expenses required for supplies and personal protective equipment, and changes in professional and general liability exposure. Because of these and other uncertainties, we cannot estimate the length or severity of the impact of COVID-19 on our business. Decreases in cash flows and results of operations may have an impact on the inputs and assumptions used in significant accounting estimates, including estimated implicit price concessions related to uninsured patient accounts, professional and general liability reserves, and potential impairments of goodwill and long-lived assets.

Relationship with Universal Health Realty Income Trust and Related Party Transactions

9 Months Ended

Sep. 30, 2020

Relationship with Universal Health Realty Income Trust and Related Party Transactions

(2) Relationship with Universal Health Realty Income Trust and Related Party Transactions

Relationship with Universal Health Realty Income Trust:

At September 30, 2020, 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 of each year, pursuant to the terms of which we conduct the Trust’s day-to-day affairs, provide administrative services and present investment opportunities. The advisory agreement was amended and restated effective January 1, 2019. The advisory agreement was renewed by the Trust for 2020 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 $1.0 million during each of the three-month periods ended September 30, 2020 and 2019, and approximately $3.1 million and $3.0 million during the nine-month periods ended September 30, 2020 and 2019, 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 are included in other income, net, on the accompanying consolidated statements of income for each period were approximately $300,000 during each of the three-month periods ended September 30, 2020 and 2019, respectively, and approximately $800,000 and $700,000 during the nine-month periods ended September 30, 2020 and 2019,

respectively. We received dividends from the Trust amounting to $543,000 and $536,000 during the three month periods ended September 30, 2020 and 2019, respectively, and $1.6 million during each of the nine-month periods ended September 30, 2020 and 2019. The carrying value of our investment in the Trust was approximately $5.6 million and $6.4 million at September 30, 2020 and December 31, 2019, respectively, and is included in other assets in the accompanying consolidated balance sheets. The market value of our investment in the Trust was $44.9 million at September 30, 2020 and $92.4 million at December 31, 2019, 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. Most of the leases were entered into at the time the Trust commenced operations and provided for initial terms of 13 to 15 years with up to six additional 5-year renewal terms. Each lease also provided for additional or bonus rental, as discussed below. The base rents are paid monthly and the bonus rents are computed and paid on a quarterly basis, based upon a computation that compares current quarter revenue to a corresponding quarter in the base year. The leases with those subsidiaries are unconditionally guaranteed by us and are cross-defaulted with one another.

Total rent expense under the operating leases on the three hospital facilities with the Trust was approximately $4 million during each of the three months ended September 30, 2020 and 2019, and approximately $12 million for each of the nine-month periods ended September 30, 2020 and 2019. Pursuant to the terms of the three hospital leases with the Trust, 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 the end of the lease terms or any renewal terms at their appraised fair market value as well as purchase any or all of the three leased hospital properties at the appraised fair market value upon one month’s notice should a change of control of the Trust occur. 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.

The table below details the renewal options and terms for each of our three acute care hospital facilities leased from the Trust:

Hospital Name	Annual Minimum Rent		End of Lease Term	Renewal Term (years)
McAllen Medical Center	$	5,485,000	December, 2026	5(a)
Wellington Regional Medical Center	$	3,030,000	December, 2021	10(b)
Southwest Healthcare System, Inland Valley Campus	$	2,648,000	December, 2021	10(b)

(a) We have one 5-year renewal option at existing lease rates (through 2031).

(b) We have two 5-year renewal options at fair market value lease rates (2022 through 2031).

A wholly-owned subsidiary of ours has notified the Trust that we are considering termination of the existing lease on Southwest Healthcare System, Inland Valley Campus prior to the scheduled expiration of the current term on December 31, 2021. As permitted pursuant to the terms of the lease, we have the right, subject to certain conditions, to propose substitution property to the Trust with a fair market value substantially equal to that of the existing leased property. We are currently evaluating potential substitution properties and expect to submit our proposal, which is subject to the Trust’s approval, to the Trust by December 31, 2020. We can provide no assurance that we will ultimately agree on a property substitution with the Trust in connection with the Inland Valley Campus property, in which case, we have the right to purchase the property for its fair market value.

In addition, certain of our subsidiaries are tenants in several medical office buildings and two FEDs owned by the Trust or by limited liability companies in which the Trust holds 95% to 100% of the ownership interest.

During the third quarter of 2019, the Trust commenced construction on a new 75,000 rentable square feet medical office building (“MOB”) that will be located on the campus of Texoma Medical Center, a hospital that is owned and operated by one of our subsidiaries. In connection with this MOB, a master flex lease has been executed between a wholly-owned subsidiary of ours and a Trust limited partnership that owns the MOB. Pursuant to the terms of this master flex lease, our subsidiary will master lease approximately 50% of the rentable square feet of the MOB, allocated to specific floors of the building, which could be reduced during the term if certain conditions are met, for a ten-year term at an initial minimum annual rent of $644,000. In April, 2020, a new lease was fully executed between the Trust and a third-party tenant for approximately 26,000 rentable square feet. As a result, the master flex lease commitment was reduced to 20,000 rentable square feet on a specific floor of the MOB.

During the third quarter of 2019, a joint-venture agreement between us and a non-related third-party was finalized in connection with the development of a newly constructed behavioral health care facility located in Clive, Iowa. Pursuant to the terms of the agreement, we hold a majority ownership interest in the venture and will act as manager of the facility when completed and opened. This joint-venture also entered into an agreement with the Trust whereby a wholly-owned subsidiary of the Trust will construct the 108-bed behavioral health care hospital and, upon completion and issuance of the certificate of occupancy, the joint-venture will lease the

facility from the Trust pursuant to a 20-year, triple net lease with five, 10-year renewal options. Construction of the approximately 80,000 square foot hospital, for which a wholly-owned subsidiary of ours will act as project manager for an aggregate fee of approximately $750,000, is expected to be completed in late 2020 or early 2021. The approximate cost of the project is estimated at $37.5 million and the initial annual rent is estimated at approximately $2.7 million.

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 chief executive officer (“CEO”) and his wife. As a result of these agreements, as amended in October, 2016, based on actuarial tables and other assumptions, during the life expectancies of the insureds, we would pay approximately $28 million in premiums, and certain trusts owned by our CEO, would pay approximately $9 million in premiums. Based on the projected premiums mentioned above, and assuming the policies remain in effect until the death of the insureds, we will be entitled to receive death benefit proceeds of no less than approximately $37 million representing the $28 million of aggregate premiums paid by us as well as the $9 million of aggregate premiums paid by the trusts. In connection with these policies, we will pay/we paid approximately $1.1 million, net, in premium payments during each of the 2020 and 2019 years.

In August, 2015, Marc D. Miller, our President 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 period (2014 through 2020), contingent upon our continued participation and minority ownership interest in the GPO. During the third quarter of 2020, we entered into an agreement with Premier pursuant to the terms of which, among other things, our ownership interest in Premier was converted into shares of Class A Common Stock of Premier. We have elected to retain a portion of the previously 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 on which the restrictions have lapsed was $61 million as of September 30, 2020 and $70 million as of December 31, 2019. The $9 million decrease in market value of our vested Premier shares since December 31, 2019 was recorded as an unrealized loss and included in “Other (income) expense, net” in our condensed consolidated statements of income for the nine-month period ended September 30, 2020. Additionally, during the third quarter of 2020, Premier declared a quarterly cash dividend of $0.19 per share. Our share of the dividend for the quarter ended September 30, 2020 is approximately $400,000 and is included in “Other (income) expense, net” in our condensed consolidated statements of income for the nine-month period ended September 30, 2020.

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 CEO and he acts as trustee of certain trusts for the benefit of our CEO and his family.

Other Noncurrent liabilities and Redeemable/Noncontrolling Interests

9 Months Ended

Sep. 30, 2020

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 September 30, 2020, outside owners held noncontrolling, minority ownership interests of: (i) 20% in an acute care facility located in Washington, D.C.; (ii) approximately 11% in an acute care facility located in Texas; (iii) 20%, 30% and 20% in three behavioral health care facilities located in Pennsylvania, Ohio and Washington, respectively, and; (iv) approximately 5% in an acute care facility located in Nevada. The noncontrolling interest and redeemable noncontrolling interest balances of $72 million and $4 million, respectively, as of September 30, 2020, 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.

Treasury

9 Months Ended

Sep. 30, 2020

Equity [Abstract]

Treasury

(4) Treasury

Credit Facilities and Outstanding Debt Securities:

Cash, Cash Equivalents and Restricted Cash

As of September 30, 2020, we had approximately $1.10 billion of cash, cash equivalents consisting primarily of short-term cash accounts on which interest is being earned at various annual rates ranging from 0.06% to 0.31%.

Credit Facilities and Outstanding Debt Securities

On October 23, 2018, we entered into a Sixth Amendment (the “Sixth Amendment”) to our credit agreement dated as of November 15, 2010, as amended on March 15, 2011, September 21, 2012, May 16, 2013, August 7, 2014 and June 7, 2016, among UHS, as borrower, the several banks and other financial institutions from time to time parties thereto, as lenders, JPMorgan Chase Bank, N.A., as administrative agent, and the other agents party thereto (the “Senior Credit Agreement”). The Sixth Amendment became effective on October 23, 2018.

The Sixth Amendment amended the Senior Credit Agreement to, among other things: (i) increased the aggregate amount of the revolving credit facility to $1 billion (increase of $200 million over the $800 million previous commitment); (ii) increased the aggregate amount of the tranche A term loan commitments to $2 billion (increase of approximately $290 million over the $1.71 billion of outstanding borrowings prior to the amendment), and; (iii) extended the maturity date of the revolving credit and tranche A term loan facilities to October 23, 2023 from August 7, 2019.

On October 31, 2018, we added a seven-year tranche B term loan facility in the aggregate principal amount of $500 million pursuant to the Senior Credit Agreement. The tranche B term loan matures on October 31, 2025. We used the proceeds to repay borrowings under the revolving credit facility, the Securitization (as defined below), to redeem our $300 million, 3.75% Senior Notes that were scheduled to mature in 2019 and for general corporate purposes.

As of September 30, 2020, we had no borrowings outstanding pursuant to our $1 billion revolving credit facility and we had $997 million of available borrowing capacity net of $3 million of outstanding letters of credit.

Pursuant to the terms of the Sixth Amendment, the tranche A term loan, which had $1.913 billion of borrowings outstanding as of September 30, 2020, provides for eight installment payments of $12.5 million per quarter which commenced in March of 2019 and are scheduled to continue through December of 2020. Thereafter, payments of $25 million per quarter are scheduled, commencing in March of 2021 until maturity in October of 2023, when all outstanding amounts will be due.

The tranche B term loan, which had $491 million of borrowings outstanding as of September 30, 2020, provides for installment payments of $1.25 million per quarter, which commenced on March 31, 2019 and are scheduled to continue until maturity in October of 2025, when all outstanding amounts will be due.

