0001564590-22-006717 | 10-K | XBRL Viewer | Universal Health Services INC

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Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Statement [Abstract]
Net revenues	$ 12,642,117	$ 11,558,897	$ 11,378,259
Operating charges:
Salaries, wages and benefits	6,163,944	5,613,097	5,588,893
Other operating expenses	3,035,869	2,672,762	2,723,911
Supplies expense	1,427,134	1,288,132	1,251,346
Depreciation and amortization	533,213	510,493	490,392
Lease and rental expense	118,863	116,059	107,809
Operating Expenses, Total	11,279,023	10,200,543	10,162,351
Income from operations	1,363,094	1,358,354	1,215,908
Interest expense, net	83,672	106,285	162,733
Other (income) expense, net	(13,891)	(14)	(13,162)
Income before income taxes	1,293,313	1,252,083	1,066,337
Provision for income taxes	305,681	299,293	238,794
Net income	987,632	952,790	827,543
Less: Net (loss) income attributable to noncontrolling interests	(3,958)	8,837	12,689
Net income attributable to UHS	$ 991,590	$ 943,953	$ 814,854
Basic earnings per share attributable to UHS	$ 11.99	$ 11.06	$ 9.16
Diluted earnings per share attributable to UHS	$ 11.82	$ 10.99	$ 9.13
Weighted average number of common shares—basic	82,519	85,061	88,762
Add: Other share equivalents	1,173	526	278
Weighted average number of common shares and equivalents—diluted	83,692	85,587	89,040

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 987,632	$ 952,790	$ 827,543
Other comprehensive income (loss):
Unrealized derivative losses on cash flow hedges	0	0	(3,925)
Minimum pension liability	1,427	4,428	8,503
Foreign currency translation adjustment	(20,743)	13,619	27,886
Other comprehensive income before tax	(19,316)	18,047	32,464
Income tax expense related to items of other comprehensive income	(1,487)	1,820	4,813
Total other comprehensive income (loss), net of tax	(17,829)	16,227	27,651
Comprehensive income	969,803	969,017	855,194
Less: Comprehensive income attributable to noncontrolling interests	(3,958)	8,837	12,689
Comprehensive income attributable to UHS	$ 973,761	$ 960,180	$ 842,505

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 115,301	$ 1,224,490
Accounts receivable, net	1,746,635	1,728,928
Supplies	206,839	190,417
Other current assets	194,781	138,034
Total current assets	2,263,556	3,281,869
Property and Equipment
Land	732,717	665,000
Buildings and improvements	6,509,629	6,030,183
Equipment	2,759,934	2,607,692
Property under finance lease	102,940	75,611
Property Equipment Gross	10,105,220	9,378,486
Accumulated depreciation	(4,896,427)	(4,512,764)
Property and equipment excluding construction in progress net	5,208,793	4,865,722
Construction-in-progress	665,482	507,402
Property, plant and equipment, net, Total	5,874,275	5,373,124
Other assets:
Goodwill	3,962,624	3,882,715
Deferred income taxes	45,707	22,689
Right of use assets-operating leases	367,477	336,513
Deferred charges	6,525	4,985
Other	573,379	574,984
Other assets	4,955,712	4,821,886
Total Assets	13,093,543	13,476,879
Current liabilities:
Current maturities of long-term debt	48,409	331,998
Accounts payable	658,900	570,523
Accrued liabilities
Compensation and related benefits	466,353	410,165
Interest	14,408	9,458
Taxes other than income	160,793	152,227
Operating lease liabilities	64,484	59,796
Medicare accelerated payments and deferred CARES Act and other grants	6	376,151
Other	560,036	526,298
Current federal and state income taxes	10,720	44,423
Total current liabilities	1,984,109	2,481,039
Other noncurrent liabilities	464,759	458,549
Medicare accelerated payments and deferred CARES Act noncurrent	0	322,617
Operating lease liabilities noncurrent	304,624	278,303
Long-term debt	4,141,879	3,524,253
Deferred income taxes	0	5,582
Commitments and contingencies (Note 8)
Redeemable noncontrolling interest	5,119	4,569
Equity:
Cumulative dividends	(545,487)	(479,503)
Retained earnings	6,604,089	6,747,678
Accumulated other comprehensive income	30,291	48,120
Universal Health Services, Inc. common stockholders’ equity	6,089,664	6,317,146
Noncontrolling interest	103,389	84,821
Total Equity	6,193,053	6,401,967
Total Liabilities and Stockholders’ Equity	13,093,543	13,476,879
Class A
Equity:
Common Stock	66	66
Class B
Equity:
Common Stock	698	778
Class C
Equity:
Common Stock	7	7
Class D
Equity:
Common Stock	$ 0	$ 0

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2021	Dec. 31, 2020
Class A
Common Stock, par value	$ 0.01	$ 0.01
Common Stock, shares authorized	12,000,000	12,000,000
Common Stock, shares issued	6,577,100	6,577,100
Common Stock, shares outstanding	6,577,100	6,577,100
Class B
Common Stock, par value	$ 0.01	$ 0.01
Common Stock, shares authorized	150,000,000	150,000,000
Common Stock, shares issued	69,834,320	77,805,530
Common Stock, shares outstanding	69,834,320	77,805,530
Class C
Common Stock, par value	$ 0.01	$ 0.01
Common Stock, shares authorized	1,200,000	1,200,000
Common Stock, shares issued	661,688	661,688
Common Stock, shares outstanding	661,688	661,688
Class D
Common Stock, par value	$ 0.01	$ 0.01
Common Stock, shares authorized	5,000,000	5,000,000
Common Stock, shares issued	17,956	18,251
Common Stock, shares outstanding	17,956	18,251

Consolidated Statements of Changes in Equity - USD ($) $ in Thousands	Total	Redeemable Noncontrolling Interest	Common Stock Class A	Common Stock Class B	Common Stock Class C	Common Stock 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) including tax benefits from exercise of stock options	10,940			10				10,930		10,940
Repurchased	(753,927)			(57)				(753,870)		(753,927)
Restricted share-based compensation expense	8,222							8,222		8,222
Dividends paid	(53,003)						(53,003)			(53,003)
Stock option expense	60,106							60,106		60,106
Distributions to noncontrolling interests	(15,359)	(500)									(15,359)
Other	1,446										1,446
Comprehensive income:
Net income to UHS / noncontrolling interests	827,002							814,854		814,854	12,148
Net income attributable to redeemable noncontrolling interest		541
Foreign currency translation adjustments (net of income tax effect)	24,193								24,193	24,193
Unrealized derivative gains on cash flow hedges (net of income tax effect)	(2,997)								(2,997)	(2,997)
Minimum pension liability (net of income tax effect)	6,455								6,455	6,455
Subtotal - comprehensive income	854,653							814,854	27,651	842,505	12,148
Subtotal attributable to redeemable noncontrolling interest		541
Balance at Dec. 31, 2019	5,578,871		66	794	7		(462,159)	5,933,504	31,893	5,504,105	74,766
Balance at Dec. 31, 2019		4,333
Common Stock
Issued/(converted) including tax benefits from exercise of stock options	12,758			4				12,754		12,758
Repurchased	(206,719)			(20)				(206,699)		(206,719)
Restricted share-based compensation expense	9,505							9,505		9,505
Dividends paid	(17,344)						(17,344)			(17,344)
Stock option expense	54,661							54,661		54,661
Distributions to noncontrolling interests	(19,305)	(500)									(19,305)
Purchase of ownership interests by minority members	17,959										17,959
Other	3,300										3,300
Comprehensive income:
Net income to UHS / noncontrolling interests	952,054							943,953		943,953	8,101
Net income attributable to redeemable noncontrolling interest		736
Foreign currency translation adjustments (net of income tax effect)	12,870								12,870	12,870
Minimum pension liability (net of income tax effect)	3,357								3,357	3,357
Subtotal - comprehensive income	968,281							943,953	16,227	960,180	8,101
Subtotal attributable to redeemable noncontrolling interest		736
Balance at Dec. 31, 2020	6,401,967		66	778	7		(479,503)	6,747,678	48,120	6,317,146	84,821
Balance at Dec. 31, 2020		4,569
Common Stock
Issued/(converted) including tax benefits from exercise of stock options	13,374			5				13,369		13,374
Repurchased	(1,220,875)			(85)				(1,220,790)		(1,220,875)
Restricted share-based compensation expense	12,936							12,936		12,936
Dividends paid	(65,984)						(65,984)			(65,984)
Stock option expense	59,306							59,306		59,306
Distributions to noncontrolling interests	(6,878)	(202)									(6,878)
Purchase of ownership interests by minority members	13,909										13,909
Other	16,247										16,247
Comprehensive income:
Net income to UHS / noncontrolling interests	986,880							991,590		991,590	(4,710)
Net income attributable to redeemable noncontrolling interest		752
Foreign currency translation adjustments (net of income tax effect)	(18,914)								(18,914)	(18,914)
Minimum pension liability (net of income tax effect)	1,085								1,085	1,085
Subtotal - comprehensive income	969,051							991,590	(17,829)	973,761	(4,710)
Subtotal attributable to redeemable noncontrolling interest		752
Balance at Dec. 31, 2021	6,193,053		$ 66	$ 698	$ 7		$ (545,487)	$ 6,604,089	$ 30,291	$ 6,089,664	$ 103,389
Balance at Dec. 31, 2021	$ 5,000	$ 5,119

Consolidated Statements of Changes in Equity (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement Of Stockholders Equity [Abstract]
Foreign currency translation adjustments, income tax effect	$ 1,829	$ 749	$ 3,693
Unrealized derivative gains on cash flow hedges, income tax effect			928
Minimum pension liability, income tax effect	$ (342)	$ (1,071)	$ (2,048)

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Cash Flows from Operating Activities:
Net income	$ 987,632	$ 952,790	$ 827,543
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	533,213	510,493	490,392
Loss (Gain) on sales of assets and businesses	(5,170)	1,957	(7,540)
Stock-based compensation expense	73,686	65,837	69,431
Costs related to extinguishment of debt	16,831	1,365	0
Provision for asset impairment	14,391	0	97,631
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(8,873)	(145,901)	(42,056)
Accrued interest	4,950	(10,028)	209
Accrued and deferred income taxes	(54,030)	9,593	(25,194)
Other working capital accounts	46,526	124,545	39,664
Medicare accelerated payments and deferred CARES Act and other grants	(698,762)	698,768	0
Other assets and deferred charges	(39,337)	(4,555)	(27,205)
Other	(82,075)	109,167	7,703
Accrued insurance expense, net of commercial premiums paid	186,215	159,223	105,672
Payments made in settlement of self-insurance claims	(91,502)	(113,085)	(97,781)
Net cash provided by operating activities	883,695	2,360,169	1,438,469
Cash Flows from Investing Activities:
Property and equipment additions	(855,659)	(731,307)	(634,095)
Acquisition of businesses and property	(105,415)	(52,009)	(8,005)
Inflows (outflows) from foreign exchange contracts that hedge our net U.K. investment	1,357	(21,740)	(19,763)
Proceeds received from sales of assets and businesses	25,425	8,168	9,450
Costs incurred for purchase and implementation of information technology applications	19,726	(2,902)	(21,418)
Decrease (Increase) in capital reserves of commercial insurance subsidiary	100	(100)	0
Investment in, and advances to, joint ventures and other	0	(2,672)	(14,579)
Net cash used in investing activities	(914,466)	(802,562)	(688,410)
Cash Flows from Financing Activities:
Repayments of long-term debt	(3,037,868)	(962,567)	(57,142)
Additional borrowings	3,254,974	801,599	39,220
Financing costs	(18,770)	(10,300)	0
Repurchase of common shares	(1,220,875)	(206,719)	(770,504)
Dividends paid	(65,896)	(17,344)	(53,003)
Issuance of common stock	13,372	12,318	10,806
Profit distributions to noncontrolling interests	(7,080)	(19,805)	(15,859)
Purchase of ownership interests by minority member	13,193	17,959	1,446
Net cash used in financing activities	(1,068,950)	(384,859)	(845,036)
Effect of exchange rate changes on cash and cash equivalents	(499)	739	959
(Decrease) increase in cash, cash equivalents and restricted cash	(1,100,220)	1,173,487	(94,018)
Cash, cash equivalents and restricted cash, beginning of period	1,279,154	105,667	199,685
Cash, cash equivalents and restricted cash, end of period	178,934	1,279,154	105,667
Supplemental Disclosures of Cash Flow Information:
Interest paid	75,607	112,598	157,406
Income taxes paid, net of refunds	362,978	286,247	260,622
Noncash purchases of property and equipment	$ 167,234	$ 74,854	$ 63,514

Business and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Business and Summary of Significant Accounting Policies

1) BUSINESS AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Services provided by our hospitals, all of which are operated by subsidiaries of ours, include general and specialty surgery, internal medicine, obstetrics, emergency room care, radiology, oncology, diagnostic care, coronary care, pediatric services, pharmacy services and/or behavioral health services. We, through our subsidiaries, provide capital resources as well as a variety of management services to our facilities, including central purchasing, information services, finance and control systems, facilities planning, physician recruitment services, administrative personnel management, marketing and public relations.

The more significant accounting policies follow:

Principles of Consolidation: The consolidated financial statements include the accounts of our majority-owned subsidiaries and partnerships controlled by us or our subsidiaries as the managing general partner. All intercompany accounts and transactions have been eliminated.

Revenue Recognition

We report net patient service revenue at the estimated net realizable amounts from patients and third-party payers and others for services rendered. We have agreements with third-party payers that provide for payments to us at amounts different from our established rates. Payment arrangements include rates per discharge, reimbursed costs, discounted charges and per diem payments. Estimates of contractual allowances under managed care plans, which represent explicit price concessions, are based upon the payment terms specified in the related contractual agreements. We closely monitor our historical collection rates, as well as changes in applicable laws, rules and regulations and contract terms, to assure that provisions are made using the most accurate information available. However, due to the complexities involved in these estimations, actual payments from payers may be different from the amounts we estimate and record.

See Note 10-Revenue Recognition, for additional disclosure related to our revenues including a disaggregation of our consolidated net revenues by major source for each of the periods presented herein.

We estimate our Medicare and Medicaid revenues using the latest available financial information, patient utilization data, government provided data and in accordance with applicable Medicare and Medicaid payment rules and regulations. The laws and regulations governing the Medicare and Medicaid programs are extremely complex and subject to interpretation and as a result, there is at least a reasonable possibility that recorded estimates will change by material amounts in the near term. Certain types of payments by the Medicare program and state Medicaid programs (e.g. Medicare Disproportionate Share Hospital, Medicare Allowable Bad Debts and Inpatient Psychiatric Services) are subject to retroactive adjustment in future periods as a result of administrative review and audit and our estimates may vary from the final settlements. Such amounts are included in accounts receivable, net, on our Consolidated Balance Sheets. The funding of both federal Medicare and state Medicaid programs are subject to legislative and regulatory changes. As such, we cannot provide any assurance that future legislation and regulations, if enacted, will not have a material impact on our future Medicare and Medicaid reimbursements. Adjustments related to the final settlement of these retrospectively determined amounts did not materially impact our results in 2021, 2020 or 2019. If it were to occur, each 1% adjustment to our estimated net Medicare revenues that are subject to retrospective review and settlement as of December 31, 2021, would change our after-tax net income by approximately $1 million.

Charity Care, Uninsured Discounts and Other Adjustments to Revenue: Collection of receivables from third-party payers and patients is our primary source of cash and is critical to our operating performance. Our primary collection risks relate to uninsured patients and the portion of the bill which is the patient’s responsibility, primarily co-payments and deductibles. We estimate our revenue adjustments for implicit price concessions based on general factors such as payer mix, the aging of the receivables and historical collection experience. We routinely review accounts receivable balances in conjunction with these factors and other economic conditions which might ultimately affect the collectability of the patient accounts and make adjustments to our allowances as warranted. At our acute care hospitals, third party liability accounts are pursued until all payment and adjustments are posted to the patient account. For those accounts with a patient balance after third party liability is finalized or accounts for uninsured patients, the patient receives statements and collection letters.

Historically, a significant portion of the patients treated throughout our portfolio of acute care hospitals are uninsured patients which, in part, has resulted from patients who are employed but do not have health insurance or who have policies with relatively high deductibles. Patients treated at our hospitals for non-elective services, who have gross income of various amounts, dependent upon the state, ranging from 200% to 400% of the federal poverty guidelines, are deemed eligible for charity care. The federal poverty guidelines are established by the federal government and are based on income and family size. Because we do not pursue collection of amounts that qualify as charity care, the transaction price is fully adjusted and there is no impact in our net revenues or in our accounts receivable, net.

A portion of the accounts receivable at our acute care facilities are comprised of Medicaid accounts that are pending approval from third-party payers but we also have smaller amounts due from other miscellaneous payers such as county indigent programs in certain states. Our patient registration process includes an interview of the patient or the patient’s responsible party at the time of registration. At that time, an insurance eligibility determination is made and an insurance plan code is assigned. There are various pre-established insurance profiles in our patient accounting system which determine the expected insurance reimbursement for each patient based on the insurance plan code assigned and the services rendered. Certain patients may be classified as Medicaid pending at registration based upon a screening evaluation if we are unable to definitively determine if they are currently Medicaid eligible. When a patient is registered as Medicaid eligible or Medicaid pending, our patient accounting system records net revenues for services provided to that patient based upon the established Medicaid reimbursement rates, subject to the ultimate disposition of the patient’s Medicaid eligibility. When the patient’s ultimate eligibility is determined, reclassifications may occur which impacts net revenues in future periods. Although the patient’s ultimate eligibility determination may result in adjustments to net revenues, these adjustments do not have a material impact on our results of operations in 2021, 2020 or 2019 since our facilities make estimates at each financial reporting period to adjust revenue based on historical collections.

We also provide discounts to uninsured patients (included in “uninsured discounts” amounts below) who do not qualify for Medicaid or charity care. Because we do not pursue collection of amounts classified as uninsured discounts, the transaction price is fully adjusted and there is no impact in our net revenues or in our net accounts receivable. In implementing the discount policy, we first attempt to qualify uninsured patients for governmental programs, charity care or any other discount program. If an uninsured patient does not qualify for these programs, the uninsured discount is applied.

Uncompensated care (charity care and uninsured discounts):

The following table shows the amounts recorded at our acute care hospitals for charity care and uninsured discounts, based on charges at established rates, for the years ended December 31, 2021, 2020 and 2019:

	(dollar amounts in thousands)
	2021					2020					2019
	Amount		%			Amount		%			Amount		%
Charity care	$	661,965		33	%	$	622,668		28	%	$	672,326		31	%
Uninsured discounts		1,336,319		67	%		1,578,470		72	%		1,511,738		69	%
Total uncompensated care	$	1,998,284		100	%	$	2,201,138		100	%	$	2,184,064		100	%

The estimated cost of providing uncompensated care:

The estimated cost of providing uncompensated care, as reflected below, were based on a calculation which multiplied the percentage of operating expenses for our acute care hospitals to gross charges for those hospitals by the above-mentioned total uncompensated care amounts. The percentage of cost to gross charges is calculated based on the total operating expenses for our acute care facilities divided by gross patient service revenue for those facilities. An increase in the level of uninsured patients to our facilities and the resulting adverse trends in the adjustments to net revenues and uncompensated care provided could have a material unfavorable impact on our future operating results.

	(amounts in thousands)
	2021		2020		2019
Estimated cost of providing charity care	$	72,095	$	73,690	$	77,886
Estimated cost of providing uninsured discounts related care		145,538		186,804		175,128
Estimated cost of providing uncompensated care	$	217,633	$	260,494	$	253,014

Concentration of Revenues: Our six acute care hospitals in the Las Vegas, Nevada market contributed, on a combined basis, 16% in 2021, 15% in 2020 and 16% in 2019 of our consolidated net revenues.

Cash, Cash Equivalents and Restricted Cash: We consider all highly liquid investments purchased with maturities of three months or less to be cash equivalents.

Cash, cash equivalents, and restricted cash as reported in the consolidated statements of cash flows are presented separately on our consolidated balance sheets as follow:

	(amounts in thousands)
	2021		2020		2019
Cash and cash equivalents	$	115,301	$	1,224,490	$	61,268
Restricted cash (a)		63,633		54,664		44,399
Total cash, cash equivalents and restricted cash	$	178,934	$	1,279,154	$	105,667

(a)Restricted cash is included in other assets on the accompanying consolidated balance sheet and consists of statutorily required capital reserves related to our commercial insurance subsidiary.

The fair value of our restricted cash was computed based upon quotes received from financial institutions. We consider these to be “level 1” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with financial securities.

Property and Equipment: Property and equipment are stated at cost. Expenditures for renewals and improvements are charged to the property accounts. Replacements, maintenance and repairs which do not improve or extend the life of the respective asset are expensed as incurred. We remove the cost and the related accumulated depreciation from the accounts for assets sold or retired and the resulting gains or losses are included in the results of operations. Construction-in-progress includes both construction projects and equipment not yet placed into service.

See Provision for Asset Impairment-Foundations Recovery Network, in Other Assets and Intangible Assets below, for additional disclosure related to a provision for asset impairment recorded during 2019 to reduce the carrying value of real property assets of certain Foundations Recovery Network, L.L.C. facilities.

While in progress, we capitalized interest on major construction projects and the development and implementation of information technology applications amounting to $4.4 million during 2021, $4.3 million during 2020 and $3.4 million during 2019.

Depreciation is provided on the straight-line method over the estimated useful lives of buildings and improvements (twenty to forty years) and equipment (three to fifteen years). Depreciation expense was $501.6 million during 2021, $478.8 million during 2020 and $455.6 million during 2019.

Long-Lived Assets: We review our long-lived assets, including intangible assets, for impairment whenever events or circumstances indicate that the carrying value of these assets may not be recoverable. The assessment of possible impairment is based on our ability to recover the carrying value of our asset based on our estimate of its undiscounted future cash flows. If the analysis indicates that the carrying value is not recoverable from future cash flows, the asset is written down to its estimated fair value and an impairment loss is recognized. Fair values are determined based on estimated future cash flows using appropriate discount rates.

Goodwill: Goodwill is reviewed for impairment at the reporting unit level on an annual basis or sooner if the indicators of impairment arise. Our judgments regarding the existence of impairment indicators are based on market conditions and operational performance of each reporting unit. We have designated October 1^st as our annual impairment assessment date and performed quantitative impairment assessments as of October 1, 2021 which indicated no impairment of goodwill. There were also no goodwill impairments during 2020 or 2019. Future changes in the estimates used to conduct the impairment reviews, including profitability and market value projections, could indicate impairment in future periods potentially resulting in a write-off of a portion or all of our goodwill.

Changes in the carrying amount of goodwill for the two years ended December 31, 2021 were as follows (in thousands):

	Acute Care Services			Behavioral Health Services		Total Consolidated
Balance, January 1, 2020	$	448,415		$	3,421,345	$	3,869,760
Goodwill acquired during the period		127			0		127
Goodwill divested during the period		0			0		0
Adjustments to goodwill (a)		(1,521	)		14,349		12,828
Balance, December 31, 2020		447,021			3,435,694		3,882,715
Goodwill acquired during the period		55,406			0		55,406
Goodwill divested during the period		0			0		0
Adjustments to goodwill (b)		13,509			10,994		24,503
Balance, December 31, 2021	$	515,936		$	3,446,688	$	3,962,624

(a)

The changes in the Behavioral Health Services’ goodwill consists primarily of foreign currency translation adjustments.

(b)

Adjustments to goodwill during 2021 consist of the following: $13.5 million in Acute Care Services consists primarily of a measurement period adjustment to the preliminary purchase price allocation related to a 2020 acquisition; and the $11.0 million in Behavioral Health Services consists of $16.3 million recorded in connection with a third party minority ownership interest in a majority owned joint venture that constructed and owns a recently opened behavioral health facility, partially offset by a $5.3 million decrease related to foreign currency translation adjustments.

Other Assets and Intangible Assets: Other assets consist primarily of amounts related to: (i) intangible assets acquired in connection with our acquisitions of Cambian Group, PLC’s adult services’ division during 2015, Ascend Health Corporation during 2012 and Psychiatric Solutions, Inc. during 2010; (ii) prepaid fees for various software and other applications used by our hospitals;

(iii) costs incurred in connection with the purchase and implementation of an electronic health records application for each of our acute care facilities; (iv) statutorily required capital reserves related to our commercial insurance subsidiary ($82 million and $73 million as of December 31, 2021 and 2020, respectively); (v) deposits; (vi) investments in various businesses, including Universal Health Realty Income Trust ($9 million and $5 million as of as of December 31, 2021 and 2020, respectively) and Premier, Inc. ($92 million and $78 million as of December 31, 2021 and 2020, respectively); (vii) the invested assets related to a deferred compensation plan that is held by an independent trustee in a rabbi-trust and that has a related payable included in other noncurrent liabilities, and; (viii) other miscellaneous assets.

Intangible assets are reviewed for impairment on an annual basis or more often if indicators of impairment arise. Our judgments regarding the existence of impairment indicators are based on market conditions and operational performance of each asset. We have designated October 1^st as our annual impairment assessment date and performed impairment assessments as of October 1, 2021. In connection with the discontinuation of a certain module of a new clinical/financial information technology application under development, our financial results for the year ended December 31, 2021 include a pre-tax provision for asset impairment of approximately $14 million to write-off the applicable portion of the capitalized costs incurred and is included in other operating expenses on the accompanying consolidated statement of income. There was no impairment recorded during 2020. During 2019 we recorded provisions for asset impairments related to Foundations Recovery Network, L.L.C., as discussed below.

Provision for Asset Impairment-Foundations Recovery Network:

Our financial results for the year ended December 31, 2019 include a pre-tax provisions for asset impairment of approximately $98 million recorded in connection with Foundations Recovery Network, L.L.C. (“Foundations”), which was acquired by us in 2015. This provision for asset impairment includes: (i) a $75 million impairment provision to write-off the carrying value of the Foundations’ tradename intangible asset, and; (ii) a $23 million impairment provision to reduce the carrying value of real property assets of certain Foundations’ facilities.

The provision for asset impairment recorded during 2019, which is included in other operating expenses in the accompanying consolidated statements of income, was recorded after evaluation of the estimated fair value of the Foundations’ tradename as well as certain related real property assets. The provision for asset impairment was impacted by the following: (i) decisions made by management during 2019 to cancel the opening of future planned de novo facilities; (ii) reductions in projected future patient volumes, revenues and cash flows resulting from continued operating trends and financial results experienced by existing facilities that significantly lagged expectations, and; (iii) competitive pressures experienced in certain markets that were deemed to be permanent.

The following table shows the amounts recorded as net intangible assets for the years ended December 31, 2021 and 2020:

	(amounts in thousands)
	2021		2020
Medicare licenses	$	57,226	$	57,226
Certificates of need		8,239		8,253
Contract relationships and other (net of $54,134 and $52,804 of accumulated amortization for 2021 and 2020, respectively)		15,576		17,107
Net Intangible Assets	$	81,041	$	82,586

Supplies: Supplies, which consist primarily of medical supplies, are stated at the lower of cost (first-in, first-out basis) or market.

Self-Insured/Other Insurance Risks: We provide for self-insured risks, primarily general and professional liability claims and workers’ compensation claims. Our estimated liability for self-insured professional and general liability claims is based on a number of factors including, among other things, the number of asserted claims and reported incidents, estimates of losses for these claims based on recent and historical settlement amounts, estimate of incurred but not reported claims based on historical experience, and estimates of amounts recoverable under our commercial insurance policies. All relevant information, including our own historical experience is used in estimating the expected amount of claims. While we continuously monitor these factors, our ultimate liability for professional and general liability claims could change materially from our current estimates due to inherent uncertainties involved in making this estimate. Our estimated self-insured reserves are reviewed and changed, if necessary, at each reporting date and changes are recognized currently as additional expense or as a reduction of expense. See Note 8 - Commitments and Contingencies for discussion of adjustments to our prior year reserves for claims related to our self-insured general and professional liability and workers’ compensation liability.

In addition, we also: (i) own commercial health insurers headquartered in Nevada and Puerto Rico, and; (ii) maintain self-insured employee benefits programs for employee healthcare and dental claims. The ultimate costs related to these programs/operations include expenses for claims incurred and paid in addition to an accrual for the estimated expenses incurred in connection with claims incurred but not yet reported. Given our significant insurance-related exposure, there can be no assurance that a sharp increase in the number and/or severity of claims asserted against us will not have a material adverse effect on our future results of operations.