Borrowings under the Senior 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 0.375% to 0.625% for revolving credit and term loan A borrowings and 0.75% for tranche B borrowings, or (2) the one, two, 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 1.375% to 1.625% for revolving credit and term loan A borrowings and 1.75% for the tranche B term loan. As of September 30, 2020, 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 Senior 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 Senior Credit Agreement includes a material adverse change clause that must be represented at each draw. The Senior Credit Agreement 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 are in compliance with all required covenants as of September 30, 2020 and December 31, 2019.

In late April, 2018, we entered into the sixth amendment to our accounts receivable securitization program (“Securitization”) dated as of October 27, 2010 with a group of conduit lenders, liquidity banks, and PNC Bank, National Association, as administrative agent, which provides for borrowings outstanding from time to time by certain of our subsidiaries in exchange for undivided security interests in their respective accounts receivable. The sixth amendment, among other things, extended the term of the Securitization program through April 26, 2021 and increased the borrowing capacity to $450 million (from $440 million previously). In July, 2020, we entered into the seventh amendment to the Securitization which temporarily waives a minimum borrowing requirement Pursuant to

the terms of our Securitization program, substantially all of the patient-related accounts receivable of our acute care hospitals (“Receivables”) serve as collateral for the outstanding borrowings. We have accounted for this Securitization as borrowings. We maintain effective control over the Receivables since, pursuant to the terms of the Securitization, the Receivables are sold from certain of our subsidiaries to special purpose entities that are wholly-owned by us. The Receivables, however, are owned by the special purpose entities, can be used only to satisfy the debts of the wholly-owned special purpose entities, and thus are not available to us except through our ownership interest in the special purpose entities. The wholly-owned special purpose entities use the Receivables to collateralize the loans obtained from the group of third-party conduit lenders and liquidity banks. The group of third-party conduit lenders and liquidity banks do not have recourse to us beyond the assets of the wholly-owned special purpose entities that securitize the loans. At September 30, 2020, we had no Securitization borrowings outstanding and we had $450 million of available borrowing capacity.

As of September 30, 2020, we had combined aggregate principal of $1.2 billion from the following senior secured notes:

•

$800 million aggregate principal amount of 2.65% senior secured notes due in October, 2030 (“2030 Notes”) which were issued on September 21, 2020.

•

$400 million aggregate principal amount of 5.00% senior secured notes due in June, 2026 (“2026 Notes”) which were issued on June 3, 2016.

Interest on the 2026 Notes is payable on June 1 and December 1 until the maturity date of June 1, 2026. Interest on the 2030 Notes is payable on April 15 and October 15, commencing April 15, 2021, until the maturity date of October 15, 2030. The 2026 Notes and 2030 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 2026 Notes and 2030 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 2030 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 Senior Credit Agreement, dated as of November 15, 2010, as amended, restated or supplemented from time to time, or other first lien obligations or any junior lien obligations. The 2030 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 2030 Notes were issued (the “Indenture”)), and certain other excluded assets). The Company’s obligations with respect to the 2030 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 Senior Credit Agreement and the Company’s 2026 Notes by a perfected first-priority security interest, subject to permitted liens, in the collateral owned by the Company and its guarantors, whether now owned or hereafter acquired. However, the liens on the collateral securing the 2030 Notes and the Guarantees will be released if: (i) the 2030 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 Senior Credit Agreement and the 2026 Notes) and any junior lien obligations are released or the collateral under the Senior 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 2030 Notes and the Guarantees will also be released if the liens on that collateral securing the Senior Credit Agreement, other first lien obligations and any junior lien obligations are released.

In connection with the issuance of the 2030 Notes, the Company, the Subsidiary Guarantors and the representatives of the several initial purchasers, entered into a Registration Rights Agreement (the “Registration Rights Agreement”), 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 2030 Notes and 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 2030 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 Agreement); (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, and; (iv) file a shelf registration statement for the resale of the 2030 Notes if the exchange offer cannot be effected within the time periods listed above. The interest rate on the 2030 Notes will increase and additional interest thereon will be payable if the Company does not comply with its obligations under the Registration Rights Agreement.

On September 28, 2020, we redeemed the entire $700 million aggregate principal amount of our previously outstanding 4.75% Senior Secured Notes due 2022 (the “2022 Notes”), at a cash redemption price equal to the sum of: (i) 100% of the aggregate principal amount of the 2022 Notes redeemed, and; (ii) accrued and unpaid interest on the 2022 Notes to the redemption date. Included in our financial results for the three and nine-month periods ended September 30, 2020, was a loss on extinguishment of debt of approximately $1 million recorded in connection with the redemption of the 2022 Notes.

At September 30, 2020, the carrying value and fair value of our debt were each approximately $3.6 billion. At December 31, 2019, the carrying value and fair value of our debt were each approximately $4.0 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:

We manage our ratio of fixed and floating rate debt with the objective of achieving a mix that management believes is appropriate. To manage this risk in a cost-effective manner, we, from time to time, enter into interest rate swap agreements in which we agree to exchange various combinations of fixed and/or variable interest rates based on agreed upon notional amounts. We account for our derivative and hedging activities using the Financial Accounting Standard Board’s guidance which requires all derivative instruments, including certain derivative instruments embedded in other contracts, to be carried at fair value on the balance sheet. For derivative transactions designated as hedges, we formally document all relationships between the hedging instrument and the related hedged item, as well as its risk-management objective and strategy for undertaking each hedge transaction.

Derivative instruments designated in a hedge relationship to mitigate exposure to variability in expected future cash flows, or other types of forecasted transactions, are considered cash flow hedges. Cash flow hedges are accounted for by recording the fair value of the derivative instrument on the balance sheet as either an asset or liability, with a corresponding amount recorded in accumulated other comprehensive income (“AOCI”) within shareholders’ equity. Amounts are reclassified from AOCI to the income statement in the period or periods the hedged transaction affects earnings. From time to time, we use interest rate derivatives in our cash flow hedge transactions. Such derivatives are designed to be highly effective in offsetting changes in the cash flows related to the hedged liability.

For hedge transactions that do not qualify for the short-cut method, at the hedge’s inception and on a regular basis thereafter, a formal assessment is performed to determine whether changes in the fair values or cash flows of the derivative instruments have been highly effective in offsetting changes in cash flows of the hedged items and whether they are expected to be highly effective in the future.

The fair value of interest rate swap agreements approximates the amount at which they could be settled, based on estimates obtained from the counterparties. When applicable, we assess the effectiveness of our hedge instruments on a quarterly basis. Although we do not anticipate nonperformance by our counterparties to interest rate swap agreements, the counterparties expose us to credit risk in the event of nonperformance. We do not hold or issue derivative financial instruments for trading purposes.

During 2015, we entered into nine forward starting interest rate swaps whereby we paid a fixed rate on a total notional amount of $1.0 billion and received one-month LIBOR. The average fixed rate payable on these swaps, all of which matured on April 15, 2019, was 1.31%.

When applicable, we measure our interest rate swaps at fair value on a recurring basis. The fair value of our interest rate swaps is based on quotes from our counterparties. We consider those inputs to be “level 2” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with derivative instruments and hedging activities.

Foreign Currency Forward Exchange Contracts:

In August 2017, the FASB issued new guidance on hedge accounting (ASU 2017-12) that is intended to more closely align hedge accounting with companies’ risk management strategies, simplify the application of hedge accounting, and increase transparency as to the scope and results of hedging programs. The new guidance amends the presentation and disclosure requirements, and changes how companies assess effectiveness. We adopted this guidance as of January 1, 2019 and applied to all existing hedges as of the adoption date.

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 $22 million and $34 million during the nine-month periods ended September 30, 2020 and 2019, respectively.

During the fourth quarter of 2019, we identified certain cash inflows related to operating activities that were incorrectly classified as cash inflows from foreign currency exchange contracts, as included cash flows from investing activities, on our condensed consolidated statements of cash flows for the quarterly periods in 2019. The cash flows related to our foreign currency exchange contracts were correctly classified on our consolidated statements of cash flows for the year ended December 31, 2019. We determined that these misclassifications were not material to the financial statements of any period during 2019. However, in order to improve the consistency and comparability of the financial statements, we have revised the condensed consolidated statements of cash flows for the nine-month period ended September 30, 2019.

Derivatives Hedging Relationships:

The following table presents the effects of our interest rate swap agreements and our foreign currency foreign exchange contracts on our results of operations for the three and nine-month periods ended September 30, 2020 and 2019 (in thousands):

	Gain/(Loss) recognized in AOCI
	Three months ended					Nine months ended
	September 30,			September 30,		September 30,		September 30,
	2020			2019		2020		2019
Cash Flow Hedge relationships
Interest rate swap agreements (a)	$	0		$	0	$	0	$	(3,925	)

Net Investment Hedge relationships
Foreign currency foreign exchange contracts	$	(28,244	)	$	33,927	$	15,291	$	79,584

(a)

The amount of gain reclassified out of AOCI into interest expense, net was $0 during each of the three-month periods ended September 30, 2020 and 2019, respectively, and $0 and $3.4 million during the nine-month periods ended September 30, 2020 and 2019, respectively.

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 follow (in thousands):

	September 30,			December 31,
	2020			2019
Cash and cash equivalents	$	1,101,230		$	61,268
Restricted cash and cash equivalents (a)		44,659			44,399
Total cash, cash equivalents and restricted cash	$	1,145,889	(b)	$	105,667

(a) Restricted cash and cash equivalents is included in other assets on the accompanying consolidated balance sheet.
(b) Consists primarily of short-term cash accounts on which interest is being earned at various annual rates ranging from 0.06% to 0.31%.

Fair Value Measurement

9 Months Ended

Sep. 30, 2020

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)	September 30, 2020		Location	Level 1		Level 2		Level 3
Assets:
Term Deposit		540,000	Cash and cash equivalents				540,000
Money market mutual funds		60,931	Other assets		60,931
Certificates of deposit		2,200	Other assets		2,200
Available for sale securities		61,082	Other assets		61,082
Deferred compensation assets		36,307	Other assets		36,307
Foreign currency exchange contracts		3,181	Other current assets				3,181
	$	703,701			160,520		543,181		-
Liabilities:
Deferred compensation liability		36,307	Other noncurrent liabilities		36,307
	$	36,307			36,307		-		-

	Balance at		Balance Sheet	Basis of Fair Value Measurement
(in thousands)	December 31, 2019		Location	Level 1		Level 2		Level 3
Assets:
Money market mutual funds	$	60,175	Other assets		60,175
Certificates of deposit		2,200	Other assets		2,200
Available for sale securities		70,478	Other assets		70,478
Deferred compensation assets		35,510	Other assets		35,510
Foreign currency exchange contracts		10,343	Other current assets				10,343
	$	178,706			168,363		10,343		-
Liabilities:
Deferred compensation liability	$	35,510	Other noncurrent liabilities		35,510
	$	35,510			35,510		-		-

The fair value of our money market mutual funds, certificates of deposit and available for sale securities are computed based upon quoted market prices in 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.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Commitments and Contingencies

9 Months Ended

Sep. 30, 2020

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) $10 million and $3 million per occurrence, respectively, effective January, 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); (ii) $5 million and $3 million per occurrence, respectively, during 2019, 2018 and 2017, and; (iii) $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 self-insured retention or underlying policy limits up to $250 million per occurrence and in the aggregate for claims incurred after 2013 and up to $200 million per occurrence and in the aggregate for claims incurred from 2011 through 2013. We remain liable for 10%, up to an annual aggregate limitation of $5 million ($8.5 million for facilities located in the U.K.), of the claims paid pursuant to the commercially insured excess coverage. In addition, from time to time based upon marketplace conditions, we may elect to purchase additional commercial coverage for certain of our facilities or businesses. Our behavioral health care facilities located in the U.K. have policies through a commercial insurance carrier located in the U.K. that provides for £10 million of professional liability coverage and £25 million of general liability coverage.