Income Taxes: Deferred tax assets and liabilities are recognized for the amount of taxes payable or deductible in future years as a result of differences between the tax bases of assets and liabilities and their reported amounts in the financial statements. We believe that future income will enable us to realize our deferred tax assets net of recorded valuation allowances relating to state net operating loss carry-forwards.

We operate in multiple jurisdictions with varying tax laws. We are subject to audits by any of these taxing authorities. Our tax returns have been examined by the Internal Revenue Service (“IRS”) through the year ended December 31, 2006. We believe that adequate accruals have been provided for federal, foreign and state taxes. See Note 6 - Income Taxes, for additional disclosure.

Other Noncurrent Liabilities: Other noncurrent liabilities include the long-term portion of our professional and general liability, workers’ compensation reserves, pension and deferred compensation liabilities, payment deferral of the employer’s share of Social Security taxes as provided for by the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), and liabilities incurred in connection with split-dollar life insurance agreements on the lives of our chief executive officer and his wife.

Redeemable Noncontrolling Interests and Noncontrolling Interest: As of December 31, 2021, outside owners held noncontrolling, minority ownership interests of: (i) 20% in an acute care facility located in Washington, D.C.; (ii) approximately 9% in an acute care facility located in Texas; (iii) 20%, 30%, 20%, 25% and 48% in five behavioral health care facilities located in Pennsylvania, Ohio, Washington, Missouri and Iowa, respectively, and; (iv) approximately 5% in an acute care facility located in Nevada. The noncontrolling interest and redeemable noncontrolling interest balances of $103 million and $5 million, respectively, as of December 31, 2021, consist primarily of the third-party ownership interests in these hospitals.

In connection with the two behavioral health care facilities located in Pennsylvania and Ohio, the minority ownership interests of which are reflected as redeemable noncontrolling interests on our Consolidated Balance Sheet, the outside owners have “put options” to put their entire ownership interest to us at any time. If exercised, the put option requires us to purchase the minority member’s interest at fair market value. Accordingly, the amounts recorded as redeemable noncontrolling interests on our Consolidated Balance Sheet reflects the estimated fair market value of these ownership interests.

Accumulated Other Comprehensive Income: The accumulated other comprehensive income (“AOCI”) component of stockholders’ equity includes: net unrealized gains and losses on effective cash flow hedges, foreign currency translation adjustments and the net minimum pension liability of a non-contributory defined benefit pension plan which covers employees at one of our subsidiaries. See Note 11 - Pension Plan for additional disclosure regarding the defined benefit pension plan.

The amounts recognized in AOCI for the two years ended December 31, 2021 were as follows (in thousands):

	Net Unrealized Gains (Losses) on Effective Cash Flow Hedges			Foreign Currency Translation Adjustment			Minimum Pension Liability			Total AOCI
Balance, January 1, 2020, net of income tax	$	(17	)	$	39,568		$	(7,658	)	$	31,893
2020 activity:
Pretax amount		0			13,619			4,428			18,047
Income tax effect		0			(749	)		(1,071	)		(1,820	)
Change, net of income tax		0			12,870			3,357			16,227
Balance, January 1, 2021, net of income tax		(17	)		52,438			(4,301	)		48,120
2021 activity:
Pretax amount		0			(20,743	)		1,427			(19,316	)
Income tax effect		0			1,829			(342	)		1,487
Change, net of income tax		0			(18,914	)		1,085			(17,829	)
Balance, December 31, 2021, net of income tax	$	(17	)	$	33,524		$	(3,216	)	$	30,291

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

Derivative instruments designated in a hedge relationship to mitigate exposure to variability in expected future cash flows, or other types of forecasted transactions, are considered cash flow hedges. Cash flow hedges are accounted for by recording the fair value

of the derivative instrument on the balance sheet as either an asset or liability, with a corresponding amount recorded in accumulated other comprehensive income (“AOCI”) within shareholders’ equity. Amounts are reclassified from AOCI to the income statement in the period or periods the hedged transaction affects earnings. From time to time, we use interest rate derivatives in our cash flow hedge transactions. Such derivatives are designed to be highly effective in offsetting changes in the cash flows related to the hedged liability.

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

In August 2017, the FASB issued new guidance on hedge accounting (ASU 2017-12) that is intended to more closely align hedge accounting with companies’ risk management strategies, simplify the application of hedge accounting, and increase transparency as to the scope and results of hedging programs. The new guidance amends the presentation and disclosure requirements, and changes how companies assess effectiveness. We adopted this guidance as of January 1, 2019 and applied to all existing hedges as of the adoption date. As of December 31, 2021 we have no cash flow hedges.

We use forward exchange contracts to hedge our net investment in foreign operations against movements in exchange rates. The effective portion of the unrealized gains or losses on these contracts is recorded in foreign currency translation adjustment within accumulated other comprehensive income and remains there until either the sale or liquidation of the subsidiary. In conjunction with the January 1, 2019 adoption of ASU 2017-12, “Targeted Improvements to Accounting for Hedging Activities”, we reclassified our presentation of the net cash inflows or outflows, which were received or paid in connection with foreign exchange contracts that hedge our net investment in foreign operations against movements in exchange rates, to investing cash flows on the consolidated statements of cash flows.

Stock-Based Compensation: We have a number of stock-based employee compensation plans. Pursuant to the FASB’s guidance, we expense the grant-date fair value of stock options and other equity-based compensation pursuant to the straight-line method over the stated vesting period of the award using the Black-Scholes option-pricing model.

The expense associated with share-based compensation arrangements is a non-cash charge. In the Consolidated Statements of Cash Flows, share-based compensation expense is an adjustment to reconcile net income to cash provided by operating activities.

Earnings per Share: Basic earnings per share are based on the weighted average number of common shares outstanding during the year. Diluted earnings per share are based on the weighted average number of common shares outstanding during the year adjusted to give effect to common stock equivalents.

The following table sets forth the computation of basic and diluted earnings per share, for the periods indicated:

	Twelve Months Ended December 31,
	2021			2020			2019
Basic and diluted:
Net Income	$	987,632		$	952,790		$	827,543
Less: Net (income) loss attributable to noncontrolling interest		3,958			(8,837	)		(12,689	)
Less: Net income attributable to unvested restricted share grants		(2,059	)		(2,981	)		(2,028	)
Net income attributable to UHS—basic and diluted	$	989,531		$	940,972		$	812,826
Basic earnings per share attributable to UHS:
Weighted average number of common shares—basic		82,519			85,061			88,762
Total basic earnings per share	$	11.99		$	11.06		$	9.16
Diluted earnings per share attributable to UHS:
Weighted average number of common shares		82,519			85,061			88,762
Net effect of dilutive stock options and grants based on the treasury stock method		1,173			526			278
Weighted average number of common shares and equivalents—diluted		83,692			85,587			89,040
Total diluted earnings per share	$	11.82		$	10.99		$	9.13

The “Net effect of dilutive stock options and grants based on the treasury stock method”, for all years presented above, excludes certain outstanding stock options applicable to each year since the effect would have been anti-dilutive. The excluded weighted-average stock options totaled approximately 4.2 million during 2021, 6.4 million during 2020 and 5.5 million during 2019.

Fair Value of Financial Instruments: The fair values of our debt and investments are based on quoted market prices. The fair values of other long-term debt, including capital lease obligations, are estimated by discounting cash flows using period-end interest rates and market conditions for instruments with similar maturities and credit quality. The carrying amounts reported in the balance sheet for cash, accounts receivable, accounts payable, and short-term borrowings approximates their fair values due to the short-term nature of these instruments. Accordingly, these items have been excluded from the fair value disclosures included elsewhere in these notes to consolidated financial statements.

Use of Estimates: The preparation of financial statements in conformity with U.S. generally accepted accounting principles requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

Mergers and Acquisitions: The acquisition method of accounting for business combinations requires that the assets acquired and liabilities assumed be recorded at the date of acquisition at their respective fair values with limited exceptions. Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Any excess of the purchase price (consideration transferred) over the estimated fair values of net assets acquired is recorded as goodwill. Transaction costs and costs to restructure the acquired company are expensed as incurred. The fair value of intangible assets, including Medicare licenses, certificates of need, tradenames and certain contracts, is based on significant judgments made by our management, and accordingly, for significant items we typically obtain assistance from third party valuation specialists.

GPO Agreement/Minority Ownership Interest: During 2013, we entered into a new group purchasing organization agreement (“GPO”) with Premier, Inc. (“Premier), a healthcare performance improvement alliance, and acquired a minority interest in the GPO for a nominal amount. During the fourth quarter of 2013, in connection with the completion of an initial public offering of the stock of Premier, we received cash proceeds for the sale of a portion of our ownership interest in the GPO, which were recorded as deferred income, on a pro rata basis, as a reduction to our supplies expense over the initial expected life of the GPO agreement. Also in connection with this GPO agreement, we received shares of restricted stock in Premier which vest ratably over a seven-year period (2014 through 2020), contingent upon our continued participation and minority ownership interest in the GPO. We recognized the fair value of this restricted stock, as a reduction to our supplies expense, in our consolidated statements of income, on a pro rata basis, over the vesting period. 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 value of which is included in other assets on our consolidated balance sheet. Based upon the closing price of Premier’s stock on each respective date, the market value of our shares of Premier was $92 million and $78 million as of December 31, 2021 and 2020, respectively. The change in market value of these shares is recorded as an unrealized gain and included in “Other (income) expense, net” on our consolidated statements of income. Additionally, Premier paid cash dividends of $1.7 million and $848,000 as of December 31, 2021 and 2020, respectively, which are included in “Other (income) expense, net” in our condensed consolidated statements of income.

Provider Taxes: We incur health-care related taxes (“Provider Taxes”) imposed by states in the form of a licensing fee, assessment or other mandatory payment which are related to: (i) healthcare items or services; (ii) the provision of, or the authority to provide, the health care items or services, or; (iii) the payment for the health care items or services. Such Provider Taxes are subject to various federal regulations that limit the scope and amount of the taxes that can be levied by states in order to secure federal matching funds as part of their respective state Medicaid programs. We derive a related Medicaid reimbursement benefit from assessed Provider Taxes in the form of Medicaid claims based payment increases and/or lump sum Medicaid supplemental payments.

Under these programs, including the impact of the Texas Uncompensated Care and Upper Payment Limit program, the Texas Delivery System Reform Incentive program, and various other state programs, we earned revenues (before Provider Taxes) of approximately $641 million during 2021, $488 million during 2020 and $419 million during 2019. These revenues were offset by Provider Taxes of approximately $211 million during 2021, $185 million during 2020 and $194 million during 2019, which are recorded in other operating expenses on the Consolidated Statements of Income as included herein. The aggregate net benefit from these programs was $430 million during 2021, $303 million during 2020 and $225 million during 2019. The aggregate net benefit pursuant to these programs is earned from multiple states and therefore no particular state’s portion is individually material to our consolidated financial statements. In addition, under various disproportionate share hospital payment programs and the Nevada state plan amendment program, we earned revenues of $74 million in 2021, $73 million in 2020 and $78 million in 2019.

CARES Act and Other Governmental Grants and Medicare Accelerated Payments: During 2021, we received approximately $189 million of additional funds from the federal government in connection with the CARES Act, which we returned during the year utilizing a portion of our cash and cash equivalents held on deposit. Therefore, there was no impact on our earnings during 2021 in connection with receipt of those funds.

Also during 2021, we made an early repayment of $695 million of funds received during 2020 pursuant to the Medicare Accelerated and Advance Payment Program (“MAAPP”). These funds, which were required to be repaid to the government beginning in the second quarter of 2021 through the third quarter of 2022, were returned to the government utilizing a portion of our cash and cash equivalents held on deposit.

As of December 31, 2020, we received an aggregate of $1.112 billion of funds consisting of: (i) $417 million received pursuant to various governmental stimulus programs, most notably the Public Health and Social Services Emergency Fund (the “PHSSEF”) as provided for by the CARES Act, of which approximately $413 million were recorded as net revenues during 2020 and approximately $4 million remained in the Medicare accelerated payments and deferred CARES Act and other grants liability account in our consolidated balance sheet, and; (ii) $695 million of MAAPP funds, which as discussed above, were repaid early to the government during 2021. As of December 31, 2020, $372 million of the MAAPP funds were included in the current liabilities in our consolidated balance sheet and $323 million were included noncurrent liabilities. There was no impact on our earnings during 2021 or 2020 in connection with receipt of the MAAPP funds.

Recent Accounting Standards: In March 2020, the FASB issued ASU 2020-04, “Facilitation of the Effects of Reference Rate Reform on Financial Reporting.” The ASU is intended to provide temporary optional expedients and exceptions to the US GAAP guidance on contract modifications and hedge accounting to ease the financial reporting burdens related to the expected market transition from LIBOR and other interbank offered rates to alternative reference rates. This guidance was effective beginning on March 12, 2020, and the Company may elect to apply the amendments prospectively through December 31, 2022. The Company is currently evaluating the impact this guidance may have on our consolidated financial statements.

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

Foreign Currency Translation: Assets and liabilities of our U.K. subsidiaries are denominated in pound sterling and translated into U.S. dollars at: (i) the rates of exchange at the balance sheet date, and; (ii) average rates of exchange prevailing during the year for revenues and expenses. The currency translation adjustments are reported as a component of accumulated other comprehensive income. See Note 3 - Financial Instruments, Foreign Currency Forward Exchange Contracts for additional disclosure.

Acquisitions and Divestitures

12 Months Ended

Dec. 31, 2021

Business Combinations [Abstract]

Acquisitions and Divestitures

2) ACQUISITIONS AND DIVESTITURES

Year ended December 31, 2021:

2021 Acquisitions of Assets and Businesses:

During 2021, we spent $105 million on the acquisition of businesses and property, consisting primarily of a micro acute care hospital located in Las Vegas, Nevada, and a physician practice management company located in California.

2021 Divestiture of Assets and Businesses:

During 2021, we received $25 million from the sale of assets and businesses.

Year ended December 31, 2020:

2020 Acquisitions of Assets and Businesses:

During 2020, we spent $52 million on the acquisition of businesses and property, consisting primarily of the real estate assets of an acute care hospital located in Las Vegas, Nevada.

2020 Divestiture of Assets and Businesses:

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

Year ended December 31, 2019:

2019 Acquisitions of Assets and Businesses:

During 2019, we spent $8 million to acquire various businesses and properties.

2019 Divestiture of Assets:

During 2019, we received $9 million from the sales of various assets.

Financial Instruments and Fair Value Measurement

12 Months Ended

Dec. 31, 2021

Financial Instruments And Fair Value Measurement [Abstract]

Financial Instruments and Fair Value Measurement

3) FINANCIAL INSTRUMENTS AND FAIR VALUE MEASUREMENT

Cash Flow Hedges:

During the years ended December 31, 2021 and 2020, we had no cash flow hedges outstanding. During 2019, we had nine interest rate swaps outstanding, all of which expired on April 15, 2019, whereby we paid a fixed rate on a total notional amount of $1.0 billion and received one-month LIBOR. The average fixed rate payable on these swaps was 1.31%.

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

Foreign Currency Forward Exchange Contracts:

We use forward exchange contracts to hedge our net investment in foreign operations against movements in exchange rates. The effective portion of the unrealized gains or losses on these contracts is recorded in foreign currency translation adjustment within accumulated other comprehensive income and remains there until either the sale or liquidation of the subsidiary. In connection with these forward exchange contracts, we recorded net cash inflows of approximately $1 million during 2021, net cash outflows of approximately $22 million during 2020 and net cash inflows of approximately $20 million during 2019.

Derivatives Hedging Relationships:

The following table presents the effects of our interest rate swap agreements and our foreign currency foreign exchange contracts on our results of operations for the three years ended December 31 (in thousands):

	Gain/(Loss) recognized in AOCI

	December 31,			December 31,			December 31,
	2021			2020			2019
Cash Flow Hedge relationships
Interest rate swap agreements (a)	$	0		$	0		$	(3,925	)

Net Investment Hedge relationships
Foreign currency foreign exchange contracts	$	(7,272	)	$	(22,097	)	$	(18,328	)

(a)	The amount of gain reclassified out of AOCI into interest expense, net was $3.4 million during 2019.

No other gains or losses were recognized in income related to derivatives in Subtopic 815-20.

Fair Value Measurement

Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. The following fair value hierarchy classifies the inputs to valuation techniques used to measure fair value into one of three levels:

•

Level 1: Unadjusted quoted prices in active markets for identical assets or liabilities.

•

Level 2: Inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly. These included quoted prices for similar assets or liabilities in active markets and quoted prices for identical or similar assets or liabilities in markets that are not active.

•

Level 3: Unobservable inputs that reflect the reporting entity’s own assumptions.

The following tables present the assets and liabilities recorded at fair value on a recurring basis:

	Balance at		Balance Sheet	Basis of Fair Value Measurement
(in thousands)	December 31, 2021		Location	Level 1		Level 2		Level 3
Assets:
Money market mutual funds	$	79,900	Other assets	$	79,900
Certificates of deposit		2,300	Other assets				2,300
Equity securities		91,919	Other assets		91,919
Deferred compensation assets		45,759	Other assets		45,759
Foreign currency exchange contracts		1,357	Other current assets				1,357
	$	221,235		$	217,578	$	3,657		-
Liabilities:
Deferred compensation liability	$	45,759	Other noncurrent liabilities	$	45,759
	$	45,759		$	45,759		-		-

	Balance at		Balance Sheet	Basis of Fair Value Measurement
(in thousands)	December 31, 2020		Location	Level 1		Level 2		Level 3
Assets:
Term Deposits	$	540,000	Cash and cash equivalents			$	540,000
Money market mutual funds		37,100	Cash and cash equivalents		37,100
Money market mutual funds		70,995	Other assets		70,995
Certificates of deposit		2,300	Other assets				2,300
Equity securities		78,367	Other assets		78,367
Deferred compensation assets		42,044	Other assets		42,044
Foreign currency exchange contracts		9,987	Other current assets				9,987
	$	780,793		$	228,506	$	552,287		-
Liabilities:
Deferred compensation liability	$	42,044	Other noncurrent liabilities	$	42,044
	$	42,044		$	42,044		-		-

The fair value of our money market mutual funds, certificates of deposit and equity securities with a readily determinable fair value are computed based upon quoted market prices in an active market. The fair value of deferred compensation assets and the offsetting liability are computed based on market prices in an active market held in a rabbi trust. The fair value of our interest rate swaps are based on quotes from our counter parties. The fair value of our foreign currency exchange contracts is valued using quoted forward exchange rates and spot rates at the reporting date

As of December 31, 2020, in addition to the $577 million reflected above in cash and cash equivalents, we have approximately $581 million of other cash accounts that earn interest at variable rates ranging from .20% to .25%.

Long-Term Debt

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Long-Term Debt

4) LONG-TERM DEBT

A summary of long-term debt follows:

	December 31,
	2021			2020
	(amounts in thousands)
Long-term debt:
Notes and Mortgages payable (including obligations under finance leases of $79,331 in 2021 and $52,905 in 2020) and term loans with varying maturities through 2099; weighted average interest rates of 5.6% in 2021 and 6.8% in 2020 (see Note 7 regarding finance leases)	$	185,027		$	61,638
Tranche A term loan		1,689,375			1,900,000
Revolving credit facility		342,600			—
2.65% Senior Secured Notes due 2030, net of unamortized discount of $1,968 in 2021 and $2,193 in 2020		798,032			797,806
1.65% Senior Secured Notes due 2026, net of unamortized discount of $813 in 2021		699,187			—
2.65% Senior Secured Notes due 2032, net of unamortized discount of $1,254 in 2021		498,746			—
Term Loan B		—			490,000
Accounts receivable securitization program		—			225,000
5.00% Senior Secured Notes due 2026		—			400,000
Total debt before unamortized financing costs		4,212,967			3,874,444
Less-Unamortized financing costs		(22,679	)		(18,193	)
Total debt after unamortized financing costs		4,190,288			3,856,251
Less-Amounts due within one year		(48,409	)		(331,998	)
Long-term debt	$	4,141,879		$	3,524,253

Credit Facilities and Outstanding Debt Securities

On August 24, 2021, we entered into a seventh amendment to our credit agreement dated as of November 15, 2010, as amended and restated as of September 21, 2012, August 7, 2014 and October 23, 2018, among UHS, as borrower, the several banks and other financial institutions from time to time parties thereto, as lenders, and JPMorgan Chase Bank, N.A., as administrative agent, (the “Credit Agreement”). In September, 2021, we entered into an eighth amendment to our Credit Agreement which modified the definition of “Adjusted LIBO Rate”.

The seventh amendment to the Credit Agreement, among other things, provided for the following:

a $1.2 billion aggregate amount revolving credit facility, which is scheduled to mature on August 24, 2026, representing an increase of $200 million over the $1.0 billion previous commitment. As of December 31, 2021, this facility had $343 million of borrowings outstanding and $854 million of available borrowing capacity, net of $4 million of outstanding letters of credit;

a $1.7 billion tranche A term loan facility, which is scheduled to mature on August 24, 2026, resulting in an initial reduction of $150 million from the $1.85 billion of borrowings outstanding under the previous tranche A term loan facility, and;

repayment of approximately $488 million of outstanding borrowings and termination of the previous tranche B term loan facility.

Pursuant to the terms of the seventh amendment, the tranche A term loan, which had $1.689 billion of borrowings outstanding as of December 31, 2021, provides for installment payments of $10.625 million per quarter beginning on December 31, 2021 through September 30, 2023 and $21.25 million per quarter beginning on December 31, 2023 through June 30, 2026. The unpaid principal balance at June 30, 2026 is due on the maturity date.

Revolving credit and tranche A term loan borrowings under the Credit Agreement bear interest at our election at either (1) the ABR rate which is defined as the rate per annum equal to the greatest of (a) the lender’s prime rate, (b) the weighted average of the federal funds rate, plus 0.5% and (c) one month LIBOR rate plus 1%, in each case, plus an applicable margin based upon our consolidated leverage ratio at the end of each quarter ranging from 0.25% to 0.625%, or (2) the one, three or six month LIBOR rate (at our election), plus an applicable margin based upon our consolidated leverage ratio at the end of each quarter ranging from 1.25% to 1.625%. As of December 31, 2021, the applicable margins were 0.25% for ABR-based loans and 1.25% for LIBOR-based loans under the revolving credit and term loan A facilities. The revolving credit facility includes a $125 million sub-limit for letters of credit. The Credit Agreement is secured by certain assets of the Company and our material subsidiaries (which generally excludes asset classes such as substantially all of the patient-related accounts receivable of our acute care hospitals, and certain real estate assets and assets held in joint-ventures with third parties) and is guaranteed by our material subsidiaries.

The Credit Agreement includes a material adverse change clause that must be represented at each draw. The Credit Agreement also contains covenants that include a limitation on sales of assets, mergers, change of ownership, liens and indebtedness, transactions

with affiliates, dividends and stock repurchases; and requires compliance with financial covenants including maximum leverage. We were in compliance with all required covenants as of December 31, 2021 and December 31, 2020.

On August 24, 2021, we completed the following via private offerings to qualified institutional buyers under Rule 144A and to non-U.S. persons outside the United States in reliance on Regulation S under the Securities Act of 1933, as amended:

Issued $700 million of aggregate principal amount of 1.65% senior secured notes due on September 1, 2026, and;

Issued $500 million of aggregate principal amount of 2.65% senior secured notes due on January 15, 2032.

In April, 2021, our accounts receivable securitization program (“Securitization”) was amended (the eighth amendment) to: (i) reduce the aggregate borrowing commitments to $20 million (from $450 million previously); (ii) slightly reduce the borrowing rates and commitment fee, and; (iii) extend the maturity date to April 25, 2022 (from April, 2021 previously). Substantially all other material terms and conditions remained unchanged. There were no borrowings outstanding pursuant to the Securitization as of December 31, 2021.

On September 13, 2021, we redeemed $400 million of aggregate principal amount of 5.00% senior secured notes, that were scheduled to mature on June 1, 2026, at 102.50% of the aggregate principal, or $410 million.

As of December 31, 2021, we had combined aggregate principal of $2.0 billion from the following senior secured notes:

$700 million aggregate principal amount of 1.65% senior secured notes due in September, 2026 (“2026 Notes”) which were issued on August 24, 2021.

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

$500 million of aggregate principal amount of 2.65% senior secured notes due in January, 2032 (“2032 Notes”) which were issued on August 24, 2021.

On September 28, 2020, we redeemed the entire $700 million aggregate principal amount of our previously outstanding 4.75% senior secured notes, which were scheduled to mature in August, 2022, at 100% of the aggregate principal amount.

Interest on the 2026 Notes is payable on March 1st and September 1st until the maturity date of September 1, 2026. Interest on the 2030 Notes payable on April 15th and October 15th, until the maturity date of October 15, 2030. Interest on the 2032 Notes is payable on January 15^th and July 15^th until the maturity date of January 15, 2032.

The 2026 Notes, 2030 Notes and 2032 Notes (collectively “The Notes”) were offered only to qualified institutional buyers under Rule 144A and to non-U.S. persons outside the United States in reliance on Regulation S under the Securities Act of 1933, as amended (the “Securities Act”). The Notes have not been registered under the Securities Act and may not be offered or sold in the United States absent registration or an applicable exemption from registration requirements.

The Notes are guaranteed (the “Guarantees”) on a senior secured basis by all of our existing and future direct and indirect subsidiaries (the “Subsidiary Guarantors”) that guarantee our Credit Agreement, or other first lien obligations or any junior lien obligations. The Notes and the Guarantees are secured by first-priority liens, subject to permitted liens, on certain of the Company’s and the Subsidiary Guarantors’ assets now owned or acquired in the future by the Company or the Subsidiary Guarantors (other than real property, accounts receivable sold pursuant to the Company’s Existing Receivables Facility (as defined in the Indenture pursuant to which The Notes were issued (the “Indenture”)), and certain other excluded assets). The Company’s obligations with respect to The Notes, the obligations of the Subsidiary Guarantors under the Guarantees, and the performance of all of the Company’s and the Subsidiary Guarantors’ other obligations under the Indenture, are secured equally and ratably with the Company’s and the Subsidiary Guarantors’ obligations under the Credit Agreement and The Notes by a perfected first-priority security interest, subject to permitted liens, in the collateral owned by the Company and its Subsidiary Guarantors, whether now owned or hereafter acquired. However, the liens on the collateral securing The Notes and the Guarantees will be released if: (i) The Notes have investment grade ratings; (ii) no default has occurred and is continuing, and; (iii) the liens on the collateral securing all first lien obligations (including the Credit Agreement and The Notes) and any junior lien obligations are released or the collateral under the Credit Agreement, any other first lien obligations and any junior lien obligations is released or no longer required to be pledged. The liens on any collateral securing The Notes and the Guarantees will also be released if the liens on that collateral securing the Credit Agreement, other first lien obligations and any junior lien obligations are released.

In connection with the issuance of The Notes, the Company, the Subsidiary Guarantors and the representatives of the several initial purchasers, entered into Registration Rights Agreements (the “Registration Rights Agreements”), whereby the Company and the Subsidiary Guarantors have agreed, at their expense, to use commercially reasonable best efforts to: (i) cause to be filed a registration statement enabling the holders to exchange The Notes and the Guarantees for registered senior secured notes issued by the Company and guaranteed by the then Subsidiary Guarantors under the Indenture (the “Exchange Securities”), containing terms identical to those of The Notes (except that the Exchange Securities will not be subject to restrictions on transfer or to any increase in annual interest rate for failure to comply with the Registration Rights Agreements); (ii) cause the registration statement to become effective; (iii) complete the exchange offer not later than 60 days after such effective date and in any event on or prior to a target registration date of March 21, 2023 in the case of the 2030 Notes and February 24, 2024 in the case of the 2026 and 2032 Notes, and; (iv) file a shelf

registration statement for the resale of The Notes if the exchange offers cannot be effected within the time periods listed above. The interest rate on The Notes will increase and additional interest thereon will be payable if the Company does not comply with its obligations under the Registration Rights Agreements.

As discussed in Note 9-Relationship with Universal Health Realty Income Trust and Other Related Party Transactions, on December 31, 2021, we (through wholly-owned subsidiaries of ours) entered into an asset exchange and substitution transaction with Universal Health Realty Income Trust (the “Trust”), pursuant to the terms of which we, among other things, transferred to the Trust, the real estate assets of Aiken Regional Medical Center (“Aiken”) and Canyon Creek Behavioral Health (“Canyon Creek”). In connection with this transaction, Aiken and Canyon Creek (as lessees), entered into a master lease and individual property leases (with the Trust as lessor), for initial lease terms on each property of approximately twelve years, ending on December 31, 2033. As a result of our purchase option within the Aiken and Canyon Spring lease agreements, this asset purchase and sale transaction is accounted for as a failed sale leaseback in accordance with U.S. GAAP and we have accounted for the transaction as a financing arrangement. Our monthly lease payments payable to the Trust will be recorded to interest expense and as a reduction of the outstanding financial liability. The amount allocated to interest expense will be determined using our incremental borrowing rate and will be based on the outstanding financial liability. In connection with this transaction, our Consolidated Balance Sheet as of December 31, 2021 reflects a financial liability of approximately $82 million which is included in Notes and Mortgages payable in the table above.