As of September 30, 2020, the total accrual for our professional and general liability claims was $262 million, of which $50 million was included in current liabilities. As of December 31, 2019, the total accrual for our professional and general liability claims was $242 million, of which $42 million was included in current liabilities.

As a result of unfavorable trends recently experienced, during the first nine months of 2020, we have recorded a $25 million increase to our reserves for self-insured professional and general liability claims ($20 million was recorded during the first quarter and $5 million was recorded during the third quarter). 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. 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 the these potential liabilities and the factors impacting these reserves, as discussed above, it is reasonably likely that our future financial results may include material adjustments to prior period reserves.

As of September 30, 2020, the total accrual for our workers’ compensation liability claims was $90 million, of which $46 million was included in current liabilities. As of December 31, 2019, the total accrual for our workers’ compensation liability claims was $81 million, of which $40 million was included in current liabilities.

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) $500 million limitation for our facilities located in Nevada; (ii) $130 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.

Information Technology Incident

As previously disclosed on September 29, 2020, we experienced an information technology security incident in the early morning hours of September 27, 2020. As a result of this cyberattack, we suspended user access to our information technology applications related to operations located in the United States. While our information technology applications were offline, patient care was delivered safely and effectively at our facilities across the country utilizing established back-up processes, including offline documentation methods.

Since that time, our information technology applications have been restored at our acute care and behavioral health hospitals, as well as at the corporate level, thereby re-establishing connections to all major systems and applications, including electronic medical records, laboratory and pharmacy systems. With the back-loading of data substantially complete at this point, our hospitals are resuming normal operations.

We have worked diligently with our information technology security partners to restore our information technology infrastructure and business operations as quickly as possible. In parallel, we immediately began investigating the nature and potential impact of the security incident and engaged third-party information technology and forensic vendors to assist. Although the investigation remains ongoing, no evidence of unauthorized access, copying or misuse of any patient or employee data has been identified to date.

Although we are unable to quantify the ultimate impact of this information technology incident, it could have an adverse effect on our future results of operations

Legal Proceedings

We operate in a highly regulated and litigious industry which subjects us to various claims and lawsuits in the ordinary course of business as well as regulatory proceedings and government investigations. These claims or suits include claims for damages for personal injuries, medical malpractice, commercial/contractual disputes, wrongful restriction of, or interference with, physicians’ staff privileges, and employment related claims. In addition, health care companies are subject to investigations and/or actions by various state and federal governmental agencies or those bringing claims on their behalf. Government action has increased with respect to investigations and/or allegations against healthcare providers concerning possible violations of fraud and abuse and false claims statutes as well as compliance with clinical and operational regulations. Currently, and from time to time, we and some of our facilities are subjected to inquiries in the form of subpoenas, Civil Investigative Demands, audits and other document requests from various federal and state agencies. These inquiries can lead to notices and/or actions including repayment obligations from state and federal government agencies associated with potential non-compliance with laws and regulations. Further, the federal False Claims Act allows private individuals to bring lawsuits (qui tam actions) against healthcare providers that submit claims for payments to the government. Various states have also adopted similar statutes. When such a claim is filed, the government will investigate the matter and decide if they are going to intervene in the pending case. These qui tam lawsuits are placed under seal by the court to comply with the False Claims Act’s requirements. If the government chooses not to intervene, the private individual(s) can proceed independently on behalf of the government. Health care providers that are found to violate the False Claims Act may be subject to substantial monetary fines/penalties as well as face potential exclusion from participating in government health care programs or be required to comply with Corporate Integrity Agreements as a condition of a settlement of a False Claims Act matter. In September 2014, the Criminal Division of the Department of Justice (“DOJ”) announced that all qui tam cases will be shared with their Division to determine if a parallel criminal investigation should be opened. The DOJ has also announced an intention to pursue civil and criminal actions against individuals within a company as well as the corporate entity or entities. In addition, health care facilities are subject to monitoring by state and federal surveyors to ensure compliance with program Conditions of Participation. In the event a facility is found to be out of compliance with a Condition of Participation and unable to remedy the alleged deficiency(s), the facility faces termination from the Medicare and Medicaid programs or compliance with a System Improvement Agreement to remedy deficiencies and ensure compliance.

The laws and regulations governing the healthcare industry are complex covering, among other things, government healthcare participation requirements, licensure, certification and accreditation, privacy of patient information, reimbursement for patient services as well as fraud and abuse compliance. These laws and regulations are constantly evolving and expanding. Further, the Legislation has added additional obligations on healthcare providers to report and refund overpayments by government healthcare programs and authorizes the suspension of Medicare and Medicaid payments “pending an investigation of a credible allegation of fraud.” We monitor our business and have developed an ethics and compliance program with respect to these complex laws, rules and regulations. Although we believe our policies, procedures and practices comply with government regulations, there is no assurance that we will not be faced with the sanctions referenced above which include fines, penalties and/or substantial damages, repayment obligations, payment suspensions, licensure revocation, and expulsion from government healthcare programs. Even if we were to ultimately prevail in any action brought against us or our facilities or in responding to any inquiry, such action or inquiry could have a material adverse effect on us.

Certain legal matters are described below:

Litigation:

Shareholder Class Action

In December 2016 a purported shareholder class action lawsuit was filed in U.S. District Court for the Central District of California against UHS and certain UHS officers alleging violations of the federal securities laws. The case was originally filed as Heed v. Universal Health Services, Inc. et. al. (Case No. 2:16-CV-09499-PSG-JC). The court subsequently appointed Teamsters Local 456 Pension Fund and Teamsters Local 456 Annuity Fund to serve as lead plaintiffs. The case has been transferred to the U.S. District Court for the Eastern District of Pennsylvania and the style of the case has been changed to Teamsters Local 456 Pension Fund, et. al.

v. Universal Health Services, Inc. et. al. (Case No. 2:17-CV-02817-LS). In September, 2017, Teamsters Local 456 Pension Fund filed an amended complaint. The amended class action complaint alleges violations of federal securities laws relating to disclosures made in public filings associated with alleged practices and operations at our behavioral health facilities. Plaintiffs seek monetary damages for shareholders during the defined class period as a result of the decrease in share price following various public disclosures or reports. In December, 2017, we filed a motion to dismiss the amended complaint. In August, 2019, the court granted our motion to dismiss. Plaintiffs subsequently filed a motion with the court seeking leave to file a second amended complaint. In April, 2020, the court denied Plaintiffs’ motion to file a second amended complaint. Plaintiffs have filed an appeal with the 3d Circuit Court of Appeals. We deny liability and intend to defend ourselves vigorously. The parties have recently initiated settlement negotiations during the pendency of the appeal, however, we can provide no assurance that a settlement will be reached. We are uncertain as to potential liability or financial exposure, if any, which may be associated with this matter.

Shareholder Derivative Cases

In March 2017, a shareholder derivative suit was filed by plaintiff David Heed in the Court of Common Pleas of Philadelphia County. A notice of removal to the United States District Court for the Eastern District of Pennsylvania was filed (Case No. 2:17-cv-01476-LS). Plaintiff filed a motion to remand. In December 2017, the Court denied plaintiff’s motion to remand and retained the case in federal court. In May, June and July 2017, additional shareholder derivative suits were filed in the United States District Court for the Eastern District of Pennsylvania. The plaintiffs in those cases are: Central Laborers’ Pension Fund (Case No. 17-cv-02187-LS); Firemen’s Retirement System of St. Louis (Case No. 17—cv-02317-LS); Waterford Township Police & Fire Retirement System (Case No. 17-cv-02595-LS); and Amalgamated Bank Longview Funds (Case No. 17-cv-03404-LS). The Fireman’s Retirement System case has since been voluntarily dismissed. The federal court consolidated all of the cases pending in the Eastern District of Pennsylvania and appointed co-lead plaintiffs and co-lead counsel. Lead Plaintiffs filed a consolidated, amended complaint. We filed a motion to dismiss the amended complaint. In addition, a shareholder derivative case was filed in Chancery Court in Delaware by the Delaware County Employees’ Retirement Fund (Case No. 2017-0475-JTL). In December 2017, the Chancery Court stayed this case pending resolution of other contemporaneous matters. Each of these cases have named certain current and former members of the Board of Directors individually and certain officers of Universal Health Services, Inc. as defendants. UHS has also been named as a nominal defendant in these cases. The derivative cases make substantially similar allegations and claims as the shareholder class action relating to practices at our behavioral health facilities and board and corporate oversight of these facilities as well as claims relating to the stock trading by the individual defendants and company repurchase of shares during the relevant time period. The cases make claims of breaches of fiduciary duties by the named board members and officers; alleged violations of federal securities laws; and common law causes of action against the individual defendants including unjust enrichment, corporate waste, abuse of control, constructive fraud and gross mismanagement. The cases seek monetary damages allegedly incurred by the company; restitution and disgorgement of profits, benefits and other compensation from the individual defendants and various forms of equitable relief relating to corporate governance matters. In August, 2019, the court granted our motion to dismiss. Plaintiffs subsequently filed a motion with the court seeking leave to file a second amended complaint. In April, 2020, the court denied Plaintiffs motion to file a second amended complaint. Plaintiffs have filed an appeal with the 3d Circuit Court of Appeals. The defendants deny liability and intend to defend these cases vigorously. The parties have recently initiated settlement negotiations during the pendency of the appeal, however, we can provide no assurance that a settlement will be reached. We are uncertain as to potential liability or financial exposure, if any, which may be associated with these matters.

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.

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

9 Months Ended

Sep. 30, 2020

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 Chief Executive Officer, the President 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, 2019. 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 September 30, 2020
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	8,137,264		$	2,487,568		$	-		$	10,624,832
Gross outpatient revenues	$	4,128,549		$	243,600		$	-		$	4,372,149
Total net revenues	$	1,610,003		$	1,299,591		$	2,947		$	2,912,541
Income/(loss) before allocation of corporate overhead and income taxes	$	177,606		$	252,532		$	(106,874	)	$	323,264
Allocation of corporate overhead	$	(55,980	)	$	(42,667	)	$	98,647		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	121,626		$	209,865		$	(8,227	)	$	323,264
Total assets as of September 30, 2020	$	4,666,917		$	6,898,757		$	1,410,084		$	12,975,758

	Nine months ended September 30, 2020
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	22,695,513		$	7,298,466		$	0		$	29,993,979
Gross outpatient revenues	$	12,204,970		$	719,513		$	0		$	12,924,483
Total net revenues	$	4,598,558		$	3,864,823		$	8,581		$	8,471,962
Income/(loss) before allocation of corporate overhead and income taxes	$	464,139		$	746,980		$	(361,414	)	$	849,705
Allocation of corporate overhead	$	(167,936	)	$	(128,147	)	$	296,083		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	296,203		$	618,833		$	(65,331	)	$	849,705
Total assets as of September 30, 2020	$	4,666,917		$	6,898,757		$	1,410,084		$	12,975,758

	Three months ended September 30, 2019
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	7,004,832		$	2,536,504		$	0		$	9,541,336
Gross outpatient revenues	$	4,477,277		$	257,690		$	0		$	4,734,967
Total net revenues	$	1,528,535		$	1,291,816		$	2,102		$	2,822,453
Income/(loss) before allocation of corporate overhead and income taxes	$	148,085		$	138,019		$	(148,029	)	$	138,075
Allocation of corporate overhead	$	(57,578	)	$	(41,651	)	$	99,229		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	90,507		$	96,368		$	(48,800	)	$	138,075
Total assets as of September 30, 2019	$	4,395,259		$	6,919,100		$	280,042		$	11,594,401

	Nine months ended September 30, 2019
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	21,220,471		$	7,568,129		$	0		$	28,788,600
Gross outpatient revenues	$	13,137,199		$	792,929		$	0		$	13,930,128
Total net revenues	$	4,575,088		$	3,898,440		$	8,484		$	8,482,012
Income/(loss) before allocation of corporate overhead and income taxes	$	528,455		$	648,173		$	(431,449	)	$	745,179
Allocation of corporate overhead	$	(172,606	)	$	(124,936	)	$	297,542		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	355,849		$	523,237		$	(133,907	)	$	745,179
Total assets as of September 30, 2019	$	4,395,259		$	6,919,100		$	280,042		$	11,594,401

(a)

Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $156 million and $135 million for the three-month periods ended September 30, 2020 and 2019, respectively, and approximately $429 million and $415 million for the nine-month periods ended September 30, 2020 and 2019, respectively. Total assets at our U.K. behavioral health care facilities were approximately $1.257 billion and $1.175 billion as of September 30, 2020 and 2019, respectively.

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

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+ Details

Earnings Per Share Data ("EPS") and Stock Based Compensation

9 Months Ended

Sep. 30, 2020

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 September 30,						Nine months ended September 30,
	2020			2019			2020			2019
Basic and Diluted:
Net income attributable to UHS	$	241,279		$	97,190		$	635,245		$	569,678
Less: Net income attributable to unvested restricted share grants		(790	)		(243	)		(1,987	)		(1,414	)
Net income attributable to UHS – basic and diluted	$	240,489		$	96,947		$	633,258		$	568,264

Weighted average number of common shares - basic		84,672			87,952			85,172			89,288
Net effect of dilutive stock options and grants based on the treasury stock method		575			403			415			231
Weighted average number of common shares and equivalents - diluted		85,247			88,355			85,587			89,519
Earnings per basic share attributable to UHS:	$	2.84		$	1.10		$	7.44		$	6.36
Earnings per diluted share attributable to UHS:	$	2.82		$	1.10		$	7.40		$	6.35

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 7.1 million for the three months ended September 30, 2020 and 6.7 million for the nine months ended September 30, 2020. The excluded weighted-average stock options totaled 4.3 million for the three months ended September 30, 2019 and 6.6 million for the nine months ended September 30, 2019. All classes of our common stock have the same dividend rights.

The decrease in our basic and diluted weighted number of common shares outstanding for the three and nine months ended September 30, 2020, as compared to the comparable prior year three and nine months, was due primarily to the impact of shares repurchased by us since January 1, 2019.

Stock-Based Compensation:

During the three-month periods ended September 30, 2020 and 2019, pre-tax compensation cost of $13.0 million and $14.9 million, respectively, was recognized related to outstanding stock options. During the nine-month periods ended September 30, 2020 and 2019, pre-tax compensation costs of $41.6 million and $45.4 million, respectively, was recognized related to outstanding stock options. In addition, during the three-month periods ended September 30, 2020 and 2019, pre-tax compensation cost of approximately $2.5 million and $2.3 million (net of cancellations), respectively, was recognized related to restricted stock. During the nine-months periods ended September 30, 2020 and 2019, pre-tax compensation costs of approximately $7.3 million and $6.0 million (net of cancellations), respectively, was recognized related to restricted stock. As of September 30, 2020 there was approximately $113.6 million of unrecognized compensation cost related to unvested options and restricted stock awards and units which is expected to be recognized over the remaining weighted average vesting period of 2.4 years. There were 2,586,966 stock options granted during the first nine months of 2020 with a weighted-average grant date fair value of $14.57 per share. There were 128,467 shares of restricted shares and restricted units granted during the first nine months of 2020 with a weighted-average grant date fair value of $69.03 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 $49.9 million and $52.2 million during the nine month periods ended September 30, 2020 and 2019, respectively.

Dispositions and acquisitions

9 Months Ended

Sep. 30, 2020

Business Combinations [Abstract]

Dispositions and acquisitions

(9) Dispositions and acquisitions

Nine-month period ended September 30, 2020:

Acquisitions:

During the first nine months of 2020, we spent $52 million on the acquisition of businesses and property, consisting primarily of the real estate and other assets of a hospital located in Nevada.

Divestitures:

During the first nine months of 2020, we received $8 million from the sale of assets and businesses.

Nine-month period ended September 30, 2019:

Acquisitions:

During the first nine months of 2019, there were no acquisitions.

Divestitures:

During the first nine months of 2019, we received approximately $7 million from the divestiture of the real property of a previously closed behavioral health care facility

Dividends

9 Months Ended

Sep. 30, 2020

Earnings Per Share [Abstract]

Dividends

(10) Dividends

We declared and paid dividends of $17.3 million, or $.20 per share, during the first quarter of 2020. As part of our various COVID-19 initiatives, we have suspended declaration and payments of quarterly dividends. We declared and paid dividends of $17.6 million, or $.20 per share, during the third quarter of 2019 and declared and paid dividends of $35.6 million during the nine-month period ended September 30, 2019.

Income Taxes

9 Months Ended

Sep. 30, 2020

Income Tax Disclosure [Abstract]

Income Taxes

(11) Income Taxes

Our effective income tax rates were 24.5% and 26.9% during the three-month periods ended September 30, 2020, and 2019, respectively, and 24.1% and 22.2% during the nine-month periods ended September 30, 2020, and 2019, respectively. The decrease in the effective tax rate during the three-month period ended September 30, 2020, as compared to the comparable quarter of 2019, was primarily due to the $6 million unfavorable adjustment related to the non-deductible DOJ Reserve recorded in the third quarter of 2019 offset by $3 million tax expense attributable to employee share-based payments during the third quarter of 2020. The increase in the effective tax rate during the nine-month period ended September 30, 2020, as compared with the same period in 2019, was primarily due to a tax expense (benefit) from employee share-based payments of $4 million expense and $12 million benefit during the nine month periods ended September 30, 2020 and 2019, respectively and a $4 million increase resulting from a favorable adjustment to the income tax provision related to the effects of a change in state tax law enacted during 2019 offset by $6 million unfavorable adjustment related to the non-deductible DOJ Reserve recorded in the third quarter of 2019.

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 and less than $1 million for the nine months ended September 30, 2020 and 2019, respectfully.

As of January 1, 2020, 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 nine months ended September 30, 2020, 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 September 30, 2020, we have less than $1 million of accrued interest and penalties. The U.S. federal statute of limitations remains open for 2017 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.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References + Details

Revenue

9 Months Ended

Sep. 30, 2020

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. The transaction price is allocated to separate performance obligations based upon the relative standalone selling price. In instances where we determine there are multiple performance obligations across multiple months, the transaction price will be allocated by applying an estimated implicit and explicit rate to gross charges based on the separate performance obligations.

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 and nine month periods ended September 30, 2020 and 2019 (in thousands):

	For the three months ended September 30, 2020
	Acute Care				Behavioral Health				Other		Total
Medicare	$	319,259	20	%	$	120,691	9	%			$	439,950	15	%
Managed Medicare		234,169	15	%		62,618	5	%				296,787	10	%
Medicaid		160,671	10	%		159,756	12	%				320,427	11	%
Managed Medicaid		126,979	8	%		316,683	24	%				443,662	15	%
Managed Care (HMO and PPOs)		585,333	36	%		321,719	25	%				907,052	31	%
UK Revenue		0	0	%		155,323	12	%				155,323	5	%
Other patient revenue and adjustments, net		56,188	3	%		127,322	10	%				183,510	6	%
Other non-patient revenue (a)		127,404	8	%		35,479	3	%		2,947		165,830	6	%
Total Net Revenue	$	1,610,003	100	%	$	1,299,591	100	%	$	2,947		2,912,541	100	%

	For the nine months ended September 30, 2020
	Acute Care				Behavioral Health				Other		Total
Medicare	$	909,594	20	%	$	346,879	9	%			$	1,256,473	15	%
Managed Medicare		638,931	14	%		181,835	5	%				820,766	10	%
Medicaid		420,082	9	%		488,864	13	%				908,946	11	%
Managed Medicaid		358,770	8	%		900,105	23	%				1,258,875	15	%
Managed Care (HMO and PPOs)		1,558,765	34	%		955,530	25	%				2,514,295	30	%
UK Revenue		0	0	%		428,795	11	%				428,795	5	%
Other patient revenue and adjustments, net		198,983	4	%		371,517	10	%				570,500	7	%
Other non-patient revenue (a)		513,433	11	%		191,298	5	%		8,581		713,312	8	%
Total Net Revenue	$	4,598,558	100	%	$	3,864,823	100	%	$	8,581	$	8,471,962	100	%


	For the three months ended September 30, 2019
	Acute Care				Behavioral Health				Other		Total
Medicare	$	333,777	22	%	$	143,514	11	%			$	477,291	17	%
Managed Medicare		197,993	13	%		60,801	5	%				258,794	9	%
Medicaid		148,570	10	%		168,871	13	%				317,441	11	%
Managed Medicaid		133,906	9	%		278,888	22	%				412,794	15	%
Managed Care (HMO and PPOs)		554,341	36	%		324,140	25	%				878,481	31	%
UK Revenue		0	0	%		134,905	10	%				134,905	5	%
Other patient revenue and adjustments, net		45,918	3	%		130,964	10	%				176,882	6	%
Other non-patient revenue		114,030	7	%		49,733	4	%		2,102		165,865	6	%
Total Net Revenue	$	1,528,535	100	%	$	1,291,816	100	%	$	2,102	$	2,822,453	100	%