At December 31, 2021, the carrying value and fair value of our debt were each approximately $4.2 billion. At December 31, 2020, the carrying value and fair value of our debt were each approximately $3.9 billion. The 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.

The aggregate scheduled maturities of our total debt outstanding as of December 31, 2021 are as follows:

	(000s)
2022	$	48,409
2023		59,648
2024		92,012
2025		91,274
2026		2,472,172
Later		1,449,452
Total maturities before unamortized financing costs		4,212,967
Less-Unamortized financing costs		(22,679	)
Total	$	4,190,288

Common Stock

12 Months Ended

Dec. 31, 2021

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Common Stock

5) COMMON STOCK

Dividends

We declared and paid cash dividends of $.80 per share ($65.9 million in the aggregate) during 2021. We declared and paid cash dividends of $17.3 million, or $.20 per share, during the first quarter of 2020 (in April, 2020, as part of various COVID-19 initiatives, we suspended declaration and payment of quarterly dividends for the remainder of the 2020 year). Cash dividends of $0.60 per share ($53.0 million in the aggregate) were declared and paid during 2019. All classes of our common stock have similar economic rights.

Stock Repurchase Programs

During the second quarter of 2021, our Board of Directors approved a resumption of our stock repurchase program which had been suspended since April, 2020, as part of various COVID-19 initiatives. As of December 31, 2021 we had an aggregate authorization of $3.7 billion related to our stock repurchase program which was approved by our Board of Directors in various increments since 2014, including an authorized $1.0 billion increase in July, 2021. Pursuant to this program, which had an aggregate remaining available repurchase authorization of $358.2 million as of December 31, 2021, shares of our Class B Common Stock may be repurchased, from time to time as conditions allow, on the open market or in negotiated private transactions. There is no expiration date for our stock repurchase programs.

The following schedule provides information related to our stock repurchase program for each of the three years ended December 31, 2021. During 2021, 8,409,721 shares ($1.20 billion in the aggregate) were repurchased pursuant to the terms of the stock repurchase program and 134,464 shares ($19.5 million in the aggregate) were repurchased in connection with the income tax withholding obligations resulting from stock-based compensation programs. During 2020, 1,951,899 shares ($196.6 million in the aggregate) were repurchased pursuant to the terms of the stock repurchase program and 81,057 shares ($10.2 million in the aggregate) were repurchased in connection with the income tax withholding obligations resulting from stock-based compensation programs. During 2019, 5,397,753 shares ($706.2 million in the aggregate) were repurchased pursuant to the terms of our stock repurchase

program and 336,943 shares ($47.7 million in the aggregate) were repurchased in connection with the income tax withholding obligations resulting from stock-based compensation programs.

	Additional dollars authorized for repurchase (in thousands)		Total number of shares purchased (a.)		Total number of shares cancelled		Average price paid per share for forfeited restricted shares		Total number of shares purchased as part of publicly announced programs		Average price paid per share for shares purchased as part of publicly announced program		Aggregate purchase price paid (in thousands)		Aggregate purchase price paid for shares purchased as part of publicly announced program		Maximum number of dollars that may yet be purchased under the program (in thousands)
Balance as of January 1, 2019																	$	462,344
2019	$	1,000,000		5,762,409		27,713	$	0.01		5,397,753	$	130.84	$	753,928	$	706,221	$	756,123
2020	$	—		2,050,735		17,779	$	0.01		1,951,899	$	100.70	$	206,719	$	196,560	$	559,563
2021	$	1,000,000		8,559,946		15,761	$	0.01		8,409,721	$	142.85	$	1,220,876	$	1,201,330	$	358,233
Total for three year period ended December 31, 2021	$	2,000,000		16,373,090		61,253	$	0.01		15,759,373	$	133.51	$	2,181,523	$	2,104,111

(a.)

Includes 15,761, 17,779 and, 27,713 of restricted shares that were forfeited by former employees pursuant to the terms of our restricted stock purchase plan during 2021, 2020 and 2019, respectively.

Stock-based Compensation Plans

At December 31, 2021, we have a number of stock-based employee compensation plans. Pursuant to the FASB’s guidance, we expense the grant-date fair value of stock options (computed utilizing the Black-Scholes option-pricing model) and other equity-based compensation pursuant to the straight-line method over the stated vesting period of the awards.

Pre-tax share-based compensation costs of $59.3 million during 2021, $54.7 million during 2020 and $60.1 million during 2019 were recognized related to outstanding stock options. In addition, pre-tax compensation costs of $14.4 million during 2021, $11.2 million during 2020 and $9.3 million during 2019 were recognized related to amortization of restricted stock and units as well as discounts provided in connection with shares purchased pursuant to our 2005 Employee Stock Purchase Plan. As of December 31, 2021, there was approximately $126.0 million of unrecognized compensation cost related to unvested stock options and restricted stock which is expected to be recognized over the remaining average vesting period of 2.6 years.

The expense associated with stock-based compensation arrangements is a non-cash charge. In the Consolidated Statements of Cash Flows, stock-based compensation expense is an adjustment to reconcile net income to cash provided by operating activities and aggregated to $73.7 million in 2021, $65.8 million in 2020 and $69.4 million in 2019. In connection with our January 1, 2017 adoption of ASU 2016-09, “Compensation-Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting”, our provision for income taxes and our net income attributable to UHS were favorably impacted by $2.4 million in 2021, unfavorably impacted by $7.4 million during 2020 and favorably impacted by $12.2 million during 2019.

In 2005, we adopted the 2005 Stock Incentive Plan (the “Stock Incentive Plan”) which was amended in 2008, 2010, 2015 and 2017 and was cancelled in 2020, as discussed below. An aggregate of 35.6 million shares of Class B Common Stock had been reserved under the Stock Incentive Plan, the remaining balance of which was cancelled in 2020. During 2020 and 2019, stock options, net of cancellations, of approximately 2.4 million and 2.1 million, respectively, were granted under the Stock Incentive Plan. Stock options to purchase Class B Common Stock have been granted to our officers, key employees and members of our Board of Directors. Commencing in 2018, our key employees and non-executive officers began receiving a portion of their stock-based compensation in the form of restricted stock (as discussed below) in addition to receiving options to purchase Class B Common Stock.

In 2020, we adopted the 2020 Omnibus Stock and Incentive Plan (the “2020 Stock Incentive Plan”) which was approved by our shareholders in May, 2020. A total of 6.1 million shares of Class B Common Stock were approved for issuance under the 2020 Stock Incentive Plan. Under the 2020 Stock Incentive Plan, shares that are subject to stock options shall be counted as one share per stock option, and every share that is subject to restricted stock awards or restricted stock units shall be counted as four shares. Various other types of equity awards are also permitted under the 2020 Stock Incentive Plan. During 2021, approximately 2.3 million stock options, net of cancellations, and 138,114 of restricted stock units, net of cancellations, were granted under the 2020 Stock Incentive Plan. During 2020, 44,000 stock options and 3,000 restricted stock units were granted under the 2020 Stock Incentive Plan to our key employees, and no shares were cancelled. Restricted stock and restricted stock units issued under the 2020 Stock Incentive Plan do not have rights to receive dividends on unvested restricted awards, however, the accrual of dividend equivalents on unvested restricted awards may be permitted. Upon adoption of the 2020 Stock Incentive Plan, no additional awards were granted under the 2005 Stock

Incentive Plan or the 2010 Employees’ Restricted Stock Purchase Plan, and reserves for future issuance pursuant to each plan were cancelled.

The per option weighted-average grant-date fair value of options granted during 2021 under the 2020 Stock Incentive Plan was $39.66. The per option weighted-average grant-date fair value of options granted during 2020 (including the 2005 and 2020 Stock Incentive Plans) and 2019 were $14.60 and $30.40, respectively. Stock options granted during 2021 and 2020 were either granted with an exercise price equal to the fair market value on the date of grant, or for our named executive officers, half of their total option award value was issued with a premium exercise price of 10% above the grant date fair market value. All stock options issued in 2019 were granted with an exercise price equal to the fair market value on the date of the grant. The majority of options are exercisable ratably over a four-year period beginning one year after the date of the grant. All outstanding options expire five years after the date of the grant. As of December 31, 2021, approximately 3.2 million shares of Class B Common Stock remain available for issuance pursuant to the 2020 Stock Incentive Plan.

The fair value of each option grant was estimated on the date of grant using the Black-Scholes option-pricing model. The following weighted average assumptions were derived from averaging the number of options granted during the most recent five-year period. The weighted-average assumptions reflected below were based upon twenty-eight option grants for the five-year period ending December 31, 2021, twenty-nine option grants for the five-year period ending December 31, 2020 and twenty-nine option grants for the five-year period ending December 31, 2019.

Year Ended December 31,	2021			2020			2019
Expected volatility		31	%		28	%		27	%
Risk free Interest rate		2	%		2	%		2	%
Expected life (years)		3.5			3.5			3.4
Forfeiture rate		8	%		8	%		9	%
Dividend yield		0.5	%		0.5	%		0.3	%

The risk-free rate is based on the U.S. Treasury zero coupon four year yield curve in effect at the time of grant. The expected life of the stock options granted was estimated using the historical behavior of employees. Expected volatility was based on historical volatility for a period equal to the stock option’s expected life. Expected dividend yield is based on our dividend yield at the time of grant. The forfeiture rate is based upon the actual historical forfeitures utilizing the 5-year term of the option.

The table below summarizes our stock option activity during the year ended December 31, 2021:

Outstanding Options	Number of Shares			Weighted Average Exercise Price
Balance, January 1, 2021		8,238,966		$	109.47
Granted		2,401,402		$	141.08
Exercised		(1,737,286	)	$	116.38
Expired		—		$	—
Cancelled		(346,967	)	$	112.84
Balance, December 31, 2021		8,556,115		$	116.80
Outstanding options vested and exercisable as of December 31, 2021		2,997,296		$	119.00

The following table provides information about unvested options for the year ended December 31, 2021:

	Shares			Weighted Average Grant Date Fair Value
Unvested options as of January 1, 2021		5,716,060		$	22.74
Granted		2,401,402		$	39.66
Vested		(2,218,647	)	$	24.61
Cancelled		(339,996	)	$	28.70
Unvested options as of December 31, 2021		5,558,819		$	28.93

The following table provides information regarding all options outstanding at December 31, 2021:

	Options Outstanding		Options Exercisable
Number of options outstanding		8,556,115		2,997,296
Weighted average exercise price	$	116.80	$	119.00
Aggregate intrinsic value as of December 31, 2021	$	144,921,069	$	35,394,928
Weighted average remaining contractual life		2.6		1.4

The total in-the-money value of all stock options exercised during the years ended December 31, 2021, 2020 and 2019 were $52.0 million, $22.2 million and $126.7 million, respectively.

The weighted average remaining contractual life for options outstanding and weighted average exercise price per share for exercisable options at December 31, 2019, 2020 and 2021 were as follows:

Year Ended:	Options Outstanding		Weighted Average Exercise Price Per Share		Weighted Average Remaining Contractual Life (in Years)		Exercisable Options		Weighted Average Exercise Price Per Share		Expected to Vest Options		Weighted Average Exercise Price Per Share
	Shares						Shares				Shares
2019		8,133,176		124.52		2.7		2,551,267		119.86		5,073,423		126.62
2020		8,238,966		109.47		2.9		2,522,906		124.62		5,099,823		110.47
2021		8,556,115		116.80		2.6		2,997,296		119.00		5,005,113		116.94

Under our Amended and Restated 2010 Employees’ Restricted Stock Purchase Plan (the “Restricted Stock Plan”), which was cancelled during 2020 upon the approval of the 2020 Stock Incentive Plan, as mentioned above, eligible participants were allowed to purchase shares of Class B Common Stock at par value, subject to certain restrictions and had 600,000 shares of Class B Common Stock reserved. The reserve balance in the Restricted Stock Plan was cancelled during 2020 and no shares were issued under the Restricted Stock Plan during 2021. During 2020 and 2019, restricted shares, net of cancellations, of approximately 111,554 and 122,336, respectively, were granted and issued under the Restricted Stock Plan, with various ratable vesting periods ranging up to five years from the date of grant. The weighted-average grant-date fair value of the restricted shares granted during 2020 and 2019 under the Restricted Stock Plan was $68.06 and $133.98, respectively. As mentioned above, in 2020, we adopted the 2020 Stock Incentive Plan. During 2021 and 2020 restricted stock units, net of cancellations, of approximately 138,114 and 3,000 respectively, were granted under the 2020 Stock Incentive Plan with four-year vesting periods from the date of grant. The weighted average grant-date fair value of the restricted stock units issued during 2021 and 2020 under the 2020 Stock Incentive Plan was $138.80 and $109.72, respectively. The fair value of each restricted stock grant or restricted stock unit was determined as the closing UHS market price on the date of grant. Restricted shares and units of Class B Common Stock have been granted to our officers and key employees.

In addition to the 2020 Stock Incentive Plan, we have our 2005 Employee Stock Purchase Plan (the “Employee Stock Plan”) which allows eligible employees to purchase shares of Class B Common Stock at a ten percent discount. There were 96,179, 115,008 and 82,449 shares issued pursuant to the Employee Stock Purchase Plan during 2021, 2020 and 2019, respectively. In connection with the Employee Stock Plan, we have reserved 2.0 million shares of Class B Common Stock for issuance and have issued approximately 1.6 million shares as of December 31, 2021. As of December 31, 2021, approximately 400,000 shares of Class B Common Stock remain available for issuance pursuant to this plan.

At December 31, 2021, 20,034,442 shares of Class B Common Stock were reserved for issuance upon conversion of shares of Class A, C and D Common Stock outstanding, for issuance upon exercise of options to purchase Class B Common Stock and for issuance of stock under other incentive plans. Class A, C and D Common Stock are convertible on a share for share basis into Class B Common Stock.

Income Taxes

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Income Taxes

6) INCOME TAXES

Components of income tax expense/(benefit) are as follows (amounts in thousands):

	Year Ended December 31,
	2021			2020			2019
Current
Federal	$	276,471		$	268,974		$	225,663
Foreign		13,754			13,978			9,284
State		44,993			43,333			40,152
		335,218			326,285			275,099
Deferred
Federal		(26,638	)		(20,382	)		(27,073	)
Foreign		1,521			(2,496	)		1,874
State		(4,420	)		(4,114	)		(11,106	)
		(29,537	)		(26,992	)		(36,305	)
Total	$	305,681		$	299,293		$	238,794

On December 22, 2017, the President of the United States signed into law comprehensive tax legislation commonly referred to as the Tax Cuts and Jobs Act of 2017 (the “TCJA-17”). The TCJA-17 contains two new anti-base erosion tax provisions, (1) the global intangible low-taxed income (“GILTI”) provisions and (2) the base erosion and anti-abuse tax (“BEAT”) provisions:

GILTI: The GILTI provisions require the inclusion of the earnings of certain foreign subsidiaries in excess of an acceptable rate of return on certain assets of the respective subsidiaries in our U.S. tax return for tax years beginning after December 31, 2017. An accounting policy election was made during 2018 to treat taxes related to GILTI as a period cost when the tax is incurred. We recorded a GILTI tax provision of zero for the years ended December 31, 2021, 2020 and 2019, respectively.

BEAT: The BEAT provisions limit the deduction for U.S. tax base erosion related payments made by U.S. operations to related foreign affiliates. We were not subject to BEAT for the years ended December 31, 2021, 2020 and 2019.

The foreign provision for income taxes is based on foreign pre-tax earnings of $79 million in 2021, $72 million in 2020 and $69 million in 2019. In the future, we anticipate repatriating only previously taxed foreign earnings subjected as well as any future earnings that would qualify for a full dividend received deduction for distributions post-December 31, 2017. As of December 31, 2021, the amount of previously taxed earnings and earnings that would qualify for a full dividend received deduction total $116 million. At this time, there are no material tax effects related to future cash repatriation of undistributed foreign earnings. As such, we have not recognized a deferred tax liability related to existing undistributed earnings.

Our provision for income taxes for the year ended December 31, 2021, 2020 and 2019 included tax benefits of $2 million, tax expenses of $7 million and tax benefits of $12 million, respectively. Excess tax benefits (when the deductible amount related to the settlement of employee equity awards for tax purposes exceeds the cumulative compensation cost recognized for financial reporting purposes) and deficiencies, if applicable, are recorded as a component of our tax provision.

A reconciliation between the federal statutory rate and the effective tax rate is as follows:

	Year Ended December 31,
	2021			2020			2019
Federal statutory rate		21.0	%		21.0	%		21.0	%
State taxes, net of federal income tax benefit		2.5	%		2.5	%		2.2	%
Tax effects of foreign operations		-0.1	%		-0.3	%		-0.3	%
Tax benefit from settlement of employee equity awards		-0.2	%		0.5	%		-1.0	%
Other items		0.3	%		0.4	%		0.8	%
Impact of income attributable to noncontrolling interests		0.1	%		-0.2	%		-0.3	%
Effective tax rate		23.6	%		23.9	%		22.4	%

Our effective tax rates were 23.6%, 23.9% and 22.4% for the years ended December 31, 2021, 2020 and 2019, respectively. The decrease in our effective tax rate for the year ended December 31, 2021 as compared to 2020 is due primarily to tax benefit of $2 million and tax expense of $7 million from employee share-based payments during the year ended December 2021 and 2020, respectively. The increase in our effective tax rate for the year ended December 31, 2020 as compared to 2019 is due primarily to tax expense from employee share-based payments of $7 million and tax benefits of $12 million during the year ended December 2020 and 2019, respectively.

Included in “Other current assets” on our Consolidated Balance Sheet are prepaid federal, state and foreign income taxes amounting to approximately $6 million and $11 million as of December 31, 2021 and 2020, respectively.

The components of deferred taxes are as follows (amounts in thousands):

		Year Ended December 31,
		2021							2020
		Assets				Liabilities			Assets				Liabilities
Self-insurance reserves	$		97,024		$			$		75,648		$
Compensation accruals			77,917							71,054
Doubtful accounts and other reserves			127,876							94,295
Other currently non-deductible accrued liabilities			31,240							61,634
Depreciable and amortizable assets							303,079							296,588
Operating lease liabilities			86,652							89,865
Right of use assets-operating leases							86,269							89,493
State and foreign net operating loss carryforwards and other state and foreign deferred tax assets			79,499							81,036
Net pension liabilities – OCI only			1,014							1,356
Other liabilities							3,811							3,697
	$		501,222		$		393,159	$		474,888		$		389,778
Valuation Allowance			(62,356	)			0			(68,003	)			0
Total deferred income taxes	$		438,866		$		393,159	$		406,885		$		389,778

At December 31, 2021, state net operating loss carryforwards (losses originating in tax years beginning prior to January 1, 2021, expiring in years 2022 through 2040), and credit carryforwards available to offset future taxable income approximated $891 million representing approximately $60 million in deferred state tax benefit (net of the federal benefit); and state related interest expense carryforwards approximated $158 million representing approximately $5 million in deferred state tax benefit (net of the federal benefit). At December 31, 2021, there were foreign net operating losses and interest expense carryforwards of approximately $51 million, most of which are carried forward indefinitely, representing approximately $13 million in deferred foreign tax benefit. At December 31, 2021, related to the acquisition of Riverside Medical Clinic Patient Services, LLC, there were estimated federal and state net operating losses of approximately $11 million carried forward indefinitely for federal purposes and $10 million through 2038 for state purposes representing approximately $2 million in deferred federal tax benefits and less than $1 million of state tax benefits.

A valuation allowance is required when it is more likely than not that some portion of the deferred tax assets will not be realized. Based on available evidence, it is more likely than not that certain of our state tax benefits will not be realized. Therefore, valuation allowances of approximately $57 million and $64 million have been reflected as of December 31, 2021 and 2020, respectively. During 2021, the valuation allowance on these state tax benefits decreased by $7 million primarily due to expired net operating losses not realized. In addition, valuation allowances of approximately $5 million and $4 million have been reflected as of December 31, 2021 and 2020, respectively, related to foreign net operating losses and credit carryforwards.

During 2021 and 2020, the estimated liabilities for uncertain tax positions (including accrued interest and penalties) were increased less than $1 million due to tax positions taken in the current and prior years. The balance at each of the years ended December 31, 2021 and 2020, if subsequently recognized, that would favorably affect the effective tax rate and the provision for income taxes is approximately $2 million as of each date.

We recognize accrued interest and penalties associated with uncertain tax positions as part of the tax provision. As of December 31, 2021 and 2020, we have accrued interest and penalties of less than $1 million as of each date. The U.S. federal statute of limitations remains open for the 2018 and subsequent years. Foreign and U.S. state and local jurisdictions have statutes of limitations generally ranging for 3 to 4 years. The statute of limitations on certain jurisdictions could expire within the next twelve months. It is reasonably possible that the amount of unrecognized tax benefits will change during the next 12 months, however, it is anticipated that any such change, if it were to occur, would not have a material impact on our results of operations.

The tabular reconciliation of unrecognized tax benefits for the years ended December 31, 2021, 2020 and 2019 is as follows (amounts in thousands):

	As of December 31,
	2021			2020		2019
Balance at January 1,	$	2,806		$	2,164	$	1,553
Additions based on tax positions related to the current year		500			500		500
Additions for tax positions of prior years		213			142		113
Reductions for tax positions of prior years		(261	)		0		0
Settlements		(714	)		0		(2	)
Balance at December 31,	$	2,544		$	2,806	$	2,164

- 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 21
-URI http://asc.fasb.org/extlink&oid=121826272&loc=d3e32857-109319

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-URI http://asc.fasb.org/extlink&oid=122134291&loc=d3e330215-122817

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 17
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=121826272&loc=d3e32809-109319

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-URI http://asc.fasb.org/extlink&oid=122134291&loc=d3e330036-122817

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 14
-URI http://asc.fasb.org/extlink&oid=121826272&loc=d3e32705-109319

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 270
-Section 50
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=6424409&loc=d3e44925-109338

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-URI http://asc.fasb.org/topic&trid=2144680

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 30
-Section 50
-Paragraph 2
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=6424122&loc=d3e41874-109331

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-URI http://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

+ Details

Lease Commitments

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Lease Commitments

7) LEASE COMMITMENTS

In February 2016, the FASB issued ASU 2016-02 (Topic 842) "Leases." Topic 842 supersedes the lease requirements in Accounting Standards Codification Topic 840, "Leases." Under Topic 842, lessees are required to recognize assets and liabilities on the balance sheet for most leases and provide enhanced disclosures. Leases will be classified as either finance or operating.

We adopted Topic 842 effective January 1, 2019. We applied Topic 842 to all leases as of January 1, 2019 with comparative periods continuing to be reported under Topic 840. We have elected the practical expedient package to not reassess at adoption (i) expired or existing contracts for whether they are or contain a lease, (ii) the lease classification of any existing leases or (iii) initial indirect costs for existing leases. We have also elected the policy exemption that allows lessees to choose to not separate lease and non-lease components by class of underlying asset and are applying this expedient to all relevant asset classes.

We determine if an arrangement is or contains a lease at inception of the contract. Our right-of-use assets represent our right to use the underlying assets for the lease term and our lease liabilities represent our obligation to make lease payments arising from the leases. Right-of-use assets and lease liabilities are recognized at commencement date based on the present value of lease payments over the lease term. We use the implicit rate noted within the contract if known or determinable. If the implicit rate is not readily available, we use our estimated incremental borrowing rate, which is derived using a collateralized borrowing rate for the same currency and term as the associated lease. A right-of-use asset and lease liability is not recognized for leases with an initial term of 12 months or less and we recognize lease expense for these leases on a straight-line basis over the lease term within lease and rental expense.

Our operating leases are primarily for real estate, including certain acute care facilities, off-campus outpatient facilities, medical office buildings, and corporate and other administrative offices. Our real estate lease agreements typically have initial terms of five to 10 years. These real estate leases may include one or more options to renew, with renewals that can extend the lease term from five to 10 years. The exercise of lease renewal options is at our sole discretion. When determining the lease term, we included options to extend or terminate the lease when it is reasonably certain that we will exercise that option.

Five of our hospital facilities are held under operating leases with Universal Health Realty Income Trust with two hospital terms expiring in 2026, two expiring in 2033, and one expiring in 2040 (see Note 9 for additional disclosure). We also lease the real property of certain facilities (see Item 2. Properties for additional disclosure).

The components of lease expense for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands):

	Twelve months ended December 31,
	2021		2020		2019

Operating lease cost	$	77,420	$	73,841	$	72,098
Variable and short term lease cost (a)		41,443		42,218		35,711
Total lease and rental expense	$	118,863	$	116,059	$	107,809

Finance lease cost:
Amortization of property under capital lease	$	3,626	$	1,985	$	1,877
Interest on debt of property under capital lease		4,124		1,763		1,876
Total finance lease cost	$	7,750	$	3,748	$	3,753

(a) Includes equipment, month-to-month and leases with a maturity of less than 12 months.

Supplemental cash flow information related to leases for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands):

	Twelve months ended December 31,
	2021		2020		2019

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	118,433	$	115,270	$	107,239
Operating cash flows from finance leases	$	4,612	$	1,885	$	2,078
Financing cash flows from finance leases	$	2,849	$	2,586	$	1,959

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	95,805	$	69,678	$	383,857
Finance leases	$	28,600	$	37,029	$	-

Included in the $383.9 million of right-of-use assets obtained in exchange for operating lease obligations is $29.3 million of new and modified operating leases entered into during the year ended December 31, 2019.

Supplemental balance sheet information related to leases as of December 31, 2021 and 2020 are as follows (in thousands):

	December 31,			December 31,
	2021			2020

Operating Leases
Right of use assets-operating leases	$	367,477		$	336,513

Operating lease liabilities	$	64,484		$	59,796
Operating lease liabilities noncurrent		304,624			278,303
Total operating lease liabilities	$	369,108		$	338,099

Finance Leases
Property and equipment	$	102,940		$	75,611
Accumulated depreciation		(30,949	)		(28,595	)
Property and equipment, net	$	71,991		$	47,016

Current maturities of long-term debt	$	2,740		$	2,060
Long-term debt		76,591			50,845
Total finance lease liabilities	$	79,331		$	52,905

Weighted Average remaining lease term, years
Operating leases		9.1			10.9
Finance leases		20.8			8.1

Weighted Average discount rate
Operating leases		3.8	%		4.4	%
Finance leases		7.1	%		9.7	%

Future maturities of lease liabilities as of December 31, 2021 are as follows (in thousands):

	Operating Leases			Finance Leases
Year ending December 31,
2022	$	75,790		$	6,809
2023		67,994			6,993
2024		59,354			7,162
2025		52,098			6,047
2026		43,193			6,057
Later years		150,024			110,263
Total lease payments		448,453			143,331
less imputed interest		(79,345	)		(64,000	)
Total	$	369,108		$	79,331

We assumed $29 million and $37 million in finance lease obligations during 2021 and 2020, respectively. No finance lease were assumed during 2019. In the ordinary course of business, our facilities routinely lease equipment pursuant to new lease arrangements that will likely result in future lease and rental expense in excess of amounts indicated above.

Commitments and Contingencies

12 Months Ended

Dec. 31, 2021

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

8) COMMITMENTS AND CONTINGENCIES

Professional and General Liability, Workers’ Compensation Liability

The vast majority of our subsidiaries are self-insured for professional and general liability exposure up to: (i) $20 million for professional liability and $3 million for general liability per occurrence in 2022 and 2021; (ii) $10 million and $3 million per occurrence in 2020 (professional liability claims are also subject to an additional annual aggregate self-insured retention of $2.5 million for claims in excess of $10 million for 2020); (iii) $5 million and $3 million per occurrence, respectively, during 2019, 2018 and 2017, and; (iv) $10 million and $3 million per occurrence, respectively, prior to 2017.

These subsidiaries are provided with several excess policies through commercial insurance carriers which provide for coverage in excess of the applicable per occurrence and aggregate self-insured retention or underlying policy limits up to $162.5 million in 2022; $155 million in 2021 and $250 million during each of 2014 through 2020. 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 £16 million of professional liability coverage, and £25 million of general liability coverage.