	For the nine months ended September 30, 2019
	Acute Care				Behavioral Health				Other		Total
Medicare	$	988,746	22	%	$	420,218	11	%			$	1,408,964	17	%
Managed Medicare		618,756	14	%		167,212	4	%				785,968	9	%
Medicaid		391,762	9	%		525,350	13	%				917,112	11	%
Managed Medicaid		413,607	9	%		821,413	21	%				1,235,020	15	%
Managed Care (HMO and PPOs)		1,690,889	37	%		1,018,739	26	%				2,709,628	32	%
UK Revenue		0	0	%		415,407	11	%				415,407	5	%
Other patient revenue and adjustments, net		133,962	3	%		381,345	10	%				515,307	6	%
Other non-patient revenue		337,366	7	%		148,756	4	%		8,484		494,606	6	%
Total Net Revenue	$	4,575,088	100	%	$	3,898,440	100	%	$	8,484	$	8,482,012	100	%

(a) Acute Care includes CARES Act and other grant income of $4 million and $161 million recorded in the three and nine-months periods ended September 30, 2020, respectively. Behavioral Health includes the reversal of CARES Act and other grant income of $9 million and CARES Act and other grant income of $52 million recorded in the three and nine-months periods ended September 30, 2020, respectively. As an accounting policy election, we have utilized ASC 958 by analogy to recognize funds received under the CARES Act from the Provider Relief Fund as revenue, given no direct authoritative guidance available to for-profit organizations to recognize revenue for government contributions and grants.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
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-Section 50
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Lease Accounting

9 Months Ended

Sep. 30, 2020

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 10 years. These real estate leases may include one or more options to renew, with renewals that can extend the lease term from five to 10 years. The exercise of lease renewal options is at our sole discretion. When determining the lease term, we included options to extend or terminate the lease when it is reasonably certain that we will exercise that option.

Three of our hospital facilities are held under operating leases with Universal Health Realty Income Trust with two hospital terms expiring in 2021 and the third expiring in 2026 (see Note 2 for additional disclosure). We are also the lessee of the real property of certain facilities.

Supplemental cash flow information related to leases for the nine-month periods ended September 30, 2020 and 2019 are as follows (in thousands):

	Nine months ended September 30,
	2020		2019

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	84,351	$	79,598
Operating cash flows from finance leases	$	1,431	$	1,589
Financing cash flows from finance leases	$	1,918	$	1,435

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	47,679	$	364,453

Included in the $364 million of right-of-use assets obtained in exchange for operating lease obligations is $14.0 million new operating leases entered into during the nine-month period ended September 30, 2019.

Recent Accounting Standards

9 Months Ended

Sep. 30, 2020

Accounting Changes And Error Corrections [Abstract]

Recent Accounting Standards

(14) Recent Accounting Standards

In June 2016, the FASB issued ASU 2016-13, "Financial Instruments - Credit Losses," which introduced new guidance for an approach based on expected losses to estimate credit losses on certain types of financial instruments. Instruments in scope include loans, held-to-maturity debt securities, and net investments in leases as well as reinsurance and trade receivables. In November 2018, the FASB issued ASU 2018-19, which clarifies that operating lease receivables are outside the scope of the new standard. The standard was be effective for us in fiscal years beginning after December 15, 2019. The adoption of this guidance did not have a material impact on our consolidated financial statements.

In January, 2017, the FASB issued ASU No. 2017-04, “Intangibles-Goodwill and Other (Topic 350): Simplifying the Accounting for Goodwill Impairment” (“ASU 2017-04”), which removes the requirement to perform a hypothetical purchase price allocation to measure goodwill impairment. A goodwill impairment will now be the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. ASU 2017-04 was effective for the annual and interim periods beginning January 1, 2020 with early adoption permitted, and applied prospectively. The adoption of this guidance did not have a material impact on our consolidated financial statements.

In August 2018, the FASB issued ASU 2018-15, Intangibles- Goodwill and Other- Internal Use Software (Topic 350): Customer's Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement that is a Service Contract, ("ASU 2018-15"), which requires customers in a cloud computing arrangement (i.e., hosting arrangement) that is a service contract to follow the internal use software guidance in ASC 350-40 to determine which implementation costs to capitalize or expense. ASU 2018-15 was effective for fiscal years beginning after December 15, 2019, including interim periods within those fiscal years. The adoption of this guidance did not have a material impact on our 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. This guidance was effective beginning on March 12, 2020, and the Company may elect to apply the amendments prospectively through December 31, 2022. The Company is currently evaluating the impact this guidance may have on our consolidated financial statements.

From time to time, new accounting guidance is issued by the FASB or other standard setting bodies that is adopted by the Company as of the effective date or, in some cases where early adoption is permitted, in advance of the effective date. The Company has assessed the recently issued guidance that is not yet effective and, unless otherwise indicated above, believes the new guidance will not have a material impact on our results of operations, cash flows or financial position.

- Definition

The entire disclosure for change in accounting principle. Includes, but is not limited to, nature, reason, and method of adopting amendment to accounting standards or other change in accounting principle.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Relationship with Universal Health Realty Income Trust and Related Party Transactions (Tables)

9 Months Ended

Sep. 30, 2020

Remaining Renewal Options and Terms for Each of Three Hospital Facilities Leased from Trust

The table below details the renewal options and terms for each of our three acute care hospital facilities leased from the Trust:

Hospital Name	Annual Minimum Rent		End of Lease Term	Renewal Term (years)
McAllen Medical Center	$	5,485,000	December, 2026	5(a)
Wellington Regional Medical Center	$	3,030,000	December, 2021	10(b)
Southwest Healthcare System, Inland Valley Campus	$	2,648,000	December, 2021	10(b)

(a) We have one 5-year renewal option at existing lease rates (through 2031).

(b) We have two 5-year renewal options at fair market value lease rates (2022 through 2031).

Treasury (Tables)

9 Months Ended

Sep. 30, 2020

Equity [Abstract]

Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations

	Gain/(Loss) recognized in AOCI
	Three months ended					Nine months ended
	September 30,			September 30,		September 30,		September 30,
	2020			2019		2020		2019
Cash Flow Hedge relationships
Interest rate swap agreements (a)	$	0		$	0	$	0	$	(3,925	)

Net Investment Hedge relationships
Foreign currency foreign exchange contracts	$	(28,244	)	$	33,927	$	15,291	$	79,584

(a)

Summary of Cash, Cash Equivalents and Restricted Cash Reported In Condensed Consolidated Statements of Cash Flows

	September 30,			December 31,
	2020			2019
Cash and cash equivalents	$	1,101,230		$	61,268
Restricted cash and cash equivalents (a)		44,659			44,399
Total cash, cash equivalents and restricted cash	$	1,145,889	(b)	$	105,667

(a) Restricted cash and cash equivalents is included in other assets on the accompanying consolidated balance sheet.
(b) Consists primarily of short-term cash accounts on which interest is being earned at various annual rates ranging from 0.06% to 0.31%.

Fair Value Measurement (Tables)

9 Months Ended

Sep. 30, 2020

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)	September 30, 2020		Location	Level 1		Level 2		Level 3
Assets:
Term Deposit		540,000	Cash and cash equivalents				540,000
Money market mutual funds		60,931	Other assets		60,931
Certificates of deposit		2,200	Other assets		2,200
Available for sale securities		61,082	Other assets		61,082
Deferred compensation assets		36,307	Other assets		36,307
Foreign currency exchange contracts		3,181	Other current assets				3,181
	$	703,701			160,520		543,181		-
Liabilities:
Deferred compensation liability		36,307	Other noncurrent liabilities		36,307
	$	36,307			36,307		-		-

	Balance at		Balance Sheet	Basis of Fair Value Measurement
(in thousands)	December 31, 2019		Location	Level 1		Level 2		Level 3
Assets:
Money market mutual funds	$	60,175	Other assets		60,175
Certificates of deposit		2,200	Other assets		2,200
Available for sale securities		70,478	Other assets		70,478
Deferred compensation assets		35,510	Other assets		35,510
Foreign currency exchange contracts		10,343	Other current assets				10,343
	$	178,706			168,363		10,343		-
Liabilities:
Deferred compensation liability	$	35,510	Other noncurrent liabilities		35,510
	$	35,510			35,510		-		-

Segment Reporting (Tables)

9 Months Ended

Sep. 30, 2020

Segment Reporting [Abstract]

Segment Reporting

	Three months ended September 30, 2020
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	8,137,264		$	2,487,568		$	-		$	10,624,832
Gross outpatient revenues	$	4,128,549		$	243,600		$	-		$	4,372,149
Total net revenues	$	1,610,003		$	1,299,591		$	2,947		$	2,912,541
Income/(loss) before allocation of corporate overhead and income taxes	$	177,606		$	252,532		$	(106,874	)	$	323,264
Allocation of corporate overhead	$	(55,980	)	$	(42,667	)	$	98,647		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	121,626		$	209,865		$	(8,227	)	$	323,264
Total assets as of September 30, 2020	$	4,666,917		$	6,898,757		$	1,410,084		$	12,975,758

	Nine months ended September 30, 2020
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	22,695,513		$	7,298,466		$	0		$	29,993,979
Gross outpatient revenues	$	12,204,970		$	719,513		$	0		$	12,924,483
Total net revenues	$	4,598,558		$	3,864,823		$	8,581		$	8,471,962
Income/(loss) before allocation of corporate overhead and income taxes	$	464,139		$	746,980		$	(361,414	)	$	849,705
Allocation of corporate overhead	$	(167,936	)	$	(128,147	)	$	296,083		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	296,203		$	618,833		$	(65,331	)	$	849,705
Total assets as of September 30, 2020	$	4,666,917		$	6,898,757		$	1,410,084		$	12,975,758

	Three months ended September 30, 2019
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	7,004,832		$	2,536,504		$	0		$	9,541,336
Gross outpatient revenues	$	4,477,277		$	257,690		$	0		$	4,734,967
Total net revenues	$	1,528,535		$	1,291,816		$	2,102		$	2,822,453
Income/(loss) before allocation of corporate overhead and income taxes	$	148,085		$	138,019		$	(148,029	)	$	138,075
Allocation of corporate overhead	$	(57,578	)	$	(41,651	)	$	99,229		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	90,507		$	96,368		$	(48,800	)	$	138,075
Total assets as of September 30, 2019	$	4,395,259		$	6,919,100		$	280,042		$	11,594,401

	Nine months ended September 30, 2019
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	21,220,471		$	7,568,129		$	0		$	28,788,600
Gross outpatient revenues	$	13,137,199		$	792,929		$	0		$	13,930,128
Total net revenues	$	4,575,088		$	3,898,440		$	8,484		$	8,482,012
Income/(loss) before allocation of corporate overhead and income taxes	$	528,455		$	648,173		$	(431,449	)	$	745,179
Allocation of corporate overhead	$	(172,606	)	$	(124,936	)	$	297,542		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	355,849		$	523,237		$	(133,907	)	$	745,179
Total assets as of September 30, 2019	$	4,395,259		$	6,919,100		$	280,042		$	11,594,401

(a)

Earnings Per Share Data ("EPS") and Stock Based Compensation (Tables)

9 Months Ended

Sep. 30, 2020

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 September 30,						Nine months ended September 30,
	2020			2019			2020			2019
Basic and Diluted:
Net income attributable to UHS	$	241,279		$	97,190		$	635,245		$	569,678
Less: Net income attributable to unvested restricted share grants		(790	)		(243	)		(1,987	)		(1,414	)
Net income attributable to UHS – basic and diluted	$	240,489		$	96,947		$	633,258		$	568,264

Weighted average number of common shares - basic		84,672			87,952			85,172			89,288
Net effect of dilutive stock options and grants based on the treasury stock method		575			403			415			231
Weighted average number of common shares and equivalents - diluted		85,247			88,355			85,587			89,519
Earnings per basic share attributable to UHS:	$	2.84		$	1.10		$	7.44		$	6.36
Earnings per diluted share attributable to UHS:	$	2.82		$	1.10		$	7.40		$	6.35

Revenue (Tables)

9 Months Ended

Sep. 30, 2020

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 and nine month periods ended September 30, 2020 and 2019 (in thousands):

	For the three months ended September 30, 2020
	Acute Care				Behavioral Health				Other		Total
Medicare	$	319,259	20	%	$	120,691	9	%			$	439,950	15	%
Managed Medicare		234,169	15	%		62,618	5	%				296,787	10	%
Medicaid		160,671	10	%		159,756	12	%				320,427	11	%
Managed Medicaid		126,979	8	%		316,683	24	%				443,662	15	%
Managed Care (HMO and PPOs)		585,333	36	%		321,719	25	%				907,052	31	%
UK Revenue		0	0	%		155,323	12	%				155,323	5	%
Other patient revenue and adjustments, net		56,188	3	%		127,322	10	%				183,510	6	%
Other non-patient revenue (a)		127,404	8	%		35,479	3	%		2,947		165,830	6	%
Total Net Revenue	$	1,610,003	100	%	$	1,299,591	100	%	$	2,947		2,912,541	100	%

	For the nine months ended September 30, 2020
	Acute Care				Behavioral Health				Other		Total
Medicare	$	909,594	20	%	$	346,879	9	%			$	1,256,473	15	%
Managed Medicare		638,931	14	%		181,835	5	%				820,766	10	%
Medicaid		420,082	9	%		488,864	13	%				908,946	11	%
Managed Medicaid		358,770	8	%		900,105	23	%				1,258,875	15	%
Managed Care (HMO and PPOs)		1,558,765	34	%		955,530	25	%				2,514,295	30	%
UK Revenue		0	0	%		428,795	11	%				428,795	5	%
Other patient revenue and adjustments, net		198,983	4	%		371,517	10	%				570,500	7	%
Other non-patient revenue (a)		513,433	11	%		191,298	5	%		8,581		713,312	8	%
Total Net Revenue	$	4,598,558	100	%	$	3,864,823	100	%	$	8,581	$	8,471,962	100	%


	For the three months ended September 30, 2019
	Acute Care				Behavioral Health				Other		Total
Medicare	$	333,777	22	%	$	143,514	11	%			$	477,291	17	%
Managed Medicare		197,993	13	%		60,801	5	%				258,794	9	%
Medicaid		148,570	10	%		168,871	13	%				317,441	11	%
Managed Medicaid		133,906	9	%		278,888	22	%				412,794	15	%
Managed Care (HMO and PPOs)		554,341	36	%		324,140	25	%				878,481	31	%
UK Revenue		0	0	%		134,905	10	%				134,905	5	%
Other patient revenue and adjustments, net		45,918	3	%		130,964	10	%				176,882	6	%
Other non-patient revenue		114,030	7	%		49,733	4	%		2,102		165,865	6	%
Total Net Revenue	$	1,528,535	100	%	$	1,291,816	100	%	$	2,102	$	2,822,453	100	%


	For the nine months ended September 30, 2019
	Acute Care				Behavioral Health				Other		Total
Medicare	$	988,746	22	%	$	420,218	11	%			$	1,408,964	17	%
Managed Medicare		618,756	14	%		167,212	4	%				785,968	9	%
Medicaid		391,762	9	%		525,350	13	%				917,112	11	%
Managed Medicaid		413,607	9	%		821,413	21	%				1,235,020	15	%
Managed Care (HMO and PPOs)		1,690,889	37	%		1,018,739	26	%				2,709,628	32	%
UK Revenue		0	0	%		415,407	11	%				415,407	5	%
Other patient revenue and adjustments, net		133,962	3	%		381,345	10	%				515,307	6	%
Other non-patient revenue		337,366	7	%		148,756	4	%		8,484		494,606	6	%
Total Net Revenue	$	4,575,088	100	%	$	3,898,440	100	%	$	8,484	$	8,482,012	100	%

Lease Accounting (Tables)

9 Months Ended

Sep. 30, 2020

Leases [Abstract]

Supplemental Cash Flow Information Related to Leases

Supplemental cash flow information related to leases for the nine-month periods ended September 30, 2020 and 2019 are as follows (in thousands):

	Nine months ended September 30,
	2020		2019

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	84,351	$	79,598
Operating cash flows from finance leases	$	1,431	$	1,589
Financing cash flows from finance leases	$	1,918	$	1,435

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	47,679	$	364,453

Relationship with Universal Health Realty Income Trust and Related Party Transactions - Additional Information (Detail)	3 Months Ended				9 Months Ended		12 Months Ended
	Sep. 30, 2020 USD ($) Facility $ / shares	Dec. 31, 2019 USD ($)	Sep. 30, 2019 USD ($) SquareFoot	Dec. 31, 2013	Sep. 30, 2020 USD ($) Hospital Facility SquareFoot Bed Lease	Sep. 30, 2019 USD ($) Hospital	Dec. 31, 2019 USD ($)	Dec. 31, 2018	Dec. 31, 2017
Related Party Transaction [Line Items]
Net revenues	$ 2,912,541,000		$ 2,822,453,000		$ 8,471,962,000	$ 8,482,012,000
Number of hospital facilities \| Hospital					3
Number of third party tenant rentable square feet \| SquareFoot					26,000
Number of flex lease commitment rentable square feet \| SquareFoot					20,000
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					1,100,000		$ 1,100,000
Chief Executive Officer \| Trust Owned by CEO
Related Party Transaction [Line Items]
Estimated payments to acquire life insurance policies					$ 9,000,000
Joint Venture Agreement
Related Party Transaction [Line Items]
Lease initial terms	20 years				20 years
Lease renewal period, years					10 years
Number of beds \| Bed					108
Number of triple net lease \| Lease					5
Number of square foot to be constructed \| SquareFoot					80,000
Expected aggregate fee					$ 750,000
Estimated project cost					37,500,000
Estimated initial annual rent					$ 2,700,000
Expected project to begin and be completed year					2020
Southwest Healthcare System, Inland Valley Campus
Related Party Transaction [Line Items]
End of Lease Term					2021-12
Annual Minimum Rent					$ 2,648,000
Minimum
Related Party Transaction [Line Items]
Lease initial terms	5 years				5 years
Minimum \| Chief Executive Officer
Related Party Transaction [Line Items]
Estimated death benefit proceeds					$ 37,000,000
Maximum
Related Party Transaction [Line Items]
Lease initial terms	10 years				10 years
Maximum \| Joint Venture Agreement
Related Party Transaction [Line Items]
Expected project to begin and be completed year					2021
Relationship with Universal Health Realty Income Trust
Related Party Transaction [Line Items]
Trust outstanding shares held, percentage	5.70%				5.70%
Percentage of advisory fee on average invested real estate assets	0.70%		0.70%		0.70%	0.70%	0.70%	0.70%	0.70%
Pre-tax share of income from the Trust	$ 300,000		$ 300,000		$ 800,000	$ 700,000
Dividends received from the Trust	543,000		536,000		1,600,000	1,600,000
Carrying value of investment in Trust	5,600,000	$ 6,400,000			5,600,000		$ 6,400,000
Market value of investment in Trust	$ 44,900,000	92,400,000			$ 44,900,000		$ 92,400,000
Lease initial terms	10 years				10 years
Lease renewal period, years					5 years
Rent expense under operating leases	$ 4,000,000		$ 4,000,000		$ 12,000,000	$ 12,000,000
Notice period on renewal of lease					90 days
Period of rights of refusal to leased facilities					180 days
Number of hospital facilities \| Hospital					3	3
Number of free-standing emergency departments to be acquired \| Facility	2				2
Number of square feet to be constructed \| SquareFoot			75,000
Percentage of master lease rentable square feet					50.00%
Annual Minimum Rent					$ 644,000
Relationship with Universal Health Realty Income Trust \| Minimum
Related Party Transaction [Line Items]
Lease initial terms	13 years				13 years
Relationship with Universal Health Realty Income Trust \| Minimum \| Limited Liability Companies
Related Party Transaction [Line Items]
Non-controlling ownership interests by subsidiaries	95.00%				95.00%
Relationship with Universal Health Realty Income Trust \| Maximum
Related Party Transaction [Line Items]
Lease initial terms	15 years				15 years
Relationship with Universal Health Realty Income Trust \| Maximum \| Limited Liability Companies
Related Party Transaction [Line Items]
Non-controlling ownership interests by subsidiaries	100.00%				100.00%
Relationship with Universal Health Realty Income Trust \| Advisory Fee
Related Party Transaction [Line Items]
Net revenues	$ 1,000,000.0		$ 1,000,000.0		$ 3,100,000	$ 3,000,000.0
Premier, Inc.
Related Party Transaction [Line Items]
Cash dividend declared per share \| $ / shares	$ 0.19
Premier, Inc. \| Other (Income) Expense, Net
Related Party Transaction [Line Items]
Dividend	$ 400,000
Premier, Inc. \| Other (Income) Expense, Net \| ASU 2016-01
Related Party Transaction [Line Items]
Unrealized gain					9,000,000
Premier, Inc. \| Group Purchasing Organization Agreement \| Restricted Stock
Related Party Transaction [Line Items]
Shares vesting period				7 years
Shares vesting period start year				2014
Shares vesting period end year				2020
Market value of retained vested shares		$ 70,000,000			$ 61,000,000

Remaining Renewal Options and Terms for Hospital Facilities Leased from Trust (Detail)

9 Months Ended

Sep. 30, 2020

USD ($)

McAllen Medical Center

Property Subject to or Available for Operating Lease [Line Items]

Annual Minimum Rent

$ 5,485,000

End of Lease Term

2026-12

Renewal Term (years)

5 years

^[1]

Wellington Regional Medical Center

Property Subject to or Available for Operating Lease [Line Items]

Annual Minimum Rent

$ 3,030,000

End of Lease Term

2021-12

Renewal Term (years)

10 years

^[2]

Southwest Healthcare System, Inland Valley Campus

Property Subject to or Available for Operating Lease [Line Items]

Annual Minimum Rent

$ 2,648,000

End of Lease Term

2021-12

Renewal Term (years)

10 years

^[2]

[1]	We have one 5-year renewal option at existing lease rates (through 2031).
[2]	We have two 5-year renewal options at fair market value lease rates (2022 through 2031).