As of December 31, 2021, the total net accrual for our professional and general liability claims was $349 million, of which $74 million was included in current liabilities. As of December 31, 2020, the total net accrual for our professional and general liability claims was $264 million, of which $74 million was included in current liabilities.

As a result of unfavorable trends experienced during 2021 and 2020, included in our results of operations were pre-tax increases of $52 million during 2021, and $25 million during 2020, to increase our reserves for self-insured professional and general liability claims. Our 2019 results of operations were not materially impacted by adjustments to our reserves for professional and general liability claims. Our estimated liability for self-insured professional and general liability claims is based on a number of factors including, among other things, the number of asserted claims and reported incidents, estimates of losses for these claims based on recent and historical settlement amounts, estimates of incurred but not reported claims based on historical experience, and estimates of amounts recoverable under our commercial insurance policies. While we continuously monitor these factors, our ultimate liability for professional and general liability claims could change materially from our current estimates due to inherent uncertainties involved in making this estimate. Given our significant self-insured exposure for professional and general liability claims, there can be no assurance that a sharp increase in the number and/or severity of claims asserted against us will not have a material adverse effect on our future results of operations.

As of December 31, 2021, the total accrual for our workers’ compensation liability claims was $115 million, $55 million of which was included in current liabilities. As of December 31, 2020, the total accrual for our workers’ compensation liability claims was $105 million, $55 million of which was included in current liabilities. Our results of operations for 2021 and 2019 were not materially impacted by adjustments to our reserves for workers’ compensation claims. However, during 2020, as a result of unfavorable trends experienced during the year, including, among other things, increased claims volumes and certain other factors resulting from the COVID-19 pandemic, our results of operations included a $20 million increase to our reserves for workers’ compensation claims, a portion of which related to prior years.

Although we are unable to predict whether or not our future financial statements will require updates to estimates for our prior year reserves for self-insured general and professional and workers’ compensation claims, given the relatively unpredictable nature of these potential liabilities and the factors impacting these reserves, as discussed above, it is reasonably likely that our future financial results may include material adjustments to prior period reserves.

Property Insurance

We have commercial property insurance policies for our properties covering catastrophic losses, including windstorm damage, up to a $1 billion policy limit, subject to a per occurrence/per location deductible of $2.5 million as of June 1, 2020. Losses resulting from named windstorms are subject to deductibles between 3% and 5% of the total insurable value of the property. In addition, we have commercial property insurance policies covering catastrophic losses resulting from earthquake and flood damage, each subject to aggregated loss limits (as opposed to per occurrence losses). Commercially insured earthquake coverage for our facilities is subject to various deductibles and limitations including: (i) $200 million limitation for our facilities located in Nevada; (ii) $150 million limitation for our facilities located in California; (iii) $100 million limitation for our facilities located in fault zones within the United States; (iv) $40 million limitation for our facilities located in Puerto Rico, and; (v) $250 million limitation for many of our facilities located in other states. Our commercially insured flood coverage has a limit of $100 million annually. There is also a $10 million sublimit for one of our facilities located in Houston, Texas, and a $1 million sublimit for our facilities located in Puerto Rico. Property insurance for our behavioral health facilities located in the U.K. are provided on an all risk basis up to a £1.5 billion policy limit, with coverage caps per location, that includes coverage for real and personal property as well as business interruption losses.

Although we are unable to predict whether or not our future financial statements will require updates to estimates for our reserves for self-insured general and professional and workers’ compensation claims, given the relatively unpredictable nature of the

these potential liabilities and the factors impacting these reserves, as discussed above, it is reasonably likely that our future financial results may include material adjustments to prior period reserves.

Below is a schedule showing the changes in our general and professional liability and workers’ compensation reserves during the three years ended December 31, 2021 (amount in thousands):

	General and
	Professional			Workers’
	Liability			Compensation			Total
Balance at January 1, 2019	$	243,051		$	71,890		$	314,941
Plus: Accrued insurance expense, net of commercial premiums paid		56,452			49,220			105,672
Less: Payments made in settlement of self-insured claims		(57,683	)		(40,106	)		(97,789	)
Balance at January 1, 2020		241,820			81,004			322,824
Plus: Accrued insurance expense, net of commercial premiums paid		91,518			67,705			159,223
Less: Payments made in settlement of self-insured claims		(69,559	)		(43,524	)		(113,083	)
Balance at January 1, 2021		263,779			105,185			368,964
Plus: Accrued insurance expense, net of commercial premiums paid		129,690			56,525			186,215
Less: Payments made in settlement of self-insured claims		(44,776	)		(46,725	)		(91,501	)
Balance at December 31, 2021	$	348,693		$	114,985		$	463,678

Information Technology Incident

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. Our information technology applications were substantially restored at our acute care and behavioral health hospitals at various times in October, 2020, on a rolling/staggered basis, and our facilities generally resumed standard operating procedures at that time.

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

Given the disruption to the standard operating procedures at our facilities during the period of September 27, 2020 into October, 2020, certain patient activity, including ambulance traffic and elective/scheduled procedures at our acute care hospitals, were diverted to competitor facilities. We also incurred significant incremental labor expense, both internal and external, to restore information technology operations as expeditiously as possible. Additionally, certain administrative functions such as coding and billing were delayed into December, 2020, which had a negative impact on our operating cash flows during the fourth quarter of 2020.

In connection with this incident, our results of operations for the year ended December 31, 2021 were favorably impacted by an aggregate of approximately $45 million resulting from: (i) receipt of commercial cyber insurance proceeds (approximately $28 million), and; (ii) collection of revenues previously reserved during 2020 (approximately $17 million).

Other Contractual Commitments:

In addition to our long-term debt obligations as discussed in Note 4 - Long-Term Debt and our operating lease obligations as discussed in Note 7 - Lease Commitments, we have various other contractual commitments outstanding as of December 31, 2021 as follows: (i) other combined estimated future purchase obligations of $367 million related to a long-term contract with third-parties consisting primarily of certain revenue cycle data processing services for our acute care facilities ($63 million), expected future costs to be paid to a third-party vendor in connection with the ongoing operation of an electronic health records application and purchase implementation of a revenue cycle and other applications for our acute care facilities ($208 million), healthcare infrastructure in Washington D.C. in connection with various agreements with the District of Columbia ($75 million), and other software applications ($21 million); (ii) estimated construction commitment of $21 million representing our share of the construction cost of a behavioral health care facility scheduled to be completed in 2023 that, subject to approval of certain regulatory conditions, we are required to build pursuant to a joint-venture agreement with a third-party; (iii) combined estimated future payments of $179 million related to our non-contributory, defined benefit pension plan ($156 million consisting of estimated payments through 2080) and other retirement plan liabilities ($23 million), and; (iv) accrued and unpaid estimated claims expense incurred in connection with our commercial health insurers and self-insured employee benefit plans ($114 million).

Legal Proceedings

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

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

Certain legal matters are described below:

Litigation:

Shareholder Derivative Cases

In March 2017, a shareholder derivative suit was filed by plaintiff David Heed in the Court of Common Pleas of Philadelphia County. A notice of removal to the United States District Court for the Eastern District of Pennsylvania was filed (Case No. 2:17-cv-01476-LS). Plaintiff filed a motion to remand. In December 2017, the Court denied plaintiff’s motion to remand and retained the case in federal court. In May, June and July 2017, additional shareholder derivative suits were filed in the United States District Court for the Eastern District of Pennsylvania. The plaintiffs in those cases are: Central Laborers’ Pension Fund (Case No. 17-cv-02187-LS); Firemen’s Retirement System of St. Louis (Case No. 17—cv-02317-LS); Waterford Township Police & Fire Retirement System (Case No. 17-cv-02595-LS); and Amalgamated Bank Longview Funds (Case No. 17-cv-03404-LS). The Fireman’s Retirement System case has since been voluntarily dismissed. The federal court consolidated all of the cases pending in the Eastern District of Pennsylvania and appointed co-lead plaintiffs and co-lead counsel. Lead Plaintiffs filed a consolidated, amended complaint. We filed a motion to dismiss the amended complaint. In addition, a shareholder derivative case was filed in Chancery Court in Delaware by the Delaware County Employees’ Retirement Fund (Case No. 2017-0475-JTL). In December 2017, the Chancery Court stayed this case pending resolution of other contemporaneous matters. Each of these cases have named certain current and former members of the Board of Directors individually and certain officers of Universal Health Services, Inc. as defendants. UHS has also been named as a nominal defendant in these cases. The derivative cases make allegations relating to admission and discharge practices at our behavioral health facilities and board and corporate oversight of these facilities as well as claims relating to the stock trading by the individual defendants and company repurchase of shares during the relevant time period. The cases make claims of breaches of fiduciary duties by the named board members and officers; alleged violations of federal securities laws; and common law causes of action against the individual defendants including unjust enrichment, corporate waste, abuse of control, constructive fraud and gross mismanagement. The cases seek monetary damages allegedly incurred by the company; restitution and disgorgement of profits, benefits and other

compensation from the individual defendants and various forms of equitable relief relating to corporate governance matters. In August 2019, the court granted our motion to dismiss. Plaintiffs subsequently filed a motion with the court seeking leave to file a second amended complaint. In April 2020, the court denied Plaintiffs motion to file a second amended complaint. Plaintiffs filed an appeal with the 3rd Circuit Court of Appeals. The defendants denied liability and defended these cases vigorously. The parties engaged in settlement negotiations during the pendency of the appeal and a settlement was reached. In December, 2021, the Court granted final approval of the settlement, which did not have a material impact on our financial statements, and the cases have been dismissed. Following the Court’s approval of the settlement, a plaintiff’s attorney fee award was negotiated by our commercial insurance carrier, for an amount which was not material to our financial statements. We anticipate that the legal fee award will be covered in full by our insurance carrier.

In July 2021, a shareholder derivative lawsuit was filed by plaintiff, Robin Knight, in the Chancery Court in Delaware against the members of the Board of Directors of the Company as well as certain officers (C.A. No.: 2021-0581-SG). The Company was named as a nominal defendant. The lawsuit alleges that in March 2020 stock options were awarded with exercise prices that did not reflect the Company’s fundamentals and business prospects, and in anticipation of future market rebound resulting in excessive gains. The lawsuit makes claims of breaches of fiduciary duties, waste of corporate assets, and unjust enrichment. The lawsuit seeks monetary damages allegedly incurred by the Company, disgorgement of the March 2020 stock awards as well as any proceeds derived therefrom and unspecified equitable relief. Defendants deny the allegations. We have filed a motion to dismiss the complaint. We are uncertain as to potential liability or financial exposure, if any, which may be associated with this matter.

The George Washington University v. Universal Health Services, Inc., et. al.

In December 2019, The George Washington University (“University”) filed a lawsuit in the Superior Court for the District of Columbia against Universal Health Services, Inc. as well as certain subsidiaries and individuals associated with the ownership and management of The George Washington University Hospital (“GW Hospital”) in Washington, D.C. (case No. 2019 CA 008019 B). The lawsuit claims that UHS failed to provide sufficient financial compensation to the University under the terms of various agreements entered into in 1997 between the University and UHS for the joint venture ownership of GW Hospital. The lawsuit includes claims for breach of contract, breach of fiduciary duty, and unjust enrichment. We deny liability and intend to defend this matter vigorously. We filed a motion to dismiss the complaint. In June 2020, the Court granted the motion in part dismissing the majority of the claims against UHS. At this time, we are uncertain as to potential liability or financial exposure, if any, which may be associated with this matter.

Disproportionate Share Hospital Payment Matter:

In late September, 2015, many hospitals in Pennsylvania, including certain of our behavioral health care hospitals located in the state, received letters from the Pennsylvania Department of Human Services (the “Department”) demanding repayment of allegedly excess Medicaid Disproportionate Share Hospital payments (“DSH”), primarily consisting of managed care payments characterized as DSH payments, for the federal fiscal year (“FFY”) 2011 amounting to approximately $4 million in the aggregate. Since that time, certain of our behavioral health care hospitals in Pennsylvania have received similar requests for repayment for alleged DSH overpayments for FFYs 2012 through 2015. For FFY 2012, the claimed overpayment amounts to approximately $4 million. For FY 2013, FY 2014 and FY 2015 the initial claimed overpayments and attempted recoupment by the Department were approximately $7 million, $8 million and $7 million, respectively. The Department has agreed to a change in methodology which, upon confirmation of the underlying data being accepted by the Department, could reduce the initial claimed overpayments for FY 2013, FY 2014 and FY 2015 to approximately $2 million, $2 million and $3 million, respectively. We filed administrative appeals for all of our facilities contesting the recoupment efforts for FFYs 2011 through 2015 as we believe the Department’s calculation methodology is inaccurate and conflicts with applicable federal and state laws and regulations. The Department has agreed to postpone the recoupment of the state’s share for FY 2011 to 2013 until all hospital appeals are resolved but started recoupment of the federal share. For FY 2014 and FY 2015, the Department has initiated the recoupment of the alleged overpayments. Starting in FFY 2016, the first full fiscal year after the January 1, 2015 effective date of Medicaid expansion in Pennsylvania, the Department no longer characterized managed care payments received by the hospitals as DSH payments. We can provide no assurance that we will ultimately be successful in our legal and administrative appeals related to the Department’s repayment demands. If our legal and administrative appeals are unsuccessful, our future consolidated results of operations and financial condition could be adversely impacted by these repayments.

Boley, et al. v. UHS, et al.

Former UHS subsidiary facility employees Mary K. Boley, Kandie Sutter, and Phyllis Johnson, individually and on behalf of a putative class of participants in the UHS Retirement Savings Plan (the “Plan”), filed a complaint in the U.S. District Court for the Eastern District of Pennsylvania against UHS, the Board of Directors of UHS, and the “Plan Committee” of UHS (Case No. 2:20-cv-02644). In subsequent amended complaints, Plaintiffs have dropped the Board of Directors and the “Plan Committee” as defendants and added the UHS Retirement Plans Investment Committee as a new defendant. Plaintiffs allege that UHS breached its fiduciary duties under the Employee Retirement Income Security Act (“ERISA”) by offering to participants in the Plan overly expensive investment options when less expensive investment options were available in the marketplace; caused participants to pay excessive recordkeeping fees associated with the Plan; breached its duty to monitor appointed fiduciaries and: in the alternative, engaged in a “knowing breach of trust” separate from the alleged violations under ERISA. UHS disputes Plaintiffs’ allegations and is actively defending against Plaintiffs’ claims. UHS’ motion for partial dismissal of Plaintiffs’ claims was denied by the Court. In March 2021,

the Court granted Plaintiffs’ motion for class certification. The Third Circuit Court of Appeal has agreed to hear an appeal of the trial court’s order granting class certification. The case will be stayed in the trial court pending conclusion of the appellate proceedings. We are uncertain as to potential liability or financial exposure, if any, which may be associated with this matter. We maintain commercial insurance coverage for claims of this nature, subject to specified deductibles and limitations.

Other Matters:

Various other suits, claims and investigations, including government subpoenas, arising against, or issued to, us are pending and additional such matters may arise in the future. Management will consider additional disclosure from time to time to the extent it believes such matters may be or become material. The outcome of any current or future litigation or governmental or internal investigations, including the matters described above, cannot be accurately predicted, nor can we predict any resulting penalties, fines or other sanctions that may be imposed at the discretion of federal or state regulatory authorities. We record accruals for such contingencies to the extent that we conclude it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. No estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made at this time regarding the matters described above or that are otherwise pending because the inherently unpredictable nature of legal proceedings may be exacerbated by various factors, including, but not limited to: (i) the damages sought in the proceedings are unsubstantiated or indeterminate; (ii) discovery is not complete; (iii) the matter is in its early stages; (iv) the matters present legal uncertainties; (v) there are significant facts in dispute; (vi) there are a large number of parties, or; (vii) there is a wide range of potential outcomes. It is possible that the outcome of these matters could have a material adverse impact on our future results of operations, financial position, cash flows and, potentially, our reputation.

Relationship with Universal Health Realty Income Trust and Other Related Party Transactions

12 Months Ended

Dec. 31, 2021

Relationship with Universal Health Realty Income Trust and Other Related Party Transactions

9) RELATIONSHIP WITH UNIVERSAL HEALTH REALTY INCOME TRUST AND OTHER RELATED PARTY TRANSACTIONS

Relationship with Universal Health Realty Income Trust:

At December 31, 2021, we held approximately 5.7% of the outstanding shares of Universal Health Realty Income Trust (the “Trust”). We serve as Advisor to the Trust under an annually renewable advisory agreement, which is scheduled to expire on December 31^st 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 renewed by the Trust for 2022 at the same rate as the prior three years, providing for an advisory 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 $4.4 million during 2021, $4.1 million during 2020 and $4.0 million during 2019.

In addition, certain of our officers and directors are also officers and/or directors of the Trust. Management believes that it has the ability to exercise significant influence over the Trust, therefore we account for our investment in the Trust using the equity method of accounting.

Our pre-tax share of income from the Trust was $6.2 million during 2021 and $1.1 million during each of 2020 and 2019, which are included in other income, net, on the accompanying consolidated statements of income for each year. We received dividends from the Trust amounting to $2.2 million during each of 2021 and 2020 and $2.1 million 2019. Included in our share of the Trust’s income during 2021 was approximately $5.0 million related to our share of gains on various transactions recorded by the Trust, including an asset purchase and sale transaction between the Trust and UHS, as discussed below.

The carrying value of our investment in the Trust was $9.4 million and $5.4 million at December 31, 2021 and 2020, respectively, and is included in other assets in the accompanying consolidated balance sheets. The market value of our investment in the Trust was $46.8 million at December 31, 2021 and $50.6 million at December 31, 2020, based on the closing price of the Trust’s stock on the respective dates.

The Trust commenced operations in 1986 by purchasing certain hospital properties from us and immediately leasing the properties back to our respective subsidiaries. Most of the leases were entered into at the time the Trust commenced operations and provided for initial terms of 13 to 15 years with up to six additional 5-year renewal terms. Each lease, at that time, also provided for additional or bonus rental, as discussed below. The base rents are paid monthly and the bonus rents are computed and paid on a quarterly basis, based upon a computation that compares current quarter revenue to a corresponding quarter in the base year. The leases with those subsidiaries are unconditionally guaranteed by us and are cross-defaulted with one another.

On December 31, 2021 we entered into an asset purchase and sale agreement with the Trust, pursuant to the terms of which:

•

a wholly-owned subsidiary of ours purchased from the Trust, the real estate assets of the Inland Valley Campus of Southwest Healthcare System located in Wildomar, California, at its fair market value of $79.6 million.

•

two wholly-owned subsidiaries of ours transferred to the Trust, the real estate assets of the following properties:

Aiken Regional Medical Center (“Aiken”), located in Aiken, South Carolina (which includes a 211-bed acute care hospital and a 62-bed behavioral health facility), at its fair-market value of approximately $57.7 million, and;

Canyon Creek Behavioral Health (“Canyon Creek”), located in Temple, Texas, at its fair-market value of approximately $24.7 million.

•

in connection with this transaction, since the fair-market value of Aiken and Canyon Creek, which totaled approximately $82.4 million in the aggregate, exceeded the $79.6 million fair-market value of the Inland Valley Campus of Southwest Healthcare System, we received approximately $2.8 million in cash from the Trust. This transaction generated a gain of approximately $68.4 million for the Trust, our share of which (approximately $4.0 million) is included in our consolidated statement of income for the year ended December 31, 2021.

Also on December 31, 2021, Aiken and Canyon Creek (as lessees), entered into a master lease and individual property leases (with the Trust as lessor), for initial lease terms on each property of approximately twelve years, ending on December 31, 2033. Subject to the terms of the master lease, Aiken and Canyon Creek have the right to renew their leases, at the then current fair market rent (as defined in the master lease), for seven, five-year optional renewal terms. The aggregate annual rental during 2022 pursuant to the leases for these two facilities, amounts to approximately $5.6 million ($3.9 million related to Aiken and $1.7 million related to Canyon Creek). There is no bonus rental component applicable to either of these leases. Beginning on January 1, 2023, and thereafter on each January 1^st through 2033, the annual rental will increase by 2.25% on a cumulative and compounded basis.

As a result of the purchase options within the lease agreements for Aiken and Canyon Creek, the asset purchase and sale transaction is accounted for as a failed sale leaseback in accordance with U.S. GAAP. We have accounted for the asset exchange and substitution transaction with the Trust as a financing arrangement and, since we did not derecognize the real property related to Aiken and Canyon Creek, we will continue to depreciate the assets. Our Consolidated Balance Sheet as of December 31, 2021 reflects a financial liability of $82.4 million, which is included in debt, for the fair value of real estate assets that we exchanged as part of the transaction. Our monthly lease payments payable to the Trust will be recorded to interest expense and as reduction to the outstanding financial liability. The amount allocated to interest expense will be determined using our incremental borrowing rate and will be based on the outstanding financial liability.

Total aggregate rent expense under the operating leases on three hospital facilities with the Trust (McAllen Medical Center, Wellington Regional Medical Center and Inland Valley Campus of Southwest Healthcare System) was $17.7 million, $17.1 million and $16.4 million during 2021, 2020 and 2019, respectively. Pursuant to the Master Leases by certain subsidiaries of ours and the Trust as described in the table below, dated 1986 and 2021 (“the Master Leases”) which govern the leases of McAllen Medical Center and Wellington Regional Medical Center (each of which is governed by the Master Lease dated 1986), and Aiken Regional Medical Center and Canyon Creek Behavioral Health (each of which is governed by the Master Lease dated 2021), we have the option to renew the leases at the lease terms described above and below by providing notice to the Trust at least 90 days prior to the termination of the then current term. We also have the right to purchase the respective leased hospitals at their appraised fair market value upon any of the following: (i) at the end of the lease terms or any renewal terms; (ii) upon one month’s notice should a change of control of the Trust occur, or; (iii) within the time period as specified in the lease in the event that we provide notice to the Trust of our intent to offer a substitution property/properties in exchange for one (or more) of the hospital properties leased from the Trust should we be unable to reach an agreement with the Trust on the properties to be substituted. In addition, we have rights of first refusal to: (i) purchase the respective leased facilities during and for 180 days after the lease terms at the same price, terms and conditions of any third-party offer, or; (ii) renew the lease on the respective leased facility at the end of, and for 180 days after, the lease term at the same terms and conditions pursuant to any third-party offer.

In addition, we are the managing, majority member in a joint venture with an unrelated third-party that operates Clive Behavioral Health, a 100-bed behavioral health care facility located in Clive, Iowa. The real property of this newly constructed facility, which was completed and opened in late, 2020, is also leased from the Trust (annual rental expense of approximately $2.5 million during 2021) pursuant to the lease terms as provided in the table below. In connection with the lease on this facility, the joint venture has the right to purchase the leased facility from the Trust at its appraised fair market value upon either of the following: (i) by providing notice at least 270 days prior to the end of the lease terms or any renewal terms, or; (ii) upon 30 days’ notice anytime within 12 months of a change of control of the Trust (UHS also has this right should the joint venture decline to exercise its purchase right). Additionally, the joint venture has rights of first offer to purchase the facility prior to any third-party sale.

The table below provides certain details for each of the hospitals leased from the Trust as of January 1, 2022:

Hospital Name	Annual Minimum Rent		End of Lease Term	Renewal Term (years)
McAllen Medical Center	$	5,485,000	December, 2026		5	(a)
Wellington Regional Medical Center	$	6,319,000	December, 2026		5	(b)
Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services	$	3,895,000	December, 2033		35	(c)
Canyon Creek Behavioral Health	$	1,670,000	December, 2033		35	(c)
Clive Behavioral Health Hospital	$	2,628,000	December, 2040		50	(d)

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

(b)

We have one 5-year renewal option at fair market value lease rates (through 2031). Upon the December 31, 2021 expiration of the lease on Wellington Regional Medical Center, a wholly-owned subsidiary of ours exercised its fair market value renewal option and renewed the lease for a 5-year term scheduled to expire on December 31, 2026. Effective January 1, 2022, the annual fair market value lease rate for this hospital is $6.3 million (there is no longer a bonus rental component of the lease payment). Beginning on January 1, 2023, and thereafter on each January 1^st through 2026, the annual rent will increase by 2.50% on a cumulative and compounded basis.

(c)	We have seven 5-year renewal options at fair market value lease rates (2034 through 2068).

(d)

This facility is operated by a joint venture in which we are the managing, majority member and an unrelated third-party holds a minority ownership interest. The joint venture has three, 10-year renewal options at computed lease rates as stipulated in the lease (2041 through 2070) and two additional, 10-year renewal options at fair market values lease rates (2071 through 2090). Beginning in January, 2022, and thereafter in each January through 2040 (and potentially through 2070 if three, 10-year renewal options are exercised), the annual rental will increase by 2.75% on a cumulative and compounded basis.

In addition, certain of our subsidiaries are tenants in several medical office buildings (“MOBs”) and two free-standing emergency departments owned by the Trust or by limited liability companies in which the Trust holds 95% to 100% of the ownership interest.

In January, 2022, the Trust commenced construction on a new 86,000 rentable square feet multi-tenant MOB that is located on the campus of Northern Nevada Sierra Medical Center in Reno, Nevada. Northern Nevada Sierra Medical Center, which is currently under construction and will be owned and operated by a wholly-owned subsidiary of ours, is a 170-bed acute care hospital that is scheduled to be completed and opened in the Spring of 2022. In connection with this MOB, a ground lease and a master flex lease was executed between a wholly-owned subsidiary of ours and the Trust, pursuant to the terms of which our subsidiary will master lease approximately 68% of the rentable square feet of the MOB at an initial minimum rent of $1.3 million annually. The master flex lease could be reduced during the term if certain conditions are met.

Other Related Party Transactions:

In December, 2010, our Board of Directors approved the Company’s entering into supplemental life insurance plans and agreements on the lives of our chief executive officer (“CEO”) and his wife. As a result of these agreements, as amended in October, 2016, based on actuarial tables and other assumptions, during the life expectancies of the insureds, we would pay approximately $28 million in premiums, and certain trusts owned by our CEO, would pay approximately $9 million in premiums. Based on the projected premiums mentioned above, and assuming the policies remain in effect until the death of the insureds, we will be entitled to receive death benefit proceeds of no less than approximately $37 million representing the $28 million of aggregate premiums paid by us as well as the $9 million of aggregate premiums paid by the trusts. In connection with these policies, we paid approximately $1.0 million, net, in premium payments during 2021 and approximately $1.1 million, net, in premium payments during each of 2020 and 2019.

In August, 2015, Marc D. Miller, our President and Chief Executive Officer and member of our Board of Directors, was appointed to the Board of Directors of Premier, Inc. (“Premier”), a healthcare performance improvement alliance. During 2013, we entered into a new group purchasing organization agreement (“GPO”) with Premier. In conjunction with the GPO agreement, we acquired a minority interest in Premier for a nominal amount. During the fourth quarter of 2013, in connection with the completion of an initial public offering of the stock of Premier, we received cash proceeds for the sale of a portion of our ownership interest in the GPO. Also in connection with this GPO agreement, we received shares of restricted stock of Premier which vested ratably over a seven-year 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 was $92 million as of December 31, 2021 and $78 million as of December 31, 2020. The $14 million increase in market value of our vested Premier shares since December 31, 2020 was recorded as an unrealized gain and included in “Other (income) expense, net” in our consolidated statements of income for the year ended December 31, 2021. During 2021, Premier declared annual cash dividends of $.78 per share paid on a quarterly basis. Additionally, during 2020, Premier declared a quarterly cash dividend during each of the third and fourth quarters of $0.19 per share per quarter. Our share of the dividends for the years ended December 31, 2021 and 2020 are approximately $1.7 million and $800,000, respectively, and are included in “Other (income) expense, net” in our condensed consolidated statements of income for the years ended December 31, 2021 and 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 Executive Chairman and he acts as trustee of certain trusts for the benefit of our Executive Chairman and his family.

Revenue Recognition

12 Months Ended

Dec. 31, 2021

Revenue From Contract With Customer [Abstract]

Revenue Recognition

10) REVENUE RECOGNITION

The company recognizes revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. Our estimate for amounts not expected to be collected based on historical experience will continue to be recognized as a reduction to net revenue. However,

subsequent changes in estimate of collectability due to a change in the financial status of a payer, for example a bankruptcy, will be recognized as bad debt expense in operating charges.