Remaining Renewal Options and Terms for Hospital Facilities Leased from Trust (Parenthetical) (Detail)	9 Months Ended
	Sep. 30, 2020 RenewalOption
McAllen Medical Center
Property Subject to or Available for Operating Lease [Line Items]
Number of renewal options at existing lease rates	1
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]
Number of renewal options at fair market lease rates	2
Renewal options term at fair market lease rates	5 years
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
Wellington Regional Medical Center \| Minimum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2022
Southwest Healthcare System, Inland Valley Campus
Property Subject to or Available for Operating Lease [Line Items]
Number of renewal options at fair market lease rates	2
Renewal options term at fair market lease rates	5 years
Southwest Healthcare System, Inland Valley Campus \| Maximum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2031
Southwest Healthcare System, Inland Valley Campus \| Minimum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2022

Other Noncurrent Liabilities and Redeemable/Noncontrolling Interests - Additional Information (Detail) $ in Millions	Sep. 30, 2020 USD ($) Facility
Minority Interest [Line Items]
Behavioral health care facilities with outside owners holding non-controlling minority interest \| Facility	3
Non-controlling interest balances	$ 72
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	11.00%
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%

Treasury - Additional Information (Detail)					3 Months Ended	9 Months Ended		12 Months Ended
Treasury - Additional Information (Detail)	Sep. 28, 2020 USD ($)	Oct. 31, 2018 USD ($)	Oct. 23, 2018 USD ($)	Jun. 07, 2016 USD ($)	Sep. 30, 2020 USD ($)	Sep. 30, 2020 USD ($) Installment	Sep. 30, 2019 USD ($)	Dec. 31, 2015 USD ($) Derivative	Sep. 21, 2020 USD ($)	Dec. 31, 2019 USD ($)	Jun. 30, 2018 USD ($)	Apr. 30, 2018 USD ($)	Jun. 03, 2016 USD ($)
Equity Class Of Treasury Stock [Line Items]
Cash and cash equivalents					$ 1,101,230,000	$ 1,101,230,000				$ 61,268,000
Line of credit facility, starting date						Oct. 23, 2018
Rate adjustment to weighted average federal funds rate for credit facility borrowings					0.50%	0.50%
Rate adjustment to one month Eurodollar rate on credit facility borrowings						1.00%
Accounts receivable securitization program credit facility, borrowing capacity											$ 440,000,000	$ 450,000,000
Accounts receivable securitization program credit facility, amount outstanding					$ 0	$ 0
Accounts receivable securitization program credit facility, available borrowing capacity					450,000,000	450,000,000
Debt instrument carrying amount					3,600,000,000	3,600,000,000				4,000,000,000.0
Fair value of debt					$ 3,600,000,000	3,600,000,000				$ 4,000,000,000.0
One Point Three One Percent Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Number of additional forward starting interest rate swaps \| Derivative								9
Maturity date of interest rate cash flow hedges								Apr. 15, 2019
Fixed rate payable on interest rate swap								1.31%
Foreign Currency Forward Exchange Contracts
Equity Class Of Treasury Stock [Line Items]
Net cash (outflows) inflows						$ 22,000,000	$ 34,000,000
Cash Flow Hedging \| One Point Three One Percent Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Notional amount of interest rate cash flow hedges								$ 1,000,000,000.0
Tranche B Term Loan \| One Month LIBOR Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio					0.75%	0.75%
Tranche B Term Loan \| One Two Three Six Month LIBOR Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio					1.75%	1.75%
Revolving Credit Facility
Equity Class Of Treasury Stock [Line Items]
Line of credit facility, borrowing capacity			$ 1,000,000,000	$ 800,000,000
Line of credit facility increased amount			$ 200,000,000
Credit facility, maturity date			Oct. 23, 2023	Aug. 07, 2019
Line of credit facility, available borrowing capacity					$ 997,000,000	$ 997,000,000
Line of credit facility amount outstanding			$ 1,000,000,000		$ 0	$ 0
Current applicable margins					1.375%	1.375%
Revolving Credit Facility \| ABR-based loans
Equity Class Of Treasury Stock [Line Items]
Current applicable margins					1.75%	1.75%
Revolving Credit Facility \| Letter of Credit
Equity Class Of Treasury Stock [Line Items]
Line of credit facility, borrowing capacity					$ 125,000,000	$ 125,000,000
Letters of credit, outstanding					3,000,000	3,000,000
Tranche A Term Loan
Equity Class Of Treasury Stock [Line Items]
Line of credit facility, borrowing capacity			2,000,000,000	$ 1,710,000,000
Line of credit facility increased amount			$ 290,000,000
Senior notes, maturity date			Oct. 23, 2023	Aug. 07, 2019
Line of credit facility amount outstanding					1,913,000,000	$ 1,913,000,000
Number of installments \| Installment						8
Tranche A Term Loan \| Quarterly Payment for First Eight Installments
Equity Class Of Treasury Stock [Line Items]
Scheduled principal payments per quarter			$ 12,500,000
Debt instrument payment, description						commenced in March of 2019 and are scheduled to continue through December of 2020.
Tranche A Term Loan \| Quarterly Payment after Eight Installments Until Maturity
Equity Class Of Treasury Stock [Line Items]
Scheduled principal payments per quarter			25,000,000
Debt instrument payment, description						commencing in March of 2021 until maturity in October of 2023
Tranche B Term Loan
Equity Class Of Treasury Stock [Line Items]
Line of credit facility, borrowing capacity		$ 500,000,000
Senior notes, maturity date						Oct. 31, 2025
Senior notes, maturity term		7 years
Line of credit facility amount outstanding					491,000,000	$ 491,000,000
Scheduled principal payments per quarter			$ 1,250,000
Debt instrument payment, description						commenced on March 31, 2019 and are scheduled to continue until maturity in October of 2025
New Senior Secured Notes
Equity Class Of Treasury Stock [Line Items]
Senior notes, issued					1,200,000,000	$ 1,200,000,000
New Senior Secured Notes \| 3.75% Senior Secured Notes due 2019
Equity Class Of Treasury Stock [Line Items]
Senior Notes		$ 300,000,000
Senior notes, interest rate		3.75%
New Senior Secured Notes \| 2.65% Senior Secured Notes due 2030
Equity Class Of Treasury Stock [Line Items]
Senior notes, maturity date						Oct. 15, 2030
Senior notes, interest rate									2.65%
Senior notes, issued									$ 800,000,000
New Senior Secured Notes \| 5.00% Senior Secured Notes due 2026
Equity Class Of Treasury Stock [Line Items]
Senior notes, maturity date						Jun. 01, 2026
Senior notes, interest rate													5.00%
Senior notes, issued													$ 400,000,000
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, issued	$ 700,000,000
Redemption price, percentage	100.00%
Loss on extinguishment of debt					$ (1,000,000)	$ (1,000,000)
Term Loan A
Equity Class Of Treasury Stock [Line Items]
Current applicable margins					1.375%	1.375%
Term Loan A \| ABR-based loans
Equity Class Of Treasury Stock [Line Items]
Current applicable margins					0.375%	0.375%
Minimum
Equity Class Of Treasury Stock [Line Items]
Short -term cash investments interest rate						0.06%
Minimum \| Revolving Credit Facility \| One Month LIBOR Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio					0.375%	0.375%
Minimum \| Revolving Credit Facility \| One Two Three Six Month LIBOR Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio					1.375%	1.375%
Minimum \| Term Loan A \| One Month LIBOR Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio					0.375%	0.375%
Minimum \| Term Loan A \| One Two Three Six Month LIBOR Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio					1.375%	1.375%
Maximum
Equity Class Of Treasury Stock [Line Items]
Short -term cash investments interest rate						0.31%
Maximum \| Revolving Credit Facility \| One Month LIBOR Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio					0.625%	0.625%
Maximum \| Revolving Credit Facility \| One Two Three Six Month LIBOR Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio					1.625%	1.625%
Maximum \| New Senior Secured Notes \| 2.65% Senior Secured Notes due 2030
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%	0.625%
Maximum \| Term Loan A \| One Two Three Six Month LIBOR Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio					1.625%	1.625%

Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations (Detail) - USD ($)
$ in Thousands

3 Months Ended

9 Months Ended

Sep. 30, 2020

Sep. 30, 2019

Sep. 30, 2020

Sep. 30, 2019

Derivative Instruments Gain Loss [Line Items]

Gain/(Loss) recognized in AOCI

$ (3,925)

Designated As Hedging Instrument | Cash Flow Hedging | Interest Rate Swap

Derivative Instruments Gain Loss [Line Items]

Gain/(Loss) recognized in AOCI

^[1]

$ 0

(3,925)

Designated As Hedging Instrument | Net Investment Hedge | Foreign Currency Foreign Exchange Contracts

Derivative Instruments Gain Loss [Line Items]

Gain/(Loss) recognized in AOCI

$ (28,244)

$ 33,927

$ 15,291

$ 79,584

[1]	The amount of gain reclassified out of AOCI into interest expense, net was $0 during each of the three-month periods ended September 30, 2020 and 2019, respectively, and $0 and $3.4 million during the nine-month periods ended September 30, 2020 and 2019, respectively.

Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations (Parenthetical) (Detail) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Interest Expense, Net \| Designated As Hedging Instrument \| Cash Flow Hedging \| Interest Rate Swap
Derivative Instruments Gain Loss [Line Items]
Gain reclassified out of AOCI into interest expenses	$ 0	$ 0	$ 0	$ 3,400,000

Summary of Cash, Cash Equivalents and Restricted Cash Reported In Condensed Consolidated Statements of Cash Flows (Detail) - USD ($)
$ in Thousands

Sep. 30, 2020

Dec. 31, 2019

Cash And Cash Equivalents Period Increase Decrease [Abstract]

Cash and cash equivalents

$ 1,101,230

$ 61,268

Restricted cash and cash equivalents

^[1]

$ 44,659

$ 44,399

Restricted Cash and Cash Equivalents, Noncurrent, Asset, Statement of Financial Position [Extensible List]

us-gaap:OtherAssetsMiscellaneousNoncurrent

Total cash, cash equivalents and restricted cash

$ 1,145,889

^[2]

$ 105,667

[1]	Restricted cash and cash equivalents is included in other assets on the accompanying consolidated balance sheet.
[2]	Consists primarily of short-term cash accounts on which interest is being earned at various annual rates ranging from 0.06% to 0.31%.

Summary of Cash, Cash Equivalents and Restricted Cash Reported In Condensed Consolidated Statements of Cash Flows (Parenthetical) (Detail)	9 Months Ended
	Sep. 30, 2020
Minimum
Cash And Cash Equivalents Period Increase Decrease [Line Items]
Short -term cash investments interest rate	0.06%
Maximum
Cash And Cash Equivalents Period Increase Decrease [Line Items]
Short -term cash investments interest rate	0.31%

Summary of Assets and Liabilities Recorded at Fair Value on Recurring Basis (Detail) - Recurring - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Assets:
Assets, fair value	$ 703,701	$ 178,706
Liabilities:
Liabilities, fair value	36,307	35,510
Term Deposit \| Cash and Cash Equivalents
Assets:
Assets, fair value	540,000
Money Market Mutual Funds \| Other Assets
Assets:
Assets, fair value	60,931	60,175
Certificates of Deposit \| Other Assets
Assets:
Assets, fair value	2,200	2,200
Available for Sale Securities \| Other Assets
Assets:
Assets, fair value	61,082	70,478
Deferred Compensation Assets \| Other Assets
Assets:
Assets, fair value	36,307	35,510
Foreign Currency Foreign Exchange Contracts \| Other Current Assets
Assets:
Assets, fair value	3,181	10,343
Deferred Compensation Liability \| Other Noncurrent Liabilities
Liabilities:
Liabilities, fair value	36,307	35,510
Basis of Fair Value Measurement, Level 1
Assets:
Assets, fair value	160,520	168,363
Liabilities:
Liabilities, fair value	36,307	35,510
Basis of Fair Value Measurement, Level 1 \| Money Market Mutual Funds \| Other Assets
Assets:
Assets, fair value	60,931	60,175
Basis of Fair Value Measurement, Level 1 \| Certificates of Deposit \| Other Assets
Assets:
Assets, fair value	2,200	2,200
Basis of Fair Value Measurement, Level 1 \| Available for Sale Securities \| Other Assets
Assets:
Assets, fair value	61,082	70,478
Basis of Fair Value Measurement, Level 1 \| Deferred Compensation Assets \| Other Assets
Assets:
Assets, fair value	36,307	35,510
Basis of Fair Value Measurement, Level 1 \| Deferred Compensation Liability \| Other Noncurrent Liabilities
Liabilities:
Liabilities, fair value	36,307	35,510
Basis of Fair Value Measurement, Level 2
Assets:
Assets, fair value	543,181	10,343
Basis of Fair Value Measurement, Level 2 \| Term Deposit \| Cash and Cash Equivalents
Assets:
Assets, fair value	540,000
Basis of Fair Value Measurement, Level 2 \| Foreign Currency Foreign Exchange Contracts \| Other Current Assets
Assets:
Assets, fair value	$ 3,181	$ 10,343

Commitments and Contingencies - Additional Information (Detail) £ in Millions	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Sep. 30, 2020 USD ($)	Sep. 30, 2020 GBP (£)	Dec. 31, 2015 USD ($)	Dec. 31, 2014 USD ($)	Dec. 31, 2013 USD ($)	Dec. 31, 2012 USD ($)	Dec. 31, 2011 USD ($)	Sep. 30, 2020 GBP (£)	Jun. 01, 2020 USD ($)	Jan. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability, current	$ 50,000,000		$ 50,000,000										$ 42,000,000
Compensation liability claims	90,000,000		90,000,000										81,000,000
Compensation and related benefits	46,000,000		46,000,000										40,000,000
Department of Human Services
Commitments and Contingencies Disclosure [Line Items]
Aggregate payment made					$ 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
Per Occurrence/Per Location Deductible \| Wind Storms
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses											$ 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		$ 1,000,000,000
Percentage of insurance deductible	5.00%		5.00%							5.00%
Maximum \| Flood
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	$ 100,000,000		$ 100,000,000
Maximum \| LAS VEGAS, NEVADA \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	500,000,000		500,000,000
Maximum \| CALIFORNIA \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	130,000,000		130,000,000
Maximum \| Faulty Zones of UNITED STATES \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	100,000,000		100,000,000
Maximum \| PUERTO RICO \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	40,000,000		40,000,000
Maximum \| PUERTO RICO \| Flood
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	1,000,000		1,000,000
Maximum \| OTHER STATES \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	250,000,000		250,000,000
Maximum \| Texas \| Flood
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	$ 10,000,000		$ 10,000,000
Minimum \| Wind Storms
Commitments and Contingencies Disclosure [Line Items]
Percentage of insurance deductible	3.00%		3.00%							3.00%
General And Professional Liability Insurance Policies
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability	$ 5,000,000	$ 20,000,000	$ 25,000,000
General and Professional Liability
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability	$ 262,000,000		$ 262,000,000										242,000,000
Subsidiaries \| Professional Liability
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability													5,000,000	$ 5,000,000	$ 5,000,000
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 \| £										£ 10
Subsidiaries \| Professional Liability \| Maximum
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability												10,000,000				$ 10,000,000
Subsidiaries \| General Liability
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability													$ 3,000,000	$ 3,000,000	$ 3,000,000
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
Subsidiaries \| General And Professional Liability Insurance Policies
Commitments and Contingencies Disclosure [Line Items]
Percentage of liability for claims paid under commercially insured coverage	10.00%		10.00%							10.00%
Subsidiaries \| General And Professional Liability Insurance Policies \| Maximum
Commitments and Contingencies Disclosure [Line Items]
Purchased several excess policies through commercial insurance carriers per occurrence					$ 250,000,000	$ 250,000,000	$ 200,000,000
Liability for claims paid under commercially insured coverage	$ 5,000,000		$ 5,000,000
Subsidiaries \| General And Professional Liability Insurance Policies \| Maximum \| Located in U.K.
Commitments and Contingencies Disclosure [Line Items]
Liability for claims paid under commercially insured coverage	$ 8,500,000		$ 8,500,000

Segment Reporting (Detail) - USD ($)
$ in Thousands

3 Months Ended

9 Months Ended

Sep. 30, 2020

Sep. 30, 2019

Sep. 30, 2020

Sep. 30, 2019

Dec. 31, 2019

Segment Reporting Information [Line Items]

Gross inpatient revenues

$ 10,624,832

$ 9,541,336

$ 29,993,979

$ 28,788,600

Gross outpatient revenues

4,372,149

4,734,967

12,924,483

13,930,128

Total net revenues

2,912,541

2,822,453

8,471,962

8,482,012

Income/(loss) before allocation of corporate overhead and income taxes

323,264

138,075

849,705

745,179

Allocation of corporate overhead

Income before income taxes

323,264

138,075

849,705

745,179

Total assets

12,975,758

11,594,401

12,975,758

11,594,401

$ 11,668,250

Acute Care Hospital Services

Segment Reporting Information [Line Items]

Gross inpatient revenues

8,137,264

7,004,832

22,695,513

21,220,471

Gross outpatient revenues

4,128,549

4,477,277

12,204,970

13,137,199

Total net revenues

1,610,003

1,528,535

4,598,558

4,575,088

Income/(loss) before allocation of corporate overhead and income taxes

177,606

148,085

464,139

528,455

Allocation of corporate overhead

(55,980)

(57,578)

(167,936)

(172,606)

Income before income taxes

121,626

90,507

296,203

355,849

Total assets

4,666,917

4,395,259

4,666,917

4,395,259

Behavioral Health Services

Segment Reporting Information [Line Items]

Gross inpatient revenues

^[1]

2,487,568

2,536,504

7,298,466

7,568,129

Gross outpatient revenues

^[1]

243,600

257,690

719,513

792,929

Total net revenues

^[1]

1,299,591

1,291,816

3,864,823

3,898,440

Income/(loss) before allocation of corporate overhead and income taxes

^[1]

252,532

138,019

746,980

648,173

Allocation of corporate overhead

^[1]

(42,667)

(41,651)

(128,147)

(124,936)

Income before income taxes

^[1]

209,865

96,368

618,833

523,237

Total assets

^[1]

6,898,757

6,919,100

6,898,757

6,919,100

Other

Segment Reporting Information [Line Items]

Gross inpatient revenues

Gross outpatient revenues

Total net revenues

2,947

2,102

8,581

8,484

Income/(loss) before allocation of corporate overhead and income taxes

(106,874)

(148,029)

(361,414)

(431,449)

Allocation of corporate overhead

98,647

99,229

296,083

297,542

Income before income taxes

(8,227)

(48,800)

(65,331)

(133,907)

Total assets

$ 1,410,084

$ 280,042

$ 1,410,084

$ 280,042

[1]

Segment Reporting (Parenthetical) (Detail) - USD ($)
$ in Thousands

3 Months Ended

9 Months Ended

Sep. 30, 2020

Sep. 30, 2019

Sep. 30, 2020

Sep. 30, 2019

Dec. 31, 2019

Dispositions and Acquisitions - Additional Information (Detail) - USD ($)	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Business Acquisition [Line Items]
Acquisition, cash paid		$ 0
Aggregate cash proceeds from divestiture of businesses	$ 8,000,000
Behavioral Health Care Facility
Business Acquisition [Line Items]
Aggregate cash proceeds from divestiture of businesses		$ 7,000,000
Real Estate and Other Assets \| Nevada
Business Acquisition [Line Items]
Acquisition, cash paid	$ 52,000,000

Dividends - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended		9 Months Ended
	Mar. 31, 2020	Sep. 30, 2019	Sep. 30, 2019
Dividends [Abstract]
Dividends declared and paid	$ 17.3	$ 17.6	$ 35.6
Dividends declared and paid, per share	$ 0.20	$ 0.20

Lease Accounting - Additional Information (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2020 USD ($) Hospital	Sep. 30, 2019 USD ($)
Lessee Lease Description [Line Items]
Lessee, operating lease, existence of option to extend [true false]	true
Number of hospital facilities \| Hospital	3
Right-of-use assets obtained in exchange for operating lease obligations	$ 47,679	$ 364,453
New Operating Leases
Lessee Lease Description [Line Items]
Right-of-use assets obtained in exchange for operating lease obligations		$ 14,000
Two Hospital Facilities
Lessee Lease Description [Line Items]
Lease Expiration Term	2021
Third Hospital Facilities
Lessee Lease Description [Line Items]
Lease Expiration Term	2026
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 Information Related to Leases (Detail) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 84,351	$ 79,598
Operating cash flows from finance leases	1,431	1,589
Financing cash flows from finance leases	1,918	1,435
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$ 47,679	$ 364,453