The performance obligation is separately identifiable from other promises in the customer contract. As the performance obligations are met (i.e.: room, board, ancillary services, level of care), revenue is recognized based upon allocated transaction price. 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 years ended December 31, 2021, 2020 and 2019 (in thousands):

	For the year ended December 31, 2021
	Acute Care				Behavioral Health				Other		Total
Medicare	$	1,292,205	18	%	$	361,914	7	%			$	1,654,119	13	%
Managed Medicare		1,118,901	16	%		244,061	4	%				1,362,962	11	%
Medicaid		539,741	8	%		751,951	14	%				1,291,692	10	%
Managed Medicaid		618,727	9	%		1,328,536	24	%				1,947,263	15	%
Managed Care (HMO and PPOs)		2,521,089	35	%		1,435,938	26	%				3,957,027	31	%
UK Revenue		0	0	%		687,725	12	%				687,725	5	%
Other patient revenue and adjustments, net		358,458	5	%		484,742	9	%				843,200	7	%
Other non-patient revenue		659,133	9	%		208,777	4	%		30,219		898,129	7	%
Total Net Revenue	$	7,108,254	100	%	$	5,503,644	100	%	$	30,219		12,642,117	100	%

	For the year ended December 31, 2020
	Acute Care				Behavioral Health				Other		Total
Medicare	$	1,242,268	20	%	$	448,323	9	%			$	1,690,591	15	%
Managed Medicare		869,488	14	%		235,442	5	%				1,104,930	10	%
Medicaid		551,551	9	%		651,081	12	%				1,202,632	10	%
Managed Medicaid		491,234	8	%		1,224,205	24	%				1,715,439	15	%
Managed Care (HMO and PPOs)		2,146,018	34	%		1,280,919	25	%				3,426,937	30	%
UK Revenue		0	0	%		584,000	11	%				584,000	5	%
Other patient revenue and adjustments, net		248,047	4	%		497,297	10	%				745,344	6	%
Other non-patient revenue (a)		788,698	12	%		287,455	6	%		12,871		1,089,024	9	%
Total Net Revenue	$	6,337,304	100	%	$	5,208,722	100	%	$	12,871		11,558,897	100	%

	For the year ended December 31, 2019
	Acute Care				Behavioral Health				Other		Total
Medicare	$	1,336,200	22	%	$	553,045	11	%			$	1,889,245	17	%
Managed Medicare		827,216	13	%		220,543	4	%				1,047,759	9	%
Medicaid		519,508	8	%		688,141	13	%				1,207,649	11	%
Managed Medicaid		560,029	9	%		1,118,612	21	%				1,678,641	15	%
Managed Care (HMO and PPOs)		2,271,002	37	%		1,363,815	26	%				3,634,817	32	%
UK Revenue		0	0	%		553,831	11	%				553,831	5	%
Other patient revenue and adjustments, net		191,422	3	%		505,144	10	%				696,566	6	%
Other non-patient revenue		459,183	7	%		206,932	4	%		3,636		669,751	6	%
Total Net Revenue	$	6,164,560	100	%	$	5,210,063	100	%	$	3,636		11,378,259	100	%

(a) The 2020 other non-patient revenue includes Acute Care CARES Act and other grant revenue of $316 million and Behavioral Health CARES Act and other grant revenue of $97 million. As an accounting policy election, we have utilized ASC 958 by analogy to recognize funds received under the CARES Act from the Provider Relief Fund as revenue, given no direct authoritative guidance

available to for-profit organizations to recognize revenue for government contributions and grants. CARES Act revenues may be subject to future adjustments based on future changes to statutes.

- 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
-SubTopic 10
-Section 50
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130556-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 9
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130550-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 15
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130558-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

+ Details

Pension Plan

12 Months Ended

Dec. 31, 2021

Compensation And Retirement Disclosure [Abstract]

Pension Plan

11) PENSION PLAN

We maintain contributory and non-contributory retirement plans for eligible employees. Our contributions to the contributory plan amounted to $69.8 million, $67.1 million and $56.3 million in 2021, 2020 and 2019, respectively. The non-contributory plan is a defined benefit pension plan which covers employees of one of our subsidiaries. The benefits are based on years of service and the employee’s highest compensation for any five years of employment. Our funding policy is to contribute annually at least the minimum amount that should be funded in accordance with the provisions of ERISA.

For defined benefit pension plans, the benefit obligation is the “projected benefit obligation”, the actuarial present value, as of December 31 measurement date, of all benefits attributed by the pension benefit formula to employee service rendered to that date. The amount of benefit to be paid depends on a number of future events incorporated into the pension benefit formula, including estimates of the average life of employees/survivors and average years of service rendered. It is measured based on assumptions concerning future interest rates and future compensation levels. The following table shows the reconciliation of the defined benefit pension plan as of December 31, 2021 and 2020:

	2021			2020
	(000s)
Change in plan assets:
Fair value of plan assets at beginning of year	$	131,685		$	120,287
Actual return (loss) on plan assets		2,771			18,169
Benefits paid		(6,389	)		(6,260	)
Administrative expenses		(707	)		(511	)
Fair value of plan assets at end of year	$	127,360		$	131,685
Change in benefit obligation:
Benefit obligation at beginning of year	$	123,237		$	117,556
Service cost	$	546		$	615
Interest cost	$	2,493		$	3,357
Benefits paid	$	(6,389	)	$	(6,260	)
Actuarial (gain) loss	$	(3,853	)	$	7,969
Benefit obligation at end of year	$	116,034		$	123,237
Amounts recognized in the Consolidated Balance Sheet:
Other non-current assets	$	11,327		$	8,449
Total amounts recognized at end of year	$	11,327		$	8,449

	2021			2020			2019
	(000s)
Components of net periodic cost (benefit)
Service cost	$	546		$	615		$	725
Interest cost		2,493			3,357			4,237
Expected return on plan assets		(4,490	)		(5,261	)		(4,558	)
Amortization of actuarial loss		—			—			1,533
Net periodic cost	$	(1,451	)	$	(1,289	)	$	1,937

	2021	2020
Measurement Dates
Benefit obligations	12/31/2021	12/31/2020
Fair value of plan assets	12/31/2021	12/31/2020

	2021			2020
Weighted average assumptions as of December 31
Discount rate		2.52	%		2.08	%
Rate of compensation increase		4.00	%		4.00	%

	2021			2020			2019
Weighted-average assumptions for net periodic benefit cost calculations
Discount rate		2.08	%		2.94	%		4.03	%
Expected long-term rate of return on plan assets		3.50	%		4.50	%		4.50	%
Rate of compensation increase		4.00	%		4.00	%		4.00	%

The “accumulated benefit obligation” for our pension plan represents the actuarial present value of benefits based on employee service and compensation as of a certain date and does not include an assumption about future compensation levels. The accumulated benefit obligation for our plan was $116.0 million and $123.2 million as of December 31, 2021 and 2020, respectively. The fair value of plan assets exceeded the accumulated benefit obligation by $11.3 million and $8.4 million as of December 31, 2021 and 2020, respectively.

We estimate that there will be no net loss or prior service cost amortized from accumulated other comprehensive income during 2022.

The market values of our pension plan assets at December 31, 2021 and December 31, 2020, reported using net asset value as a practical expedient, by asset category are as follows:

	2021		2020
Equities:
U.S. Large Cap	$	7,306	$	10,946
U.S. Mid Cap	$	2,014	$	3,403
U.S. Small Cap	$	1,913	$	3,581
International Developed	$	5,062	$	8,315
Emerging Markets	$	3,152	$	5,631
Fixed income:
Core Fixed Income	$	22,904	$	27,782
Long Duration Fixed Income	$	84,277	$	68,886
Real Estate:
REIT Fund	$	—	$	2,474
Cash/Currency:
Cash Equivalents	$	732	$	667
Total market value	$	127,360	$	131,685

To develop the expected long-term rate of return on plan assets assumption, we considered the historical returns and the future expectations for returns for each asset class, as well as the target asset allocation of the pension portfolio.

The following table shows expected benefit payments for the years 2022 through 2031 for our defined pension plan. There will be benefit payments under this plan beyond 2031.

Estimated Future Benefit Payments (000s)
2022	$	6,994
2023		7,056
2024		7,057
2025		7,029
2026		6,973
2027-2031		33,438
Total	$	68,547

	2021			2020
Plan Assets
Asset Category
Equity securities		15	%		24	%
Fixed income securities		84	%		73	%
Other		1	%		3	%
Total		100	%		100	%

Investment Policy, Guidelines and Objectives have been established for the defined benefit pension plan. The investment policy is in keeping with the fiduciary requirements under existing federal laws and managed in accordance with the Prudent Investor Rule.

Total portfolio risk is regularly evaluated and compared to that of the plan’s policy target allocation and judged on a relative basis over a market cycle. The following asset allocation policy and ranges have been established in accordance with the overall risk and return objectives of the portfolio:

	As of 12/31/2021			Permitted Range
Total Equity		15	%	10-30%
Total Fixed Income		84	%	70-90%
Other		1	%	0-10%

In accordance with the investment policy, the portfolio will invest in high quality, large and small capitalization companies traded on national exchanges, and investment grade securities. The investment managers will not write or buy options for speculative purposes; securities may not be margined or sold short. The manager may employ futures or options for the purpose of hedging exposure, and will not purchase unregistered sectors, private placements, partnerships or commodities.

- Definition

The entire disclosure for retirement benefits.

+ References

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+ Details

Segment Reporting

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Segment Reporting

12) SEGMENT REPORTING

Our reportable operating segments consist of acute care hospital services and behavioral health care services. The “Other” segment column below includes centralized services including, but not limited to, information technology, purchasing, reimbursement, accounting and finance, taxation, legal, advertising and design and construction. The chief operating decision making group for our acute care services and behavioral health care services is comprised of our Chief Executive Officer and the Presidents of each operating segment. The Presidents for each operating segment also manage the profitability of each respective segment’s various facilities. The operating segments are managed separately because each operating segment represents a business unit that offers different types of healthcare services or operates in different healthcare environments. The accounting policies of the operating segments are the same as those described in the summary of significant accounting policies included in Note 1-Business and Summary of Significant Accounting Policies. 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, based upon each segment’s respective percentage of total operating expenses.

2021	Acute Care Hospital Services			Behavioral Health Services (a.)			Other			Total Consolidated
	(Dollar amounts in thousands)
Gross inpatient revenues	$	36,522,155		$	9,927,401		$	—		$	46,449,556
Gross outpatient revenues	$	20,633,921		$	1,013,547		$	—		$	21,647,468
Total net revenues	$	7,108,254		$	5,503,644		$	30,219		$	12,642,117
Income (loss) before allocation of corporate overhead and income taxes	$	734,666		$	1,025,557		$	(466,910	)	$	1,293,313
Allocation of corporate overhead	$	(233,298	)	$	(172,512	)	$	405,810		$	0
Income (loss) after allocation of corporate overhead and before income taxes	$	501,368		$	853,045		$	(61,100	)	$	1,293,313
Total assets	$	5,534,912		$	7,250,427		$	308,204		$	13,093,543

2020	Acute Care Hospital Services			Behavioral Health Services (a.)			Other			Total Consolidated
	(Dollar amounts in thousands)
Gross inpatient revenues	$	30,562,093		$	9,718,934		$	—		$	40,281,027
Gross outpatient revenues	$	16,272,520		$	963,799		$	—		$	17,236,319
Total net revenues	$	6,337,304		$	5,208,722		$	12,871		$	11,558,897
Income (loss) before allocation of corporate overhead and income taxes	$	693,427		$	1,023,257		$	(464,601	)	$	1,252,083
Allocation of corporate overhead	$	(223,921	)	$	(170,849	)	$	394,770		$	0
Income (loss) after allocation of corporate overhead and before income taxes	$	469,506		$	852,408		$	(69,831	)	$	1,252,083
Total assets	$	4,927,456		$	7,044,617		$	1,504,806		$	13,476,879

2019	Acute Care Hospital Services			Behavioral Health Services (a.)			Other			Total Consolidated
	(Dollar amounts in thousands)
Gross inpatient revenues	$	28,430,922		$	10,100,903		$	—		$	38,531,825
Gross outpatient revenues	$	17,666,629		$	1,066,704		$	—		$	18,733,333
Total net revenues	$	6,164,560		$	5,210,063		$	3,636		$	11,378,259
Income (loss) before allocation of corporate overhead and income taxes	$	713,410		$	900,965		$	(548,038	)	$	1,066,337
Allocation of corporate overhead	$	(230,166	)	$	(166,571	)	$	396,737		$	0
Income (loss) after allocation of corporate overhead and before income taxes	$	483,244		$	734,394		$	(151,301	)	$	1,066,337
Total assets	$	4,405,643		$	6,910,790		$	351,817		$	11,668,250

(a.)

Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $688 million in 2021, $584 million in 2020 and $554 million in 2019. Total assets at our U.K. behavioral health care facilities were approximately $1.351 billion as of December 31, 2021, $1.334 billion as of December 31, 2020 and $1.270 billion as of December 31, 2019. In addition, included in our 2019 Behavioral Health Services operating segment Income (loss) before allocation of corporate overhead and income taxes is a pre-tax $98 million provision for asset impairment to reduce the carrying value of a tradename intangible asset and real property assets.

- 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.

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+ Details

Schedule II-Valuation and Qualifying Accounts

12 Months Ended

Dec. 31, 2021

Valuation And Qualifying Accounts [Abstract]

Schedule Of Valuation And Qualifying Accounts

SCHEDULE II—VALUATION AND QUALIFYING ACCOUNTS

(amounts in thousands)

	Balance at		Charges to			Balance
	beginning		costs and			at end
Valuation Allowance for Deferred Tax Assets:	of period		expenses			of period
Year ended December 31, 2021	$	68,003	$	(5,647	)	$	62,356
Year ended December 31, 2020	$	75,277	$	(7,274	)	$	68,003
Year ended December 31, 2019	$	79,264	$	(3,987	)	$	75,277

Business and Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Principles of Consolidation

Revenue Recognition

Charity Care, Uninsured Discounts and Other Adjustments to Revenue

Uncompensated care (charity care and uninsured discounts):

	(dollar amounts in thousands)
	2021					2020					2019
	Amount		%			Amount		%			Amount		%
Charity care	$	661,965		33	%	$	622,668		28	%	$	672,326		31	%
Uninsured discounts		1,336,319		67	%		1,578,470		72	%		1,511,738		69	%
Total uncompensated care	$	1,998,284		100	%	$	2,201,138		100	%	$	2,184,064		100	%

The estimated cost of providing uncompensated care:

	(amounts in thousands)
	2021		2020		2019
Estimated cost of providing charity care	$	72,095	$	73,690	$	77,886
Estimated cost of providing uninsured discounts related care		145,538		186,804		175,128
Estimated cost of providing uncompensated care	$	217,633	$	260,494	$	253,014

Concentration of Revenues

Concentration of Revenues: Our six acute care hospitals in the Las Vegas, Nevada market contributed, on a combined basis, 16% in 2021, 15% in 2020 and 16% in 2019 of our consolidated net revenues.

Cash, Cash Equivalents and Restricted Cash

Cash, Cash Equivalents and Restricted Cash: We consider all highly liquid investments purchased with maturities of three months or less to be cash equivalents.

Cash, cash equivalents, and restricted cash as reported in the consolidated statements of cash flows are presented separately on our consolidated balance sheets as follow:

	(amounts in thousands)
	2021		2020		2019
Cash and cash equivalents	$	115,301	$	1,224,490	$	61,268
Restricted cash (a)		63,633		54,664		44,399
Total cash, cash equivalents and restricted cash	$	178,934	$	1,279,154	$	105,667

(a)Restricted cash is included in other assets on the accompanying consolidated balance sheet and consists of statutorily required capital reserves related to our commercial insurance subsidiary.

Property and Equipment

Long-Lived Assets

Goodwill

Changes in the carrying amount of goodwill for the two years ended December 31, 2021 were as follows (in thousands):

	Acute Care Services			Behavioral Health Services		Total Consolidated
Balance, January 1, 2020	$	448,415		$	3,421,345	$	3,869,760
Goodwill acquired during the period		127			0		127
Goodwill divested during the period		0			0		0
Adjustments to goodwill (a)		(1,521	)		14,349		12,828
Balance, December 31, 2020		447,021			3,435,694		3,882,715
Goodwill acquired during the period		55,406			0		55,406
Goodwill divested during the period		0			0		0
Adjustments to goodwill (b)		13,509			10,994		24,503
Balance, December 31, 2021	$	515,936		$	3,446,688	$	3,962,624

(a)

The changes in the Behavioral Health Services’ goodwill consists primarily of foreign currency translation adjustments.

(b)

Other Assets and Intangible Assets

Provision for Asset Impairment-Foundations Recovery Network:

The following table shows the amounts recorded as net intangible assets for the years ended December 31, 2021 and 2020:

	(amounts in thousands)
	2021		2020
Medicare licenses	$	57,226	$	57,226
Certificates of need		8,239		8,253
Contract relationships and other (net of $54,134 and $52,804 of accumulated amortization for 2021 and 2020, respectively)		15,576		17,107
Net Intangible Assets	$	81,041	$	82,586

Supplies

Supplies: Supplies, which consist primarily of medical supplies, are stated at the lower of cost (first-in, first-out basis) or market.

Self-Insured/Other Insurance Risks

Income Taxes

Other Noncurrent Liabilities

Redeemable Noncontrolling Interests and Noncontrolling Interest

Accumulated Other Comprehensive Income

The amounts recognized in AOCI for the two years ended December 31, 2021 were as follows (in thousands):

	Net Unrealized Gains (Losses) on Effective Cash Flow Hedges			Foreign Currency Translation Adjustment			Minimum Pension Liability			Total AOCI
Balance, January 1, 2020, net of income tax	$	(17	)	$	39,568		$	(7,658	)	$	31,893
2020 activity:
Pretax amount		0			13,619			4,428			18,047
Income tax effect		0			(749	)		(1,071	)		(1,820	)
Change, net of income tax		0			12,870			3,357			16,227
Balance, January 1, 2021, net of income tax		(17	)		52,438			(4,301	)		48,120
2021 activity:
Pretax amount		0			(20,743	)		1,427			(19,316	)
Income tax effect		0			1,829			(342	)		1,487
Change, net of income tax		0			(18,914	)		1,085			(17,829	)
Balance, December 31, 2021, net of income tax	$	(17	)	$	33,524		$	(3,216	)	$	30,291

Accounting for Derivative Financial Investments and Hedging Activities and Foreign Currency Forward Exchange Contracts

Stock-Based Compensation

Earnings Per Share

The following table sets forth the computation of basic and diluted earnings per share, for the periods indicated:

	Twelve Months Ended December 31,
	2021			2020			2019
Basic and diluted:
Net Income	$	987,632		$	952,790		$	827,543
Less: Net (income) loss attributable to noncontrolling interest		3,958			(8,837	)		(12,689	)
Less: Net income attributable to unvested restricted share grants		(2,059	)		(2,981	)		(2,028	)
Net income attributable to UHS—basic and diluted	$	989,531		$	940,972		$	812,826
Basic earnings per share attributable to UHS:
Weighted average number of common shares—basic		82,519			85,061			88,762
Total basic earnings per share	$	11.99		$	11.06		$	9.16
Diluted earnings per share attributable to UHS:
Weighted average number of common shares		82,519			85,061			88,762
Net effect of dilutive stock options and grants based on the treasury stock method		1,173			526			278
Weighted average number of common shares and equivalents—diluted		83,692			85,587			89,040
Total diluted earnings per share	$	11.82		$	10.99		$	9.13

Fair Value of Financial Instruments

Use of Estimates

Mergers and Acquisitions

GPO Agreement/Minority Ownership Interest

Provider Taxes

CARES Act and Other Governmental Grants and Medicare Accelerated Payments

Recent Accounting Standards

Foreign Currency Translation

Business and Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Uncompensated Care

	(dollar amounts in thousands)
	2021					2020					2019
	Amount		%			Amount		%			Amount		%
Charity care	$	661,965		33	%	$	622,668		28	%	$	672,326		31	%
Uninsured discounts		1,336,319		67	%		1,578,470		72	%		1,511,738		69	%
Total uncompensated care	$	1,998,284		100	%	$	2,201,138		100	%	$	2,184,064		100	%

Estimated Cost of Providing Uncompensated Care

	(amounts in thousands)
	2021		2020		2019
Estimated cost of providing charity care	$	72,095	$	73,690	$	77,886
Estimated cost of providing uninsured discounts related care		145,538		186,804		175,128
Estimated cost of providing uncompensated care	$	217,633	$	260,494	$	253,014

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

Cash, cash equivalents, and restricted cash as reported in the consolidated statements of cash flows are presented separately on our consolidated balance sheets as follow:

	(amounts in thousands)
	2021		2020		2019
Cash and cash equivalents	$	115,301	$	1,224,490	$	61,268
Restricted cash (a)		63,633		54,664		44,399
Total cash, cash equivalents and restricted cash	$	178,934	$	1,279,154	$	105,667

(a)Restricted cash is included in other assets on the accompanying consolidated balance sheet and consists of statutorily required capital reserves related to our commercial insurance subsidiary.

Summary of Changes in Carrying Amount of Goodwill

Changes in the carrying amount of goodwill for the two years ended December 31, 2021 were as follows (in thousands):

	Acute Care Services			Behavioral Health Services		Total Consolidated
Balance, January 1, 2020	$	448,415		$	3,421,345	$	3,869,760
Goodwill acquired during the period		127			0		127
Goodwill divested during the period		0			0		0
Adjustments to goodwill (a)		(1,521	)		14,349		12,828
Balance, December 31, 2020		447,021			3,435,694		3,882,715
Goodwill acquired during the period		55,406			0		55,406
Goodwill divested during the period		0			0		0
Adjustments to goodwill (b)		13,509			10,994		24,503
Balance, December 31, 2021	$	515,936		$	3,446,688	$	3,962,624

(a)

The changes in the Behavioral Health Services’ goodwill consists primarily of foreign currency translation adjustments.

(b)

Summary of Net Intangible Assets

The following table shows the amounts recorded as net intangible assets for the years ended December 31, 2021 and 2020:

	(amounts in thousands)
	2021		2020
Medicare licenses	$	57,226	$	57,226
Certificates of need		8,239		8,253
Contract relationships and other (net of $54,134 and $52,804 of accumulated amortization for 2021 and 2020, respectively)		15,576		17,107
Net Intangible Assets	$	81,041	$	82,586

Amounts Recognized in AOCI

The amounts recognized in AOCI for the two years ended December 31, 2021 were as follows (in thousands):

	Net Unrealized Gains (Losses) on Effective Cash Flow Hedges			Foreign Currency Translation Adjustment			Minimum Pension Liability			Total AOCI
Balance, January 1, 2020, net of income tax	$	(17	)	$	39,568		$	(7,658	)	$	31,893
2020 activity:
Pretax amount		0			13,619			4,428			18,047
Income tax effect		0			(749	)		(1,071	)		(1,820	)
Change, net of income tax		0			12,870			3,357			16,227
Balance, January 1, 2021, net of income tax		(17	)		52,438			(4,301	)		48,120
2021 activity:
Pretax amount		0			(20,743	)		1,427			(19,316	)
Income tax effect		0			1,829			(342	)		1,487
Change, net of income tax		0			(18,914	)		1,085			(17,829	)
Balance, December 31, 2021, net of income tax	$	(17	)	$	33,524		$	(3,216	)	$	30,291

Computation of Basic and Diluted Earnings Per Share

The following table sets forth the computation of basic and diluted earnings per share, for the periods indicated:

	Twelve Months Ended December 31,
	2021			2020			2019
Basic and diluted:
Net Income	$	987,632		$	952,790		$	827,543
Less: Net (income) loss attributable to noncontrolling interest		3,958			(8,837	)		(12,689	)
Less: Net income attributable to unvested restricted share grants		(2,059	)		(2,981	)		(2,028	)
Net income attributable to UHS—basic and diluted	$	989,531		$	940,972		$	812,826
Basic earnings per share attributable to UHS:
Weighted average number of common shares—basic		82,519			85,061			88,762
Total basic earnings per share	$	11.99		$	11.06		$	9.16
Diluted earnings per share attributable to UHS:
Weighted average number of common shares		82,519			85,061			88,762
Net effect of dilutive stock options and grants based on the treasury stock method		1,173			526			278
Weighted average number of common shares and equivalents—diluted		83,692			85,587			89,040
Total diluted earnings per share	$	11.82		$	10.99		$	9.13

Financial Instruments and Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2021

Financial Instruments And Fair Value Measurement [Abstract]

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

	Gain/(Loss) recognized in AOCI

	December 31,			December 31,			December 31,
	2021			2020			2019
Cash Flow Hedge relationships
Interest rate swap agreements (a)	$	0		$	0		$	(3,925	)

Net Investment Hedge relationships
Foreign currency foreign exchange contracts	$	(7,272	)	$	(22,097	)	$	(18,328	)

(a)	The amount of gain reclassified out of AOCI into interest expense, net was $3.4 million during 2019.

Summary of Assets and Liabilities Recorded at Fair Value on Recurring Basis

The following tables present the assets and liabilities recorded at fair value on a recurring basis:

	Balance at		Balance Sheet	Basis of Fair Value Measurement
(in thousands)	December 31, 2021		Location	Level 1		Level 2		Level 3
Assets:
Money market mutual funds	$	79,900	Other assets	$	79,900
Certificates of deposit		2,300	Other assets				2,300
Equity securities		91,919	Other assets		91,919
Deferred compensation assets		45,759	Other assets		45,759
Foreign currency exchange contracts		1,357	Other current assets				1,357
	$	221,235		$	217,578	$	3,657		-
Liabilities:
Deferred compensation liability	$	45,759	Other noncurrent liabilities	$	45,759
	$	45,759		$	45,759		-		-

	Balance at		Balance Sheet	Basis of Fair Value Measurement
(in thousands)	December 31, 2020		Location	Level 1		Level 2		Level 3
Assets:
Term Deposits	$	540,000	Cash and cash equivalents			$	540,000
Money market mutual funds		37,100	Cash and cash equivalents		37,100
Money market mutual funds		70,995	Other assets		70,995
Certificates of deposit		2,300	Other assets				2,300
Equity securities		78,367	Other assets		78,367
Deferred compensation assets		42,044	Other assets		42,044
Foreign currency exchange contracts		9,987	Other current assets				9,987
	$	780,793		$	228,506	$	552,287		-
Liabilities:
Deferred compensation liability	$	42,044	Other noncurrent liabilities	$	42,044
	$	42,044		$	42,044		-		-

Long-Term Debt (Tables)

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Summary of Long-Term Debt

A summary of long-term debt follows:

	December 31,
	2021			2020
	(amounts in thousands)
Long-term debt:
Notes and Mortgages payable (including obligations under finance leases of $79,331 in 2021 and $52,905 in 2020) and term loans with varying maturities through 2099; weighted average interest rates of 5.6% in 2021 and 6.8% in 2020 (see Note 7 regarding finance leases)	$	185,027		$	61,638
Tranche A term loan		1,689,375			1,900,000
Revolving credit facility		342,600			—
2.65% Senior Secured Notes due 2030, net of unamortized discount of $1,968 in 2021 and $2,193 in 2020		798,032			797,806
1.65% Senior Secured Notes due 2026, net of unamortized discount of $813 in 2021		699,187			—
2.65% Senior Secured Notes due 2032, net of unamortized discount of $1,254 in 2021		498,746			—
Term Loan B		—			490,000
Accounts receivable securitization program		—			225,000
5.00% Senior Secured Notes due 2026		—			400,000
Total debt before unamortized financing costs		4,212,967			3,874,444
Less-Unamortized financing costs		(22,679	)		(18,193	)
Total debt after unamortized financing costs		4,190,288			3,856,251
Less-Amounts due within one year		(48,409	)		(331,998	)
Long-term debt	$	4,141,879		$	3,524,253

Aggregate Scheduled Maturities of Debt Outstanding

The aggregate scheduled maturities of our total debt outstanding as of December 31, 2021 are as follows:

	(000s)
2022	$	48,409
2023		59,648
2024		92,012
2025		91,274
2026		2,472,172
Later		1,449,452
Total maturities before unamortized financing costs		4,212,967
Less-Unamortized financing costs		(22,679	)
Total	$	4,190,288

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

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+ Details

Common Stock (Tables)

12 Months Ended

Dec. 31, 2021

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

	Additional dollars authorized for repurchase (in thousands)		Total number of shares purchased (a.)		Total number of shares cancelled		Average price paid per share for forfeited restricted shares		Total number of shares purchased as part of publicly announced programs		Average price paid per share for shares purchased as part of publicly announced program		Aggregate purchase price paid (in thousands)		Aggregate purchase price paid for shares purchased as part of publicly announced program		Maximum number of dollars that may yet be purchased under the program (in thousands)
Balance as of January 1, 2019																	$	462,344
2019	$	1,000,000		5,762,409		27,713	$	0.01		5,397,753	$	130.84	$	753,928	$	706,221	$	756,123
2020	$	—		2,050,735		17,779	$	0.01		1,951,899	$	100.70	$	206,719	$	196,560	$	559,563
2021	$	1,000,000		8,559,946		15,761	$	0.01		8,409,721	$	142.85	$	1,220,876	$	1,201,330	$	358,233
Total for three year period ended December 31, 2021	$	2,000,000		16,373,090		61,253	$	0.01		15,759,373	$	133.51	$	2,181,523	$	2,104,111

(a.)

Includes 15,761, 17,779 and, 27,713 of restricted shares that were forfeited by former employees pursuant to the terms of our restricted stock purchase plan during 2021, 2020 and 2019, respectively.

Weighted-Average Assumptions Fair Value of Option Grants

The weighted-average assumptions reflected below were based upon twenty-eight option grants for the five-year period ending December 31, 2021, twenty-nine option grants for the five-year period ending December 31, 2020 and twenty-nine option grants for the five-year period ending December 31, 2019.

Year Ended December 31,	2021			2020			2019
Expected volatility		31	%		28	%		27	%
Risk free Interest rate		2	%		2	%		2	%
Expected life (years)		3.5			3.5			3.4
Forfeiture rate		8	%		8	%		9	%
Dividend yield		0.5	%		0.5	%		0.3	%

Stock Option Activity

The table below summarizes our stock option activity during the year ended December 31, 2021:

Outstanding Options	Number of Shares			Weighted Average Exercise Price
Balance, January 1, 2021		8,238,966		$	109.47
Granted		2,401,402		$	141.08
Exercised		(1,737,286	)	$	116.38
Expired		—		$	—
Cancelled		(346,967	)	$	112.84
Balance, December 31, 2021		8,556,115		$	116.80
Outstanding options vested and exercisable as of December 31, 2021		2,997,296		$	119.00

Information about Unvested Options

The following table provides information about unvested options for the year ended December 31, 2021:

	Shares			Weighted Average Grant Date Fair Value
Unvested options as of January 1, 2021		5,716,060		$	22.74
Granted		2,401,402		$	39.66
Vested		(2,218,647	)	$	24.61
Cancelled		(339,996	)	$	28.70
Unvested options as of December 31, 2021		5,558,819		$	28.93

Information about all Outstanding Options

The following table provides information regarding all options outstanding at December 31, 2021:

	Options Outstanding		Options Exercisable
Number of options outstanding		8,556,115		2,997,296
Weighted average exercise price	$	116.80	$	119.00
Aggregate intrinsic value as of December 31, 2021	$	144,921,069	$	35,394,928
Weighted average remaining contractual life		2.6		1.4

Weighted Average Remaining Contractual Life for Options Outstanding and Weighted Average Exercise Price Per Share for Exercisable Options

The weighted average remaining contractual life for options outstanding and weighted average exercise price per share for exercisable options at December 31, 2019, 2020 and 2021 were as follows:

Year Ended:	Options Outstanding		Weighted Average Exercise Price Per Share		Weighted Average Remaining Contractual Life (in Years)		Exercisable Options		Weighted Average Exercise Price Per Share		Expected to Vest Options		Weighted Average Exercise Price Per Share
	Shares						Shares				Shares
2019		8,133,176		124.52		2.7		2,551,267		119.86		5,073,423		126.62
2020		8,238,966		109.47		2.9		2,522,906		124.62		5,099,823		110.47
2021		8,556,115		116.80		2.6		2,997,296		119.00		5,005,113		116.94

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Components of Income Tax Expense (Benefit)

Components of income tax expense/(benefit) are as follows (amounts in thousands):

	Year Ended December 31,
	2021			2020			2019
Current
Federal	$	276,471		$	268,974		$	225,663
Foreign		13,754			13,978			9,284
State		44,993			43,333			40,152
		335,218			326,285			275,099
Deferred
Federal		(26,638	)		(20,382	)		(27,073	)
Foreign		1,521			(2,496	)		1,874
State		(4,420	)		(4,114	)		(11,106	)
		(29,537	)		(26,992	)		(36,305	)
Total	$	305,681		$	299,293		$	238,794

Reconciliation Between Federal Statutory Rate and Effective Tax Rate

A reconciliation between the federal statutory rate and the effective tax rate is as follows:

	Year Ended December 31,
	2021			2020			2019
Federal statutory rate		21.0	%		21.0	%		21.0	%
State taxes, net of federal income tax benefit		2.5	%		2.5	%		2.2	%
Tax effects of foreign operations		-0.1	%		-0.3	%		-0.3	%
Tax benefit from settlement of employee equity awards		-0.2	%		0.5	%		-1.0	%
Other items		0.3	%		0.4	%		0.8	%
Impact of income attributable to noncontrolling interests		0.1	%		-0.2	%		-0.3	%
Effective tax rate		23.6	%		23.9	%		22.4	%

Components of Deferred Taxes

The components of deferred taxes are as follows (amounts in thousands):

		Year Ended December 31,
		2021							2020
		Assets				Liabilities			Assets				Liabilities
Self-insurance reserves	$		97,024		$			$		75,648		$
Compensation accruals			77,917							71,054
Doubtful accounts and other reserves			127,876							94,295
Other currently non-deductible accrued liabilities			31,240							61,634
Depreciable and amortizable assets							303,079							296,588
Operating lease liabilities			86,652							89,865
Right of use assets-operating leases							86,269							89,493
State and foreign net operating loss carryforwards and other state and foreign deferred tax assets			79,499							81,036
Net pension liabilities – OCI only			1,014							1,356
Other liabilities							3,811							3,697
	$		501,222		$		393,159	$		474,888		$		389,778
Valuation Allowance			(62,356	)			0			(68,003	)			0
Total deferred income taxes	$		438,866		$		393,159	$		406,885		$		389,778

Reconciliation of Unrecognized Tax Benefits

The tabular reconciliation of unrecognized tax benefits for the years ended December 31, 2021, 2020 and 2019 is as follows (amounts in thousands):

	As of December 31,
	2021			2020		2019
Balance at January 1,	$	2,806		$	2,164	$	1,553
Additions based on tax positions related to the current year		500			500		500
Additions for tax positions of prior years		213			142		113
Reductions for tax positions of prior years		(261	)		0		0
Settlements		(714	)		0		(2	)
Balance at December 31,	$	2,544		$	2,806	$	2,164

Lease Commitments (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Components of Lease Expense

The components of lease expense for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands):

	Twelve months ended December 31,
	2021		2020		2019

Operating lease cost	$	77,420	$	73,841	$	72,098
Variable and short term lease cost (a)		41,443		42,218		35,711
Total lease and rental expense	$	118,863	$	116,059	$	107,809

Finance lease cost:
Amortization of property under capital lease	$	3,626	$	1,985	$	1,877
Interest on debt of property under capital lease		4,124		1,763		1,876
Total finance lease cost	$	7,750	$	3,748	$	3,753

(a) Includes equipment, month-to-month and leases with a maturity of less than 12 months.

Supplemental Cash Flow Information Related to Leases

Supplemental cash flow information related to leases for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands):

	Twelve months ended December 31,
	2021		2020		2019

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	118,433	$	115,270	$	107,239
Operating cash flows from finance leases	$	4,612	$	1,885	$	2,078
Financing cash flows from finance leases	$	2,849	$	2,586	$	1,959

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	95,805	$	69,678	$	383,857
Finance leases	$	28,600	$	37,029	$	-

Supplemental Balance Sheet Information Related to Leases

Supplemental balance sheet information related to leases as of December 31, 2021 and 2020 are as follows (in thousands):

	December 31,			December 31,
	2021			2020

Operating Leases
Right of use assets-operating leases	$	367,477		$	336,513

Operating lease liabilities	$	64,484		$	59,796
Operating lease liabilities noncurrent		304,624			278,303
Total operating lease liabilities	$	369,108		$	338,099

Finance Leases
Property and equipment	$	102,940		$	75,611
Accumulated depreciation		(30,949	)		(28,595	)
Property and equipment, net	$	71,991		$	47,016

Current maturities of long-term debt	$	2,740		$	2,060
Long-term debt		76,591			50,845
Total finance lease liabilities	$	79,331		$	52,905

Weighted Average remaining lease term, years
Operating leases		9.1			10.9
Finance leases		20.8			8.1

Weighted Average discount rate
Operating leases		3.8	%		4.4	%
Finance leases		7.1	%		9.7	%

Future Maturities of Lease Liabilities

Future maturities of lease liabilities as of December 31, 2021 are as follows (in thousands):

	Operating Leases			Finance Leases
Year ending December 31,
2022	$	75,790		$	6,809
2023		67,994			6,993
2024		59,354			7,162
2025		52,098			6,047
2026		43,193			6,057
Later years		150,024			110,263
Total lease payments		448,453			143,331
less imputed interest		(79,345	)		(64,000	)
Total	$	369,108		$	79,331

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2021

Commitments And Contingencies Disclosure [Abstract]

Schedule of Changes in General and Professional Liability and Workers Compensation Reserves

Below is a schedule showing the changes in our general and professional liability and workers’ compensation reserves during the three years ended December 31, 2021 (amount in thousands):

	General and
	Professional			Workers’
	Liability			Compensation			Total
Balance at January 1, 2019	$	243,051		$	71,890		$	314,941
Plus: Accrued insurance expense, net of commercial premiums paid		56,452			49,220			105,672
Less: Payments made in settlement of self-insured claims		(57,683	)		(40,106	)		(97,789	)
Balance at January 1, 2020		241,820			81,004			322,824
Plus: Accrued insurance expense, net of commercial premiums paid		91,518			67,705			159,223
Less: Payments made in settlement of self-insured claims		(69,559	)		(43,524	)		(113,083	)
Balance at January 1, 2021		263,779			105,185			368,964
Plus: Accrued insurance expense, net of commercial premiums paid		129,690			56,525			186,215
Less: Payments made in settlement of self-insured claims		(44,776	)		(46,725	)		(91,501	)
Balance at December 31, 2021	$	348,693		$	114,985		$	463,678

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

12 Months Ended

Dec. 31, 2021

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

The table below provides certain details for each of the hospitals leased from the Trust as of January 1, 2022:

Hospital Name	Annual Minimum Rent		End of Lease Term	Renewal Term (years)
McAllen Medical Center	$	5,485,000	December, 2026		5	(a)
Wellington Regional Medical Center	$	6,319,000	December, 2026		5	(b)
Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services	$	3,895,000	December, 2033		35	(c)
Canyon Creek Behavioral Health	$	1,670,000	December, 2033		35	(c)
Clive Behavioral Health Hospital	$	2,628,000	December, 2040		50	(d)

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

(b)

(c)	We have seven 5-year renewal options at fair market value lease rates (2034 through 2068).

(d)

Revenue Recognition (Tables)

12 Months Ended

Dec. 31, 2021

Revenue From Contract With Customer [Abstract]

Schedule of Disaggregates Revenue by Major Source

The following table disaggregates our revenue by major source for the years ended December 31, 2021, 2020 and 2019 (in thousands):

	For the year ended December 31, 2021
	Acute Care				Behavioral Health				Other		Total
Medicare	$	1,292,205	18	%	$	361,914	7	%			$	1,654,119	13	%
Managed Medicare		1,118,901	16	%		244,061	4	%				1,362,962	11	%
Medicaid		539,741	8	%		751,951	14	%				1,291,692	10	%
Managed Medicaid		618,727	9	%		1,328,536	24	%				1,947,263	15	%
Managed Care (HMO and PPOs)		2,521,089	35	%		1,435,938	26	%				3,957,027	31	%
UK Revenue		0	0	%		687,725	12	%				687,725	5	%
Other patient revenue and adjustments, net		358,458	5	%		484,742	9	%				843,200	7	%
Other non-patient revenue		659,133	9	%		208,777	4	%		30,219		898,129	7	%
Total Net Revenue	$	7,108,254	100	%	$	5,503,644	100	%	$	30,219		12,642,117	100	%

	For the year ended December 31, 2020
	Acute Care				Behavioral Health				Other		Total
Medicare	$	1,242,268	20	%	$	448,323	9	%			$	1,690,591	15	%
Managed Medicare		869,488	14	%		235,442	5	%				1,104,930	10	%
Medicaid		551,551	9	%		651,081	12	%				1,202,632	10	%
Managed Medicaid		491,234	8	%		1,224,205	24	%				1,715,439	15	%
Managed Care (HMO and PPOs)		2,146,018	34	%		1,280,919	25	%				3,426,937	30	%
UK Revenue		0	0	%		584,000	11	%				584,000	5	%
Other patient revenue and adjustments, net		248,047	4	%		497,297	10	%				745,344	6	%
Other non-patient revenue (a)		788,698	12	%		287,455	6	%		12,871		1,089,024	9	%
Total Net Revenue	$	6,337,304	100	%	$	5,208,722	100	%	$	12,871		11,558,897	100	%

	For the year ended December 31, 2019
	Acute Care				Behavioral Health				Other		Total
Medicare	$	1,336,200	22	%	$	553,045	11	%			$	1,889,245	17	%
Managed Medicare		827,216	13	%		220,543	4	%				1,047,759	9	%
Medicaid		519,508	8	%		688,141	13	%				1,207,649	11	%
Managed Medicaid		560,029	9	%		1,118,612	21	%				1,678,641	15	%
Managed Care (HMO and PPOs)		2,271,002	37	%		1,363,815	26	%				3,634,817	32	%
UK Revenue		0	0	%		553,831	11	%				553,831	5	%
Other patient revenue and adjustments, net		191,422	3	%		505,144	10	%				696,566	6	%
Other non-patient revenue		459,183	7	%		206,932	4	%		3,636		669,751	6	%
Total Net Revenue	$	6,164,560	100	%	$	5,210,063	100	%	$	3,636		11,378,259	100	%

available to for-profit organizations to recognize revenue for government contributions and grants. CARES Act revenues may be subject to future adjustments based on future changes to statutes.

Pension Plan (Tables)

12 Months Ended

Dec. 31, 2021

Compensation And Retirement Disclosure [Abstract]

Reconciliation of Defined Benefit Pension Plan

The following table shows the reconciliation of the defined benefit pension plan as of December 31, 2021 and 2020:

	2021			2020
	(000s)
Change in plan assets:
Fair value of plan assets at beginning of year	$	131,685		$	120,287
Actual return (loss) on plan assets		2,771			18,169
Benefits paid		(6,389	)		(6,260	)
Administrative expenses		(707	)		(511	)
Fair value of plan assets at end of year	$	127,360		$	131,685
Change in benefit obligation:
Benefit obligation at beginning of year	$	123,237		$	117,556
Service cost	$	546		$	615
Interest cost	$	2,493		$	3,357
Benefits paid	$	(6,389	)	$	(6,260	)
Actuarial (gain) loss	$	(3,853	)	$	7,969
Benefit obligation at end of year	$	116,034		$	123,237
Amounts recognized in the Consolidated Balance Sheet:
Other non-current assets	$	11,327		$	8,449
Total amounts recognized at end of year	$	11,327		$	8,449

Components of Net Periodic Pension Cost (Benefit)

	2021			2020			2019
	(000s)
Components of net periodic cost (benefit)
Service cost	$	546		$	615		$	725
Interest cost		2,493			3,357			4,237
Expected return on plan assets		(4,490	)		(5,261	)		(4,558	)
Amortization of actuarial loss		—			—			1,533
Net periodic cost	$	(1,451	)	$	(1,289	)	$	1,937

Measurement Dates

	2021	2020
Measurement Dates
Benefit obligations	12/31/2021	12/31/2020
Fair value of plan assets	12/31/2021	12/31/2020

Weighted-average Assumptions for Net Periodic Benefit Cost

	2021			2020
Weighted average assumptions as of December 31
Discount rate		2.52	%		2.08	%
Rate of compensation increase		4.00	%		4.00	%

Weighted Average Assumptions

	2021			2020			2019
Weighted-average assumptions for net periodic benefit cost calculations
Discount rate		2.08	%		2.94	%		4.03	%
Expected long-term rate of return on plan assets		3.50	%		4.50	%		4.50	%
Rate of compensation increase		4.00	%		4.00	%		4.00	%

Market Values of Our Pension Plan Assets

The market values of our pension plan assets at December 31, 2021 and December 31, 2020, reported using net asset value as a practical expedient, by asset category are as follows:

	2021		2020
Equities:
U.S. Large Cap	$	7,306	$	10,946
U.S. Mid Cap	$	2,014	$	3,403
U.S. Small Cap	$	1,913	$	3,581
International Developed	$	5,062	$	8,315
Emerging Markets	$	3,152	$	5,631
Fixed income:
Core Fixed Income	$	22,904	$	27,782
Long Duration Fixed Income	$	84,277	$	68,886
Real Estate:
REIT Fund	$	—	$	2,474
Cash/Currency:
Cash Equivalents	$	732	$	667
Total market value	$	127,360	$	131,685

Estimated Future Benefit

There will be benefit payments under this plan beyond 2031.

Estimated Future Benefit Payments (000s)
2022	$	6,994
2023		7,056
2024		7,057
2025		7,029
2026		6,973
2027-2031		33,438
Total	$	68,547

Plan Assets

	2021			2020
Plan Assets
Asset Category
Equity securities		15	%		24	%
Fixed income securities		84	%		73	%
Other		1	%		3	%
Total		100	%		100	%

Asset Allocation Policy and Ranges Established in accordance with Overall Risk and Return Objectives of Portfolio

The following asset allocation policy and ranges have been established in accordance with the overall risk and return objectives of the portfolio:

	As of 12/31/2021			Permitted Range
Total Equity		15	%	10-30%
Total Fixed Income		84	%	70-90%
Other		1	%	0-10%

Segment Reporting (Tables)

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Segment Reporting

2021	Acute Care Hospital Services			Behavioral Health Services (a.)			Other			Total Consolidated
	(Dollar amounts in thousands)
Gross inpatient revenues	$	36,522,155		$	9,927,401		$	—		$	46,449,556
Gross outpatient revenues	$	20,633,921		$	1,013,547		$	—		$	21,647,468
Total net revenues	$	7,108,254		$	5,503,644		$	30,219		$	12,642,117
Income (loss) before allocation of corporate overhead and income taxes	$	734,666		$	1,025,557		$	(466,910	)	$	1,293,313
Allocation of corporate overhead	$	(233,298	)	$	(172,512	)	$	405,810		$	0
Income (loss) after allocation of corporate overhead and before income taxes	$	501,368		$	853,045		$	(61,100	)	$	1,293,313
Total assets	$	5,534,912		$	7,250,427		$	308,204		$	13,093,543

2020	Acute Care Hospital Services			Behavioral Health Services (a.)			Other			Total Consolidated
	(Dollar amounts in thousands)
Gross inpatient revenues	$	30,562,093		$	9,718,934		$	—		$	40,281,027
Gross outpatient revenues	$	16,272,520		$	963,799		$	—		$	17,236,319
Total net revenues	$	6,337,304		$	5,208,722		$	12,871		$	11,558,897
Income (loss) before allocation of corporate overhead and income taxes	$	693,427		$	1,023,257		$	(464,601	)	$	1,252,083
Allocation of corporate overhead	$	(223,921	)	$	(170,849	)	$	394,770		$	0
Income (loss) after allocation of corporate overhead and before income taxes	$	469,506		$	852,408		$	(69,831	)	$	1,252,083
Total assets	$	4,927,456		$	7,044,617		$	1,504,806		$	13,476,879

2019	Acute Care Hospital Services			Behavioral Health Services (a.)			Other			Total Consolidated
	(Dollar amounts in thousands)
Gross inpatient revenues	$	28,430,922		$	10,100,903		$	—		$	38,531,825
Gross outpatient revenues	$	17,666,629		$	1,066,704		$	—		$	18,733,333
Total net revenues	$	6,164,560		$	5,210,063		$	3,636		$	11,378,259
Income (loss) before allocation of corporate overhead and income taxes	$	713,410		$	900,965		$	(548,038	)	$	1,066,337
Allocation of corporate overhead	$	(230,166	)	$	(166,571	)	$	396,737		$	0
Income (loss) after allocation of corporate overhead and before income taxes	$	483,244		$	734,394		$	(151,301	)	$	1,066,337
Total assets	$	4,405,643		$	6,910,790		$	351,817		$	11,668,250

(a.)

Business and Summary of Significant Accounting Policies - Additional Information (Detail) shares in Millions		3 Months Ended	12 Months Ended
	Oct. 01, 2021 USD ($)	Dec. 31, 2013	Dec. 31, 2021 USD ($) Hospital Facility shares	Dec. 31, 2020 USD ($) Hospital shares	Dec. 31, 2019 USD ($) Hospital shares
Summary Of Business And Significant Accounting Policies [Line Items]
Effect of change on after-tax net income			$ 987,632,000	$ 952,790,000	$ 827,543,000
Number of hospital facilities \| Hospital			5
Capitalized interest			$ 4,400,000	4,300,000	3,400,000
Depreciation expense			501,600,000	478,800,000	455,600,000
Impairment of goodwill or indefinite-lived intangible assets	$ 0			0	0
Impairment of other and intangible assets				0
Provision for asset impairment			$ 14,391,000	0	$ 97,631,000
Behavioral health care facilities with outside owners holding non-controlling minority interest \| Facility			5
Redeemable non-controlling interest balances			$ 5,000,000
Non-controlling interest balances			103,000,000
Cash flow hedges			$ 0	$ 0
Anti-dilutive weighted average stock options excluded from computation of earnings per share \| shares			4.2	6.4	5.5
Revenues			$ 12,642,117,000	$ 11,558,897,000	$ 11,378,259,000
Additional funds received from government by CARES Act			189,000,000
CARES Act and other Governmental grants and Medicare accelerated payments received				1,112,000,000
Revenues from grants				413,000,000
Deferred revenues from grants				4,000,000
MAAPP funds included in current liabilities			6,000	376,151,000
MAAPP funds included in noncurrent liabilities			0	322,617,000
Medicare Accelerated and Advance Payment Program
Summary Of Business And Significant Accounting Policies [Line Items]
Medicare accelerated payments received			695,000,000	695,000,000
MAAPP funds included in current liabilities				372,000,000
MAAPP funds included in noncurrent liabilities				323,000,000
Public Health and Social Services Emergency Fund
Summary Of Business And Significant Accounting Policies [Line Items]
Governmental grants received by CARES Act				417,000,000
Foundations
Summary Of Business And Significant Accounting Policies [Line Items]
Provision for asset impairment					98,000,000
Impairment provision for tradename intangible asset					75,000,000
Impairment charges for real property assets					$ 23,000,000
Other (Income) Expense, Net
Summary Of Business And Significant Accounting Policies [Line Items]
Provision for asset impairment			14,000,000
Commercial Insurance Subsidiary
Summary Of Business And Significant Accounting Policies [Line Items]
Statutorily required capital reserves			$ 82,000,000	$ 73,000,000
Universal Health Realty Income Trust
Summary Of Business And Significant Accounting Policies [Line Items]
Number of hospital facilities \| Hospital			3	3	3
Investments			$ 9,000,000	$ 5,000,000
Premier, Inc.
Summary Of Business And Significant Accounting Policies [Line Items]
Investments			92,000,000	78,000,000
Premier, Inc. \| Group Purchasing Organization Agreement \| Restricted Stock
Summary Of Business And Significant Accounting Policies [Line Items]
Shares vesting period		7 years
Shares vesting period start year		2014
Shares vesting period end year		2020
Market value of retained vested shares			92,000,000	78,000,000
Acute Care Hospital Services
Summary Of Business And Significant Accounting Policies [Line Items]
Revenues			$ 7,108,254,000	6,337,304,000	$ 6,164,560,000
Acute Care Hospital Services \| Las Vegas, Nevada
Summary Of Business And Significant Accounting Policies [Line Items]
Number of hospital facilities \| Hospital			6
Acute Care Facility \| Washington, District of Columbia \| Outside Owners
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners			20.00%
Acute Care Facility \| Texas \| Outside Owners
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners			9.00%
Acute Care Facility \| Nevada \| Outside Owners
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners			5.00%
Behavioral Health Care Facility \| Pennsylvania \| Outside Owners
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners			20.00%
Behavioral Health Care Facility \| Ohio \| Outside Owners
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners			30.00%
Behavioral Health Care Facility \| Washington \| Outside Owners
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners			20.00%
Behavioral Health Care Facility \| Missouri \| Outside Owners
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners			25.00%
Behavioral Health Care Facility \| Lowa \| Outside Owners
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners			48.00%
State Medicaid programs
Summary Of Business And Significant Accounting Policies [Line Items]
Revenue offset amount			$ 211,000,000	185,000,000	194,000,000
Net aggregate benefit			430,000,000	303,000,000	225,000,000
Net revenues			$ 74,000,000	$ 73,000,000	$ 78,000,000
Net Revenue \| Las Vegas, Nevada \| Geographic Concentration Risk
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of revenue			16.00%	15.00%	16.00%
Minimum
Summary Of Business And Significant Accounting Policies [Line Items]
Patients treated at hospitals for non elective services gross income federal poverty guidelines			200.00%
Minimum \| Building and Building Improvements
Summary Of Business And Significant Accounting Policies [Line Items]
Property and equipment, useful lives			20 years
Minimum \| Equipment
Summary Of Business And Significant Accounting Policies [Line Items]
Property and equipment, useful lives			3 years
Maximum
Summary Of Business And Significant Accounting Policies [Line Items]
Patients treated at hospitals for non elective services gross income federal poverty guidelines			400.00%
Maximum \| Building and Building Improvements
Summary Of Business And Significant Accounting Policies [Line Items]
Property and equipment, useful lives			40 years
Maximum \| Equipment
Summary Of Business And Significant Accounting Policies [Line Items]
Property and equipment, useful lives			15 years
Medicare
Summary Of Business And Significant Accounting Policies [Line Items]
Revenues			$ 1,654,119,000	$ 1,690,591,000	$ 1,889,245,000
Medicare \| Acute Care Hospital Services
Summary Of Business And Significant Accounting Policies [Line Items]
Revenues			1,292,205,000	1,242,268,000	1,336,200,000
Health Care \| State Medicaid programs
Summary Of Business And Significant Accounting Policies [Line Items]
Revenues			641,000,000	$ 488,000,000	$ 419,000,000
ASU 2014-09 \| Revision of Prior Period Change in Accounting Principle Adjustment
Summary Of Business And Significant Accounting Policies [Line Items]
Effect of change on after-tax net income			$ 1,000,000
ASU 2014-09 \| Medicare
Summary Of Business And Significant Accounting Policies [Line Items]
Percentage of estimated net revenue adjustment			1.00%	1.00%	1.00%
ASU 2016-01 \| Premier, Inc. \| Other (Income) Expense, Net
Summary Of Business And Significant Accounting Policies [Line Items]
Payments of cash dividends			$ 1,700,000	$ 848,000

Uncompensated Care (Detail) - USD ($) $ in Thousands	12 Months Ended
Uncompensated Care (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Health Care Trust Funds [Line Items]
Total uncompensated care	$ 1,998,284	$ 2,201,138	$ 2,184,064
Uncompensated care, percentage	100.00%	100.00%	100.00%
Charity Care
Health Care Trust Funds [Line Items]
Total uncompensated care	$ 661,965	$ 622,668	$ 672,326
Uncompensated care, percentage	33.00%	28.00%	31.00%
Uninsured Discounts
Health Care Trust Funds [Line Items]
Total uncompensated care	$ 1,336,319	$ 1,578,470	$ 1,511,738
Uncompensated care, percentage	67.00%	72.00%	69.00%

Estimated Cost of Providing Uncompensated Care (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Health Care Trust Funds [Line Items]
Estimated cost of providing uncompensated care	$ 217,633	$ 260,494	$ 253,014
Charity Care
Health Care Trust Funds [Line Items]
Estimated cost of providing uncompensated care	72,095	73,690	77,886
Uninsured Discounts
Health Care Trust Funds [Line Items]
Estimated cost of providing uncompensated care	$ 145,538	$ 186,804	$ 175,128

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

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

Cash And Cash Equivalents Period Increase Decrease [Abstract]

Cash and cash equivalents

$ 115,301

$ 1,224,490

$ 61,268

Restricted cash

^[1]

$ 63,633

$ 54,664

$ 44,399

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

Other Assets

Total cash, cash equivalents and restricted cash

$ 178,934

$ 1,279,154

$ 105,667

[1]	(a)Restricted cash is included in other assets on the accompanying consolidated balance sheet and consists of statutorily required capital reserves related to our commercial insurance subsidiary.

Summary of Changes in Carrying Amount of Goodwill (Detail) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2021

Dec. 31, 2020

Goodwill [Line Items]

Goodwill, Beginning Balance

$ 3,882,715

$ 3,869,760

Goodwill acquired during the period

55,406

127

Goodwill divested during the period

Adjustments to goodwill

24,503

^[1]

12,828

^[2]

Goodwill, Ending Balance

3,962,624

3,882,715

Acute Care Services

Goodwill [Line Items]

Goodwill, Beginning Balance

447,021

448,415

Goodwill acquired during the period

55,406

127

Goodwill divested during the period

Adjustments to goodwill

13,509

^[1]

(1,521)

^[2]

Goodwill, Ending Balance

515,936

447,021

Behavioral Health Services

Goodwill [Line Items]

Goodwill, Beginning Balance

3,435,694

3,421,345

Goodwill acquired during the period

Goodwill divested during the period

Adjustments to goodwill

10,994

^[1]

14,349

^[2]

Goodwill, Ending Balance

$ 3,446,688

$ 3,435,694

[1]

[2]

The changes in the Behavioral Health Services’ goodwill consists primarily of foreign currency translation adjustments.

Summary of Changes in Carrying Amount of Goodwill (Parenthetical) (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2021 USD ($)
Acute Care Services \| 2020 Acquisition
Goodwill [Line Items]
Adjustments to goodwill	$ 13.5
Behavioral Health Services
Goodwill [Line Items]
Adjustments to goodwill	11.0
Behavioral Health Services \| Foreign Currency Translation Adjustments
Goodwill [Line Items]
Adjustments to goodwill	(5.3)
Behavioral Health Services \| Third Party Minority Ownership Interest
Goodwill [Line Items]
Adjustments to goodwill	$ 16.3

Summary of Net Intangible Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Finite Lived Intangible Assets [Line Items]
Net Intangible Assets	$ 81,041	$ 82,586
Medicare Licenses
Finite Lived Intangible Assets [Line Items]
Net Intangible Assets	57,226	57,226
Certificates of Need
Finite Lived Intangible Assets [Line Items]
Net Intangible Assets	8,239	8,253
Contract Relationships and Other
Finite Lived Intangible Assets [Line Items]
Net Intangible Assets	$ 15,576	$ 17,107

Summary of Net Intangible Assets (Parenthetical) (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Goodwill And Intangible Assets Disclosure [Abstract]
Intangible assets, net of accumulated amortization	$ 54,134	$ 52,804

Amounts Recognized in AOCI (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning balance, net of income tax	$ 6,317,146
Other comprehensive income (loss), Pretax amount	(19,316)	$ 18,047	$ 32,464
Other comprehensive income (loss), Income tax effect	1,487	(1,820)	(4,813)
Total other comprehensive income (loss), net of tax	(17,829)	16,227	27,651
Ending balance, net of income tax	6,089,664	6,317,146
Net Unrealized Gains (Losses) on Effective Cash Flow Hedges
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning balance, net of income tax	(17)	(17)
Other comprehensive income (loss), Pretax amount	0	0
Other comprehensive income (loss), Income tax effect	0	0
Total other comprehensive income (loss), net of tax	0	0
Ending balance, net of income tax	(17)	(17)	(17)
Foreign Currency Translation Adjustment
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning balance, net of income tax	52,438	39,568
Other comprehensive income (loss), Pretax amount	(20,743)	13,619
Other comprehensive income (loss), Income tax effect	1,829	(749)
Total other comprehensive income (loss), net of tax	(18,914)	12,870
Ending balance, net of income tax	33,524	52,438	39,568
Minimum Pension Liability
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning balance, net of income tax	(4,301)	(7,658)
Other comprehensive income (loss), Pretax amount	1,427	4,428
Other comprehensive income (loss), Income tax effect	(342)	(1,071)
Total other comprehensive income (loss), net of tax	1,085	3,357
Ending balance, net of income tax	(3,216)	(4,301)	(7,658)
Accumulated Other Comprehensive Income (Loss)
Accumulated Other Comprehensive Income Loss [Line Items]
Beginning balance, net of income tax	48,120	31,893
Ending balance, net of income tax	$ 30,291	$ 48,120	$ 31,893

- Definition

Amount before tax, after reclassification adjustments of other comprehensive income (loss).

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=124431353&loc=SL124442411-227067

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 830
-SubTopic 30
-Section 45
-Paragraph 20
-URI http://asc.fasb.org/extlink&oid=118261656&loc=d3e32211-110900

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 830
-SubTopic 30
-Section 50
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=6450520&loc=d3e32583-110901

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Amount after tax and reclassification adjustments of other comprehensive income (loss).

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- Definition

Amount of tax expense (benefit) allocated to other comprehensive income (loss).

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- Definition

Total of all stockholders' equity (deficit) items, net of receivables from officers, directors, owners, and affiliates of the entity which are attributable to the parent. The amount of the economic entity's stockholders' equity attributable to the parent excludes the amount of stockholders' equity which is allocable to that ownership interest in subsidiary equity which is not attributable to the parent (noncontrolling interest, minority interest). This excludes temporary equity and is sometimes called permanent equity.

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+ Details

Computation of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Basic and diluted:
Net Income	$ 987,632	$ 952,790	$ 827,543
Less: Net (income) loss attributable to noncontrolling interest	3,958	(8,837)	(12,689)
Less: Net income attributable to unvested restricted share grants	(2,059)	(2,981)	(2,028)
Net income attributable to UHS—basic and diluted	$ 989,531	$ 940,972	$ 812,826
Basic earnings per share attributable to UHS:
Weighted average number of common shares—basic	82,519	85,061	88,762
Total basic earnings per share	$ 11.99	$ 11.06	$ 9.16
Diluted earnings per share attributable to UHS:
Weighted average number of common shares—basic	82,519	85,061	88,762
Net effect of dilutive stock options and grants based on the treasury stock method	1,173	526	278
Weighted average number of common shares and equivalents—diluted	83,692	85,587	89,040
Total diluted earnings per share	$ 11.82	$ 10.99	$ 9.13

Acquisitions and Divestitures - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Aggregate cash proceeds from divestiture of businesses	$ 25
2020 Divestiture of Assets and Businesses
Business Acquisition [Line Items]
Aggregate cash proceeds from divestiture of businesses		$ 8
2019 Divestiture of Assets
Business Acquisition [Line Items]
Aggregate cash proceeds from divestiture of businesses			$ 9
2019 Acquisitions of Assets and Businesses
Business Acquisition [Line Items]
Acquisition, cash paid			$ 8
Nevada
Business Acquisition [Line Items]
Acquisition, cash paid	$ 105
Nevada \| 2020 Acquisitions of Assets and Businesses
Business Acquisition [Line Items]
Acquisition, cash paid		$ 52

Financial Instruments and Fair Value Measurement - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($) Derivative
Financial Instruments And Fair Value Measurement [Line Items]
Cash flow hedges	$ 0	$ 0
Cash and cash equivalents		577,000,000
Other cash accounts		$ 581,000,000
Minimum
Financial Instruments And Fair Value Measurement [Line Items]
Other cash accounts, variable interest rates		0.20%
Maximum
Financial Instruments And Fair Value Measurement [Line Items]
Other cash accounts, variable interest rates		0.25%
One Point Three One Percent Forward Starting Interest Rate Swaps
Financial Instruments And Fair Value Measurement [Line Items]
Number of interest rate swaps outstanding \| Derivative			9
Maturity date of interest rate cash flow hedges			Apr. 15, 2019
Fixed rate payable on interest rate swap			1.31%
Foreign Currency Forward Exchange Contracts
Financial Instruments And Fair Value Measurement [Line Items]
Net cash (outflows) inflows	$ 1,000,000	$ (22,000,000)	$ 20,000,000
Cash Flow Hedging \| One Point Three One Percent Forward Starting Interest Rate Swaps
Financial Instruments And Fair Value Measurement [Line Items]
Notional amount of interest rate cash flow hedges			$ 1,000,000,000.0

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

12 Months Ended

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

Derivative Instruments Gain Loss [Line Items]

Gain/(Loss) recognized in AOCI

$ 0

$ (3,925)

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

Derivative Instruments Gain Loss [Line Items]

Gain/(Loss) recognized in AOCI

^[1]

(3,925)

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

Derivative Instruments Gain Loss [Line Items]

Gain/(Loss) recognized in AOCI

$ (7,272)

$ (22,097)

$ (18,328)

[1]	The amount of gain reclassified out of AOCI into interest expense, net was $3.4 million during 2019.

Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations (Parenthetical) (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2019 USD ($)
Designated As Hedging Instrument \| Interest Expense, Net \| Cash Flow Hedging \| Interest Rate Swap
Derivative Instruments Gain Loss [Line Items]
Gain reclassified out of AOCI into interest expenses	$ 3.4

Summary of Assets and Liabilities Recorded at Fair Value on Recurring Basis (Detail) - Recurring - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Assets:
Assets, fair value	$ 221,235	$ 780,793
Liabilities:
Liabilities, fair value	45,759	42,044
Term Deposit \| Cash and Cash Equivalents
Assets:
Assets, fair value		540,000
Money Market Mutual Funds \| Cash and Cash Equivalents
Assets:
Assets, fair value		37,100
Money Market Mutual Funds \| Other Assets
Assets:
Assets, fair value	79,900	70,995
Certificates of Deposit \| Other Assets
Assets:
Assets, fair value	2,300	2,300
Equity Securities \| Other Assets
Assets:
Assets, fair value	91,919	78,367
Deferred Compensation Assets \| Other Assets
Assets:
Assets, fair value	45,759	42,044
Foreign Currency Foreign Exchange Contracts \| Other Current Assets
Assets:
Assets, fair value	1,357	9,987
Deferred Compensation Liability \| Other Noncurrent Liabilities
Liabilities:
Liabilities, fair value	45,759	42,044
Basis of Fair Value Measurement, Level 1
Assets:
Assets, fair value	217,578	228,506
Liabilities:
Liabilities, fair value	45,759	42,044
Basis of Fair Value Measurement, Level 1 \| Money Market Mutual Funds \| Cash and Cash Equivalents
Assets:
Assets, fair value		37,100
Basis of Fair Value Measurement, Level 1 \| Money Market Mutual Funds \| Other Assets
Assets:
Assets, fair value	79,900	70,995
Basis of Fair Value Measurement, Level 1 \| Equity Securities \| Other Assets
Assets:
Assets, fair value	91,919	78,367
Basis of Fair Value Measurement, Level 1 \| Deferred Compensation Assets \| Other Assets
Assets:
Assets, fair value	45,759	42,044
Basis of Fair Value Measurement, Level 1 \| Deferred Compensation Liability \| Other Noncurrent Liabilities
Liabilities:
Liabilities, fair value	45,759	42,044
Basis of Fair Value Measurement, Level 2
Assets:
Assets, fair value	3,657	552,287
Basis of Fair Value Measurement, Level 2 \| Term Deposit \| Cash and Cash Equivalents
Assets:
Assets, fair value		540,000
Basis of Fair Value Measurement, Level 2 \| Certificates of Deposit \| Other Assets
Assets:
Assets, fair value	2,300	2,300
Basis of Fair Value Measurement, Level 2 \| Foreign Currency Foreign Exchange Contracts \| Other Current Assets
Assets:
Assets, fair value	$ 1,357	$ 9,987

Summary of Long-Term Debt (Detail) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Accounts receivable securitization program	$ 0
Total debt before unamortized financing costs	4,212,967,000	$ 3,874,444,000
Less-Unamortized financing costs	(22,679,000)	(18,193,000)
Total debt after unamortized financing costs	4,190,288,000	3,856,251,000
Less-Amounts due within one year	(48,409,000)	(331,998,000)
Long-term debt	4,141,879,000	3,524,253,000
Tranche A Term Loan
Debt Instrument [Line Items]
Line of credit facility amount outstanding	1,689,375,000	1,900,000,000
Revolving Credit Facility
Debt Instrument [Line Items]
Line of credit facility amount outstanding	342,600,000
Term Loan B
Debt Instrument [Line Items]
Line of credit facility amount outstanding		490,000,000
1.65% Senior Secured Notes due 2026
Debt Instrument [Line Items]
Senior Notes	699,187,000
Accounts Receivable Securitization Program
Debt Instrument [Line Items]
Accounts receivable securitization program		225,000,000
2.65% Senior Secured Notes due 2032
Debt Instrument [Line Items]
Senior Notes	498,746,000
5.00% Senior Secured Notes due 2026
Debt Instrument [Line Items]
Senior Notes		400,000,000
2.65% Senior Secured Notes due 2030
Debt Instrument [Line Items]
Senior Notes	798,032,000	797,806,000
Notes And Mortgages Payable
Debt Instrument [Line Items]
Notes and Mortgages payable (including obligations under finance leases of $79,331 in 2021 and $52,905 in 2020) and term loans with varying maturities through 2099; weighted average interest rates of 5.6% in 2021 and 6.8% in 2020 (see Note 7 regarding finance leases)	$ 185,027,000	$ 61,638,000

Summary of Long-Term Debt (Parenthetical) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Obligations under finance leases	$ 79,331	$ 52,905
2.65% Senior Secured Notes due 2030
Debt Instrument [Line Items]
Debt instruments, maturity date	2030	2030
Senior notes, interest rate	2.65%	2.65%
Unamortized discount	$ 1,968	$ 2,193
1.65% Senior Secured Notes due 2026
Debt Instrument [Line Items]
Debt instruments, maturity date	2026
Senior notes, interest rate	1.65%
Unamortized discount	$ 813
2.65% Senior Secured Notes due 2032
Debt Instrument [Line Items]
Debt instruments, maturity date	2032
Senior notes, interest rate	2.65%
Unamortized discount	$ 1,254
5.00% Senior Secured Notes due 2026
Debt Instrument [Line Items]
Debt instruments, maturity date		2026
Senior notes, interest rate		5.00%
Notes And Mortgages Payable
Debt Instrument [Line Items]
Obligations under finance leases	$ 79,331	$ 52,905
Weighted average interest	5.60%	6.80%
Term Loans With Varying Maturities
Debt Instrument [Line Items]
Debt instruments, maturity date	2099

Long-Term Debt - Additional Information (Detail) - USD ($)					12 Months Ended
	Sep. 13, 2021	Aug. 24, 2021	Sep. 28, 2020	Oct. 23, 2018	Dec. 31, 2021	Apr. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 21, 2020
Debt Instrument [Line Items]
Line of credit facility, starting date					Aug. 24, 2021
Rate adjustment to weighted average federal funds rate for credit facility borrowings					0.50%
Rate adjustment to one month Eurodollar rate on credit facility borrowings					1.00%
Accounts receivable securitization program credit facility, borrowing capacity							$ 450,000,000
Accounts receivable securitization program credit facility, available borrowing capacity						$ 20,000,000
Accounts receivable securitization program credit facility, amount outstanding					$ 0
Initial lease terms of property					12 years
Financial liability					$ 82,000
Debt instrument carrying amount					4,190,288,000			$ 3,856,251,000
Fair value of debt					$ 4,200,000,000			$ 3,900,000,000
1.65% Senior Secured Notes due 2026
Debt Instrument [Line Items]
Senior notes, interest rate					1.65%
2.65% Senior Secured Notes due 2032
Debt Instrument [Line Items]
Senior notes, interest rate					2.65%
5.00% Senior Secured Notes due 2026
Debt Instrument [Line Items]
Senior notes, interest rate								5.00%
Revolving Credit Facility
Debt Instrument [Line Items]
Line of credit facility, borrowing capacity		$ 1,200,000,000		$ 1,000,000,000.0
Line of credit facility, maturity date					Aug. 24, 2026
Line of credit facility increased (decreased) amount		$ 200,000,000
Line of credit facility amount outstanding					$ 342,600,000
Line of credit facility, available borrowing capacity					$ 854,000,000
Revolving Credit Facility \| One Month LIBOR Rate Plus Index Based Loans
Debt Instrument [Line Items]
Current applicable margins					1.25%
Revolving Credit Facility \| ABR-based loans
Debt Instrument [Line Items]
Current applicable margins					0.25%
Revolving Credit Facility \| Minimum \| One Month LIBOR Rate Plus Index Based Loans
Debt Instrument [Line Items]
Consolidated Leverage Ratio					0.25%
Revolving Credit Facility \| Minimum \| One Three Six Month LIBOR Rate Plus Index Based Loans
Debt Instrument [Line Items]
Consolidated Leverage Ratio					1.25%
Revolving Credit Facility \| Maximum \| One Month LIBOR Rate Plus Index Based Loans
Debt Instrument [Line Items]
Consolidated Leverage Ratio					0.625%
Revolving Credit Facility \| Maximum \| One Three Six Month LIBOR Rate Plus Index Based Loans
Debt Instrument [Line Items]
Consolidated Leverage Ratio					1.625%
Revolving Credit Facility \| Letter of Credit
Debt Instrument [Line Items]
Line of credit facility, borrowing capacity					$ 125,000,000
Letters of credit, outstanding					4,000,000
Tranche A Term Loan
Debt Instrument [Line Items]
Line of credit facility, borrowing capacity					$ 1,850,000,000
Line of credit facility, maturity date					Aug. 24, 2026
Line of credit facility increased (decreased) amount					$ (150,000,000)
Line of credit facility amount outstanding					$ 1,689,375,000			$ 1,900,000,000
Tranche A Term Loan \| Quarterly Payment Beginning on December 31,2021 Through September 2023
Debt Instrument [Line Items]
Scheduled principal payments per quarter				$ 10,625,000
Debt instrument payment, description					beginning on December 31, 2021 through September 30, 2023
Tranche A Term Loan \| Quarterly Payment Beginning on December 31,2023 Through June 30, 2026
Debt Instrument [Line Items]
Scheduled principal payments per quarter					$ 21,250,000
Debt instrument payment, description					beginning on December 31, 2023 through June 30, 2026
Tranche B Term Loan
Debt Instrument [Line Items]
Line of credit facility amount outstanding					$ 488,000,000
Term Loan A
Debt Instrument [Line Items]
Current applicable margins					1.25%
Term Loan A \| ABR-based loans
Debt Instrument [Line Items]
Current applicable margins					0.25%
Term Loan A \| Minimum \| One Month LIBOR Rate Plus Index Based Loans
Debt Instrument [Line Items]
Consolidated Leverage Ratio					0.25%
Term Loan A \| Minimum \| One Three Six Month LIBOR Rate Plus Index Based Loans
Debt Instrument [Line Items]
Consolidated Leverage Ratio					1.25%
Term Loan A \| Maximum \| One Month LIBOR Rate Plus Index Based Loans
Debt Instrument [Line Items]
Consolidated Leverage Ratio					0.625%
Term Loan A \| Maximum \| One Three Six Month LIBOR Rate Plus Index Based Loans
Debt Instrument [Line Items]
Consolidated Leverage Ratio					1.625%
New Senior Secured Notes
Debt Instrument [Line Items]
Senior notes, issued					$ 2,000,000,000.0
New Senior Secured Notes \| Maximum
Debt Instrument [Line Items]
Number of days to complete exchange offer					60 days
New Senior Secured Notes \| 1.65% Senior Secured Notes due 2026
Debt Instrument [Line Items]
Line of credit facility, maturity date		Sep. 01, 2026
Senior notes, issued		$ 700,000,000
Senior notes, interest rate		1.65%
New Senior Secured Notes \| 2.65% Senior Secured Notes due 2032
Debt Instrument [Line Items]
Line of credit facility, maturity date		Jan. 15, 2032
Senior notes, issued		$ 500,000,000
Senior notes, interest rate		2.65%
New Senior Secured Notes \| 5.00% Senior Secured Notes due 2026
Debt Instrument [Line Items]
Senior notes, interest rate	5.00%		4.75%
Senior notes, redeemed	$ 400,000,000		$ 700,000,000
Redemption price, percentage	102.50%		100.00%
Senior notes, redemption price	$ 410,000,000
New Senior Secured Notes \| 2.65% Senior Secured Notes due 2030
Debt Instrument [Line Items]
Line of credit facility, maturity date					Oct. 15, 2030
Senior notes, issued									$ 800,000,000
Senior notes, interest rate									2.65%
New Senior Secured Notes \| 5.00% Senior Secured Notes due 2026
Debt Instrument [Line Items]
Line of credit facility, maturity date					Sep. 01, 2026

Aggregate Scheduled Maturities of Debt Outstanding (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Disclosure [Abstract]
2022	$ 48,409
2023	59,648
2024	92,012
2025	91,274
2026	2,472,172
Later	1,449,452
Total debt before unamortized financing costs	4,212,967	$ 3,874,444
Less-Unamortized financing costs	(22,679)	(18,193)
Total debt after unamortized financing costs	$ 4,190,288	$ 3,856,251

Common Stock - Additional Information (Detail) - USD ($)	3 Months Ended	12 Months Ended
	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Jul. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Dividends declared and paid, per share	$ 0.20	$ 0.80		$ 0.60
Stock repurchase programs authorized to purchase, value		$ 3,700,000,000			$ 1,000,000,000.0
Stock repurchased, value		1,220,875,000	$ 206,719,000	$ 753,927,000
Compensation cost recognized		$ 73,686,000	65,837,000	69,431,000
Restricted stock units granted		2,401,402
Weighted-average grant date fair value		$ 39.66
Forfeitures utilization term		5 years
Total in-the-money value of all stock options exercised during the year		$ 52,000,000.0	$ 22,200,000	126,700,000
Weighted average grant-date fair value of restricted stock units		$ 28.93	$ 22.74
ASU 2016-09 \| Revision of Prior Period, Accounting Standards Update, Adjustment
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
New accounting adoption impact on income taxes and net income		$ 2,400,000	$ 7,400,000	12,200,000
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation cost recognized, pre-tax charge		59,300,000	54,700,000	60,100,000
Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation cost recognized, after-tax		14,400,000	$ 11,200,000	$ 9,300,000
Unrecognized compensation cost		$ 126,000,000.0
Unrecognized compensation cost vesting period		2 years 7 months 6 days
Unvested Stock option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		$ 126,000,000.0
Unrecognized compensation cost vesting period		2 years 7 months 6 days
Income Tax Withholding Obligations
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock repurchased, shares		134,464	81,057	336,943
Stock repurchased, value		$ 19,500,000	$ 10,200,000	$ 47,700,000
Stock Repurchase Programs Twenty Twenty One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock repurchase programs authorized to purchase, value		$ 1,000,000,000
Stock repurchased, shares		8,409,721
Stock repurchased, value		$ 1,200,000,000
Total number of shares cancelled		15,761
Stock Repurchase Programs Twenty Twenty
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock repurchased, shares			1,951,899
Stock repurchased, value			$ 196,600,000
Total number of shares cancelled			17,779
Stock Repurchase Programs Twenty Nineteen
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock repurchase programs authorized to purchase, value				$ 1,000,000,000
Stock repurchased, shares				5,397,753
Stock repurchased, value				$ 706,200,000
Total number of shares cancelled				27,713
Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted-average grant date fair value of option granted, number of shares			2,400,000	2,100,000
Additional stock options granted		0
2020 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted-average grant date fair value of option granted, number of shares		2,300,000	44,000
Total number of shares cancelled		0
2020 Stock Incentive Plan \| Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted stock units granted		138,114	3,000
Weighted average grant-date fair value of restricted stock units		$ 138.80	$ 109.72
2010 Employees' Restricted Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Additional stock options granted		0
Number of shares issued		0
2010 Employees' Restricted Stock Purchase Plan \| Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted stock units granted			111,554	122,336
Weighted-average grant date fair value			$ 68.06	$ 133.98
2010 Employees' Restricted Stock Purchase Plan \| Restricted Stock \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares vesting period			5 years	5 years
Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted-average grant date fair value		$ 39.66	$ 14.60	$ 30.40
Options are exercisable, in period		4 years
Exercise price percentage		10.00%
Employee Stock Purchase Plan Twenty Zero Five
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted stock units granted		96,179	115,008	82,449
Common Stock remain available for issuance		400,000
Stock issued during period, net of cancellations		1,600,000
Class B
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock repurchase programs authorized to purchase, value		$ 358,200,000
Common Stock, shares issued		69,834,320	77,805,530
Issuance upon conversion of shares		20,034,442
Class B \| Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares reserved		35,600,000
Class B \| 2020 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common Stock, shares issued			6,100,000
Common Stock remain available for issuance		3,200,000
Class B \| 2010 Employees' Restricted Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares reserved		600,000
Class B \| Employee Stock Purchase Plan Twenty Zero Five
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares reserved		2,000,000.0
Special Dividend
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Dividends declared and paid	$ 17,300,000	$ 65,900,000		$ 53,000,000.0

Schedule of Information Related to Stock Repurchase Programs (Detail) - USD ($)

12 Months Ended

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

Jul. 31, 2021

Dec. 31, 2018

Class of Stock [Line Items]

Additional dollars authorized for repurchase

$ 3,700,000,000

$ 1,000,000,000.0

Aggregate purchase price paid for shares purchased as part of publicly announced program

$ 1,220,875,000

$ 206,719,000

$ 753,927,000

Stock Repurchase Program

Class of Stock [Line Items]

Total number of shares purchased as part of publicly announced programs

15,759,373

Average price paid per share for shares purchased as part of publicly announced program

$ 133.51

Aggregate purchase price paid for shares purchased as part of publicly announced program

$ 2,104,111,000

Stock Repurchase Programs Twenty Eighteen

Class of Stock [Line Items]

Maximum number of dollars that may yet be purchased under the program

$ 462,344,000

Stock Repurchase Programs Twenty Nineteen

Class of Stock [Line Items]

Additional dollars authorized for repurchase

$ 1,000,000,000

Total number of shares purchased

^[1]

5,762,409

Total number of shares cancelled

27,713

Average price paid per share for forfeited restricted shares

$ 0.01

Total number of shares purchased as part of publicly announced programs

5,397,753

Aggregate purchase price paid

$ 753,928,000

Aggregate purchase price paid for shares purchased as part of publicly announced program

706,200,000

Maximum number of dollars that may yet be purchased under the program

$ 756,123,000

Stock Repurchase Programs Twenty Nineteen | Stock Repurchase Program

Class of Stock [Line Items]

Total number of shares purchased as part of publicly announced programs

5,397,753

Average price paid per share for shares purchased as part of publicly announced program

$ 130.84

Aggregate purchase price paid for shares purchased as part of publicly announced program

$ 706,221,000

Stock Repurchase Programs Twenty Twenty

Class of Stock [Line Items]

Total number of shares purchased

^[1]

2,050,735

Total number of shares cancelled

17,779

Average price paid per share for forfeited restricted shares

$ 0.01

Total number of shares purchased as part of publicly announced programs

1,951,899

Aggregate purchase price paid

$ 206,719,000

Aggregate purchase price paid for shares purchased as part of publicly announced program

196,600,000

Maximum number of dollars that may yet be purchased under the program

$ 559,563,000

Stock Repurchase Programs Twenty Twenty | Stock Repurchase Program

Class of Stock [Line Items]

Total number of shares purchased as part of publicly announced programs

1,951,899

Average price paid per share for shares purchased as part of publicly announced program

$ 100.70

Aggregate purchase price paid for shares purchased as part of publicly announced program

$ 196,560,000

Stock Repurchase Programs Twenty Twenty One

Class of Stock [Line Items]

Additional dollars authorized for repurchase

$ 1,000,000,000

Total number of shares purchased

^[1]

8,559,946

Total number of shares cancelled

15,761

Average price paid per share for forfeited restricted shares

$ 0.01

Total number of shares purchased as part of publicly announced programs

8,409,721

Aggregate purchase price paid

$ 1,220,876,000

Aggregate purchase price paid for shares purchased as part of publicly announced program

1,200,000,000

Maximum number of dollars that may yet be purchased under the program

$ 358,233,000

Stock Repurchase Programs Twenty Twenty One | Stock Repurchase Program

Class of Stock [Line Items]

Total number of shares purchased as part of publicly announced programs

8,409,721

Average price paid per share for shares purchased as part of publicly announced program

$ 142.85

Aggregate purchase price paid for shares purchased as part of publicly announced program

$ 1,201,330,000

Stock Repurchase Programs Twenty Nineteen to Twenty Twenty One

Class of Stock [Line Items]

Additional dollars authorized for repurchase

$ 2,000,000,000

Total number of shares purchased

^[1]

16,373,090

Total number of shares cancelled

61,253

Average price paid per share for forfeited restricted shares

$ 0.01

Aggregate purchase price paid

$ 2,181,523,000

[1]	Includes 15,761, 17,779 and, 27,713 of restricted shares that were forfeited by former employees pursuant to the terms of our restricted stock purchase plan during 2021, 2020 and 2019, respectively.

Schedule of Information Related to Stock Repurchase Programs (Parenthetical) (Detail) - shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Class of Stock [Line Items]
Restricted shares forfeited by former employee	339,996
Restricted Stock Purchase Plan
Class of Stock [Line Items]
Restricted shares forfeited by former employee	15,761	17,779	27,713

Assumptions Used in Black-Scholes Model to Determine Fair Value for Stock Option Awards Granted (Detail)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Expected volatility	31.00%	28.00%	27.00%
Risk free Interest rate	2.00%	2.00%	2.00%
Expected life (years)	3 years 6 months	3 years 6 months	3 years 4 months 24 days
Forfeiture rate	8.00%	8.00%	9.00%
Dividend yield	0.50%	0.50%	0.30%

Summary of Option Activities (Detail) - $ / shares	12 Months Ended
Summary of Option Activities (Detail) - $ / shares	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Outstanding Options, Number of shares, beginning balance	8,238,966
Granted, Number of Shares	2,401,402
Exercised, Number of Shares	(1,737,286)
Cancelled, Number of Shares	(346,967)
Outstanding Options, Number of shares, ending balance	8,556,115
Outstanding options vested and exercisable, Number of Shares	2,997,296	2,522,906	2,551,267
Outstanding Options, Average Option Price, beginning balance	$ 109.47
Granted, Average Option Price	141.08
Exercised, Average Option Price	116.38
Cancelled, Average Option Price	112.84
Outstanding Options, Average Option Price, ending balance	116.80
Outstanding options vested and exercisable, Average Option Price	$ 119.00	$ 124.62	$ 119.86

Schedule of Information about Unvested Options (Detail)	12 Months Ended
Schedule of Information about Unvested Options (Detail)	Dec. 31, 2021 $ / shares shares
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Unvested options, Shares, beginning balance \| shares	5,716,060
Granted, Shares \| shares	2,401,402
Vested, Shares \| shares	(2,218,647)
Cancelled, Shares \| shares	(339,996)
Unvested options, Shares, ending balance \| shares	5,558,819
Unvested options, Weighted Average Grant Date Fair Value, beginning balance \| $ / shares	$ 22.74
Granted, Weighted Average Grant Date Fair Value \| $ / shares	39.66
Vested, Weighted Average Grant Date Fair Value \| $ / shares	24.61
Cancelled, Weighted Average Grant Date Fair Value \| $ / shares	28.70
Unvested options, Weighted Average Grant Date Fair Value, ending balance \| $ / shares	$ 28.93

Schedule of Information about All Outstanding Options (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Number, Options Outstanding	8,556,115	8,238,966	8,133,176
Weighted average exercise price, Options Outstanding	$ 116.80	$ 109.47	$ 124.52
Aggregate intrinsic value, Options Outstanding	$ 144,921,069
Weighted average remaining contractual life, Options Outstanding	2 years 7 months 6 days	2 years 10 months 24 days	2 years 8 months 12 days
Number, Options Exercisable	2,997,296	2,522,906	2,551,267
Weighted Average Exercise Price, Options Exercisable	$ 119.00	$ 124.62	$ 119.86
Aggregate intrinsic value, Options Exercisable	$ 35,394,928
Weighted average remaining contractual life, Options Exercisable	1 year 4 months 24 days

Schedule of Weighted Average Remaining Contractual Life for Options Outstanding and Weighted Average Exercise Price Per Share for Exercisable Options (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Options Outstanding, Shares	8,556,115	8,238,966	8,133,176
Options Outstanding, Weighted Average Exercise Price Per Share	$ 116.80	$ 109.47	$ 124.52
Options Outstanding, Weighted Average Remaining Contractual Life (in Years)	2 years 7 months 6 days	2 years 10 months 24 days	2 years 8 months 12 days
Number, Options Exercisable	2,997,296	2,522,906	2,551,267
Weighted Average Exercise Price, Options Exercisable	$ 119.00	$ 124.62	$ 119.86
Expected to Vest Options , Shares	5,005,113	5,099,823	5,073,423
Expected to Vest Options, Weighted Average Exercise Price Per Share	$ 116.94	$ 110.47	$ 126.62

Components of Income Tax Expense Benefit (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Current, Federal	$ 276,471	$ 268,974	$ 225,663
Current, Foreign	13,754	13,978	9,284
Current, State	44,993	43,333	40,152
Current, Total	335,218	326,285	275,099
Deferred, Federal	(26,638)	(20,382)	(27,073)
Deferred, Foreign	1,521	(2,496)	1,874
Deferred, State	(4,420)	(4,114)	(11,106)
Deferred, Total	(29,537)	(26,992)	(36,305)
Provision for income taxes	$ 305,681	$ 299,293	$ 238,794

Income Taxes - Additional Information (Detail)	12 Months Ended
Income Taxes - Additional Information (Detail)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Dec. 31, 2018 Provision
Income Taxes [Line Items]
Number of anti-base erosion tax provisions \| Provision				2
Provisional deferred tax - GILTI	$ 0	$ 0	$ 0
Foreign pre-tax earnings	79,000,000	72,000,000	69,000,000
Qualified dividend received deduction	116,000,000
Tax expense (benefit) from employee share-based payments	$ (2,000,000)	$ 7,000,000	$ (12,000,000)
Effective tax rates	23.60%	23.90%	22.40%
Deferred federal state and foreign tax benefit	$ 6,000,000	$ 11,000,000
Future taxable income, amount	891,000,000
Deferred state tax benefit (net of the federal benefit)	(4,420,000)	(4,114,000)	$ (11,106,000)
Deferred foreign tax benefit	13,000,000
Deferred federal tax benefits	26,638,000	20,382,000	27,073,000
State tax benefits	(44,993,000)	(43,333,000)	$ (40,152,000)
Valuation allowances	62,356,000	68,003,000
Increase in estimated liabilities for uncertain tax positions	1,000,000	1,000,000
Impact of unrecognized tax benefits if recognized	$ 2,000,000	2,000,000
Period of expiration of the statute of limitations for certain jurisdictions	within the next twelve months
Jurisdictions statutes of limitations expiration period	12 months
Maximum
Income Taxes [Line Items]
Accrued interest and penalties	$ 1,000,000	1,000,000
Foreign and U.S. state and local jurisdictions have statutes of limitations, in years	4 years
Minimum
Income Taxes [Line Items]
Foreign and U.S. state and local jurisdictions have statutes of limitations, in years	3 years
Allowance in relation to state tax benefit
Income Taxes [Line Items]
Valuation allowances	$ 57,000,000	64,000,000
Net Operating Losses Not Realized
Income Taxes [Line Items]
Decrease in valuation allowance	7,000,000
Foreign Net Operating Losses and Credit Carryforwards
Income Taxes [Line Items]
Decrease in valuation allowance	5,000,000	$ 4,000,000
State and Local Jurisdiction
Income Taxes [Line Items]
Deferred state tax benefit (net of the federal benefit)	60,000,000
Interest expense carryforwards	158,000,000
Interest expense, deferred tax benefit	5,000,000
Foreign Tax Authority
Income Taxes [Line Items]
Net operating losses and interest expense	51,000,000
Riverside Medical Clinic Patient Services, LLC
Income Taxes [Line Items]
Operating loss carry forward federal and state	11,000,000
Operating loss carry forward state	10,000,000
Deferred federal tax benefits	2,000,000
State tax benefits	$ 1,000,000

Reconciliation between Federal Statutory Rate and Effective Tax Rate (Detail)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Federal statutory rate	21.00%	21.00%	21.00%
State taxes, net of federal income tax benefit	2.50%	2.50%	2.20%
Tax effects of foreign operations	(0.10%)	(0.30%)	(0.30%)
Tax benefit from settlement of employee equity awards	(0.20%)	0.50%	(1.00%)
Other items	0.30%	0.40%	0.80%
Impact of income attributable to noncontrolling interests	0.10%	(0.20%)	(0.30%)
Effective tax rate	23.60%	23.90%	22.40%

Components of Deferred Taxes (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Self-insurance reserves	$ 97,024	$ 75,648
Compensation accruals	77,917	71,054
Doubtful accounts and other reserves	127,876	94,295
Other currently non-deductible accrued liabilities	31,240	61,634
Operating lease liabilities	86,652	89,865
State and foreign net operating loss carryforwards and other state and foreign deferred tax assets	79,499	81,036
Net pension liabilities – OCI only	1,014	1,356
Deferred income tax assets, Gross	501,222	474,888
Valuation Allowance	(62,356)	(68,003)
Total deferred income taxes	438,866	406,885
Depreciable and amortizable assets	303,079	296,588
Right of use assets-operating leases	86,269	89,493
Other liabilities	3,811	3,697
Deferred income tax liabilities, Gross	$ 393,159	$ 389,778

Reconciliation of Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Balance at January 1,	$ 2,806	$ 2,164	$ 1,553
Additions based on tax positions related to the current year	500	500	500
Additions for tax positions of prior years	213	142	113
Reductions for tax positions of prior years	(261)	0	0
Settlements	(714)	0	(2)
Balance at December 31,	$ 2,544	$ 2,806	$ 2,164

Lease Commitments - Additional Information (Detail)	12 Months Ended
Lease Commitments - Additional Information (Detail)	Dec. 31, 2021 USD ($) Hospital	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Lessee Lease Description [Line Items]
Lessee, operating lease, existence of option to extend [true false]	true
Number of hospital facilities \| Hospital	5
Right-of-use assets obtained in exchange for operating lease obligations	$ 95,805,000	$ 69,678,000	$ 383,857,000
Finance lease obligations	$ 29,000,000	$ 37,000,000	0
New Operating Leases
Lessee Lease Description [Line Items]
Right-of-use assets obtained in exchange for operating lease obligations			$ 29,300,000
Two Hospital Facilities
Lessee Lease Description [Line Items]
Lease expiration term	2026
Third and Fourth Hospital Facilities
Lessee Lease Description [Line Items]
Lease expiration term	2033
Fifth Hospital Facility
Lessee Lease Description [Line Items]
Lease expiration term	2040
Minimum
Lessee Lease Description [Line Items]
Initial term of real estate lease	5 years
Real estate leases option to extend lease term	5 years
Maximum
Lessee Lease Description [Line Items]
Initial term of real estate lease	10 years
Real estate leases option to extend lease term	10 years

Components of Lease Expense (Detail) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

Leases [Abstract]

Operating lease cost

$ 77,420

$ 73,841

$ 72,098

Variable and short term lease cost

^[1]

41,443

42,218

35,711

Total lease and rental expense

118,863

116,059

107,809

Finance lease cost:

Amortization of property under capital lease

3,626

1,985

1,877

Interest on debt of property under capital lease

4,124

1,763

1,876

Total finance lease cost

$ 7,750

$ 3,748

$ 3,753

[1]	Includes equipment, month-to-month and leases with a maturity of less than 12 months.

Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 118,433	$ 115,270	$ 107,239
Operating cash flows from finance leases	4,612	1,885	2,078
Financing cash flows from finance leases	2,849	2,586	1,959
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	95,805	69,678	$ 383,857
Finance leases	$ 28,600	$ 37,029

Supplemental Balance Sheet Information Related to Leases (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Operating Leases
Right of use assets-operating leases	$ 367,477	$ 336,513
Operating lease liabilities	64,484	59,796
Operating lease liabilities noncurrent	304,624	278,303
Total operating lease liabilities	369,108	338,099
Finance Leases
Accumulated depreciation	(4,896,427)	(4,512,764)
Property, plant and equipment, net, Total	5,874,275	5,373,124
Current maturities of long-term debt	$ 2,740	$ 2,060
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	us-gaap:DebtCurrent	us-gaap:DebtCurrent
Long-term debt	$ 76,591	$ 50,845
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	us-gaap:LongTermDebtAndCapitalLeaseObligations	us-gaap:LongTermDebtAndCapitalLeaseObligations
Total finance lease liabilities	$ 79,331	$ 52,905
Weighted Average remaining lease term, years
Operating leases	9 years 1 month 6 days	10 years 10 months 24 days
Finance leases	20 years 9 months 18 days	8 years 1 month 6 days
Weighted Average discount rate
Operating leases	3.80%	4.40%
Finance leases	7.10%	9.70%
Finance Lease
Finance Leases
Property and equipment	$ 102,940	$ 75,611
Accumulated depreciation	(30,949)	(28,595)
Property, plant and equipment, net, Total	$ 71,991	$ 47,016

Future Maturities of Lease Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Operating Leases
2022	$ 75,790
2023	67,994
2024	59,354
2025	52,098
2026	43,193
Later years	150,024
Total lease payments	448,453
less imputed interest	(79,345)
Total	369,108	$ 338,099
Finance Leases
2022	6,809
2023	6,993
2024	7,162
2025	6,047
2026	6,057
Later years	110,263
Total lease payments	143,331
less imputed interest	(64,000)
Total	$ 79,331	$ 52,905

Commitments and Contingencies - Additional Information (Detail) £ in Millions	12 Months Ended
	Dec. 31, 2021 USD ($)	Dec. 31, 2021 GBP (£)	Dec. 31, 2020 USD ($)	Dec. 31, 2015 USD ($)	Dec. 31, 2014 USD ($)	Dec. 31, 2013 USD ($)	Dec. 31, 2012 USD ($)	Dec. 31, 2011 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 GBP (£)	Jun. 01, 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	$ 463,678,000		$ 368,964,000									$ 322,824,000	$ 314,941,000
Self-insured for professional and general liability, current	74,000,000		74,000,000
Compensation liability claims	115,000,000		105,000,000
Compensation and related benefits	55,000,000		55,000,000
Impact of information technology incident on revenue	45,000,000
Proceeds from commercial cyber insurance	28,000,000
Revenues reserved			17,000,000
Combined estimated future purchase obligations	367,000,000
Defined benefit pension plan estimated payments through 2089	156,000,000
Other retirement plan liabilities	23,000,000
Repayment of legal settlement amount on demand				$ 4,000,000	$ 4,000,000	$ 4,000,000	$ 4,000,000	$ 4,000,000
Amount claimed from over payments of legal settlements				7,000,000	8,000,000	7,000,000	$ 4,000,000
Amount claimed from over payments of legal settlements due to change in calculations				3,000,000	2,000,000	$ 2,000,000
Construction Commitment
Commitments and Contingencies Disclosure [Line Items]
Combined estimated future purchase obligations	21,000,000
Revenue Cycle Data Processing Services
Commitments and Contingencies Disclosure [Line Items]
Combined estimated future purchase obligations	63,000,000
Electronic Health Records And Revenue Cycle Application
Commitments and Contingencies Disclosure [Line Items]
Combined estimated future purchase obligations	208,000,000
Other Software Applications
Commitments and Contingencies Disclosure [Line Items]
Combined estimated future purchase obligations	21,000,000
Related to Certain Equipment
Commitments and Contingencies Disclosure [Line Items]
Combined estimated future purchase obligations	179,000,000
Commercial Health Insurer and Self-insured Employee Benefit Plans
Commitments and Contingencies Disclosure [Line Items]
Combined estimated future purchase obligations	114,000,000
Healthcare Infrastructure
Commitments and Contingencies Disclosure [Line Items]
Combined estimated future purchase obligations	75,000,000
Wind Storms
Commitments and Contingencies Disclosure [Line Items]
Maximum insurance deductible											$ 2,500,000
Cygnet Health Care Limited
Commitments and Contingencies Disclosure [Line Items]
Property insurance \| £		£ 1,500
Maximum \| Wind Storms
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	$ 1,000,000,000
Percentage of insurance deductible	5.00%									5.00%
Maximum \| Earthquake \| LAS VEGAS, NEVADA
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	$ 200,000,000
Maximum \| Earthquake \| CALIFORNIA
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	150,000,000
Maximum \| Earthquake \| OTHER STATES
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	250,000,000
Maximum \| Earthquake \| Faulty Zones of UNITED STATES
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	100,000,000
Maximum \| Earthquake \| PUERTO RICO
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	40,000,000
Maximum \| Flood
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	100,000,000
Maximum \| Flood \| Texas
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	10,000,000
Maximum \| Flood \| PUERTO RICO
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	$ 1,000,000
Minimum \| Wind Storms
Commitments and Contingencies Disclosure [Line Items]
Percentage of insurance deductible	3.00%									3.00%
General And Professional Liability Insurance Policies
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability	$ 52,000,000		25,000,000
General and Professional Liability
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability	348,693,000		263,779,000									241,820,000	243,051,000
Workers’ Compensation Liability Insurance Policies
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability			20,000,000
Subsidiaries \| Professional Liability
Commitments and Contingencies Disclosure [Line Items]
Purchased several excess policies through commercial insurance carriers per occurrence			2,500,000
Purchased several excess policies through commercial insurance carriers per occurrence excess claim amount			10,000,000
Subsidiaries \| Professional Liability \| Cygnet Health Care Limited
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability \| £										£ 16
Subsidiaries \| Professional Liability \| Maximum
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability	20,000,000		10,000,000									5,000,000	5,000,000	$ 5,000,000	$ 10,000,000
Subsidiaries \| Professional Liability \| Maximum \| Forecast
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability									$ 20,000,000
Subsidiaries \| General Liability \| Cygnet Health Care Limited
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability \| £										£ 25
Subsidiaries \| General Liability \| Maximum
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability	3,000,000		3,000,000									3,000,000	3,000,000	3,000,000	3,000,000
Subsidiaries \| General Liability \| Maximum \| Forecast
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability									3,000,000
Subsidiaries \| General And Professional Liability Insurance Policies \| Maximum
Commitments and Contingencies Disclosure [Line Items]
Purchased several excess policies through commercial insurance carriers per occurrence	$ 155,000,000		$ 250,000,000	$ 250,000,000	$ 250,000,000							$ 250,000,000	$ 250,000,000	$ 250,000,000	$ 250,000,000
Subsidiaries \| General And Professional Liability Insurance Policies \| Maximum \| Forecast
Commitments and Contingencies Disclosure [Line Items]
Purchased several excess policies through commercial insurance carriers per occurrence									$ 162,500,000

Commitments and Contingencies - Schedule of Changes in General and Professional Liability and Workers Compensation Reserves (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Commitments and Contingencies Disclosure [Line Items]
Beginning balance	$ 368,964	$ 322,824	$ 314,941
Plus: Accrued insurance expense, net of commercial premiums paid	186,215	159,223	105,672
Less: Payments made in settlement of self-insured claims	(91,501)	(113,083)	(97,789)
Ending balance	463,678	368,964	322,824
General and Professional Liability
Commitments and Contingencies Disclosure [Line Items]
Beginning balance	263,779	241,820	243,051
Plus: Accrued insurance expense, net of commercial premiums paid	129,690	91,518	56,452
Less: Payments made in settlement of self-insured claims	(44,776)	(69,559)	(57,683)
Ending balance	348,693	263,779	241,820
Workers’ Compensation
Commitments and Contingencies Disclosure [Line Items]
Beginning balance	105,185	81,004	71,890
Plus: Accrued insurance expense, net of commercial premiums paid	56,525	67,705	49,220
Less: Payments made in settlement of self-insured claims	(46,725)	(43,524)	(40,106)
Ending balance	$ 114,985	$ 105,185	$ 81,004

Relationship with Universal Health Realty Income Trust and Other Related Party Transactions - Additional Information (Detail)	1 Months Ended	3 Months Ended			12 Months Ended
	Jan. 31, 2022 USD ($) Bed SquareFoot	Dec. 31, 2020 USD ($) $ / shares	Sep. 30, 2020 $ / shares	Dec. 31, 2013	Dec. 31, 2021 USD ($) Hospital Facility Bed $ / shares	Dec. 31, 2020 USD ($) Hospital	Dec. 31, 2019 USD ($) Hospital
Related Party Transaction [Line Items]
Net revenues					$ 12,642,117,000	$ 11,558,897,000	$ 11,378,259,000
Lessee, operating lease, existence of option to extend [true false]					true
Lease and rental expense					$ 118,863,000	116,059,000	107,809,000
Number of hospital facilities \| Hospital					5
Chief Executive Officer
Related Party Transaction [Line Items]
Estimated payments to acquire life insurance policies					$ 9,000,000
Payments to acquire life insurance policies, net					1,000,000.0	1,100,000	1,100,000
Acute Care Hospital Services
Related Party Transaction [Line Items]
Net revenues					7,108,254,000	$ 6,337,304,000	$ 6,164,560,000
Asset Purchase and Sale Agreement \| Subsidiaries
Related Party Transaction [Line Items]
Gain on sale of real estate assets					$ 4,000,000.0
Minimum
Related Party Transaction [Line Items]
Lease initial terms					5 years
Real estate leases option to extend lease term					5 years
Minimum \| Chief Executive Officer
Related Party Transaction [Line Items]
Estimated death benefit proceeds					$ 37,000,000
Maximum
Related Party Transaction [Line Items]
Lease initial terms					10 years
Real estate leases option to extend lease term					10 years
Relationship with Universal Health Realty Income Trust
Related Party Transaction [Line Items]
Trust outstanding shares held, percentage					5.70%
Percentage of advisory fee on average invested real estate assets					0.70%	0.70%	0.70%
Pre-tax share of income from the Trust					$ 6,200,000	$ 1,100,000	$ 1,100,000
Dividends received from the Trust					2,200,000	2,200,000	$ 2,100,000
Proceeds from transactions including asset purchase and sale transaction					5,000,000.0
Carrying value of investment in Trust		$ 5,400,000			9,400,000	5,400,000
Market value of investment in Trust		$ 50,600,000			$ 46,800,000	$ 50,600,000
Lease renewal period, years					5 years
Financial liability included in debt					$ 82,400,000
Number of hospital facilities \| Hospital					3	3	3
Notice period on renewal of lease					90 days
Period of rights of refusal to leased facilities					180 days
Number of free-standing emergency departments to be acquired \| Facility					2
Relationship with Universal Health Realty Income Trust \| Subsequent Event
Related Party Transaction [Line Items]
Number of beds available in acute care hospital \| Bed	170
Number of square feet to be constructed \| SquareFoot	86,000
Percentage of master lease rentable square feet	68.00%
Relationship with Universal Health Realty Income Trust \| McAllen Medical Center, Wellington Regional Medical Center and Inland Valley Campus of Southwest Healthcare System
Related Party Transaction [Line Items]
Lease and rental expense					$ 17,700,000	$ 17,100,000	$ 16,400,000
Relationship with Universal Health Realty Income Trust \| Aiken, South Carolina \| Behavioral Health Care Facility
Related Party Transaction [Line Items]
Number of bed available in behavioral health care facility \| Bed					100
Lease and rental expense					$ 2,500,000
Notice period on renewal of lease					270 days
Period of rights of refusal to leased facilities					30 days
Relationship with Universal Health Realty Income Trust \| Aiken Regional Medical Center
Related Party Transaction [Line Items]
Lease rent receivable					$ 3,900,000
Relationship with Universal Health Realty Income Trust \| Canyon Creek Behavioral Health
Related Party Transaction [Line Items]
Lease rent receivable					$ 1,700,000
Relationship with Universal Health Realty Income Trust \| Aiken Regional Medical Center and Canyon Creek Behavioral Health
Related Party Transaction [Line Items]
Lease initial terms					5 years
Initial lease term on property					12 years
Lease expiration date					Dec. 31, 2033
Lessee, operating lease, existence of option to extend [true false]					true
Real estate leases option to extend lease term					7 years
Number of facilities leased \| Facility					2
Lease rent receivable					$ 5,600,000
Percentage of annual rental increase on cumulative and compound basis					2.25%
Relationship with Universal Health Realty Income Trust \| Aiken Regional Medical Center and Canyon Creek Behavioral Health \| Bonus Rental
Related Party Transaction [Line Items]
Lease revenue					$ 0
Relationship with Universal Health Realty Income Trust \| Asset Purchase and Sale Agreement \| Subsidiaries
Related Party Transaction [Line Items]
Cash received for sale of real estate asset					2,800,000
Gain on sale of real estate assets					68,400,000
Relationship with Universal Health Realty Income Trust \| Asset Purchase and Sale Agreement \| Subsidiaries \| Inland Valley Campus of Southwest Healthcare System \| Wildomar, California
Related Party Transaction [Line Items]
Fair market value of real estate assets received					79,600,000
Relationship with Universal Health Realty Income Trust \| Asset Purchase and Sale Agreement \| Subsidiaries \| Aiken Regional Medical Center \| Aiken South Carolina
Related Party Transaction [Line Items]
Fair market value of real estate assets sold					$ 57,700,000
Relationship with Universal Health Realty Income Trust \| Asset Purchase and Sale Agreement \| Subsidiaries \| Aiken Regional Medical Center \| Aiken South Carolina \| Acute Care Hospital Services
Related Party Transaction [Line Items]
Number of beds available in acute care hospital \| Bed					211
Relationship with Universal Health Realty Income Trust \| Asset Purchase and Sale Agreement \| Subsidiaries \| Aiken Regional Medical Center \| Aiken South Carolina \| Behavioral Health Care Facility
Related Party Transaction [Line Items]
Number of bed available in behavioral health care facility \| Bed					62
Relationship with Universal Health Realty Income Trust \| Asset Purchase and Sale Agreement \| Subsidiaries \| Canyon Creek Behavioral Health \| Temple, Texas
Related Party Transaction [Line Items]
Fair market value of real estate assets sold					$ 24,700,000
Relationship with Universal Health Realty Income Trust \| Asset Purchase and Sale Agreement \| Subsidiaries \| Aiken Regional Medical Center and Canyon Creek Behavioral Health
Related Party Transaction [Line Items]
Fair market value of real estate assets sold					$ 82,400,000
Relationship with Universal Health Realty Income Trust \| Minimum
Related Party Transaction [Line Items]
Lease initial terms					13 years
Relationship with Universal Health Realty Income Trust \| Minimum \| Subsequent Event
Related Party Transaction [Line Items]
Lease and rental expense	$ 1,300,000
Relationship with Universal Health Realty Income Trust \| Minimum \| Limited Liability Companies
Related Party Transaction [Line Items]
Non-controlling ownership interests by subsidiaries					95.00%
Relationship with Universal Health Realty Income Trust \| Maximum
Related Party Transaction [Line Items]
Lease initial terms					15 years
Relationship with Universal Health Realty Income Trust \| Maximum \| Limited Liability Companies
Related Party Transaction [Line Items]
Non-controlling ownership interests by subsidiaries					100.00%
Relationship with Universal Health Realty Income Trust \| Advisory Fee
Related Party Transaction [Line Items]
Net revenues					$ 4,400,000	4,100,000	$ 4,000,000.0
Premier, Inc.
Related Party Transaction [Line Items]
Cash dividend declared per share \| $ / shares		$ 0.19	$ 0.19		$ 0.78
Premier, Inc. \| Other (Income) Expense, Net
Related Party Transaction [Line Items]
Dividend					$ 1,700,000	800,000
Premier, Inc. \| Other (Income) Expense, Net \| Accounting Standards Update 2016-01
Related Party Transaction [Line Items]
Unrealized gain (loss)					14,000,000
Premier, Inc. \| Group Purchasing Organization Agreement \| Restricted Stock
Related Party Transaction [Line Items]
Shares vesting period				7 years
Shares vesting period start year				2014
Shares vesting period end year				2020
Market value of retained vested shares					$ 92,000,000	$ 78,000,000

Summary of Details of Hospitals Leased from Trust (Detail) - USD ($)

12 Months Ended

Jan. 01, 2022

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

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

Annual Minimum Rent

$ 118,863,000

$ 116,059,000

$ 107,809,000

Subsequent Event | McAllen Medical Center

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

Annual Minimum Rent

$ 5,485,000

End of Lease Term

2026-12

Renewal Term (years)

^[1]

5 years

Subsequent Event | Wellington Regional Medical Center

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

Annual Minimum Rent

$ 6,319,000

End of Lease Term

2026-12

Renewal Term (years)

^[2]

5 years

Subsequent Event | Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services

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

Annual Minimum Rent

$ 3,895,000

End of Lease Term

2033-12

Renewal Term (years)

^[3]

35 years

Subsequent Event | Canyon Creek Behavioral Health

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

Annual Minimum Rent

$ 1,670,000

End of Lease Term

2033-12

Renewal Term (years)

^[3]

35 years

Subsequent Event | Clive Behavioral Health Hospital

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

Annual Minimum Rent

$ 2,628,000

End of Lease Term

2040-12

Renewal Term (years)

^[4]

50 years

[1]	We have one 5-year renewal option at existing lease rates (through 2031).
[2]	We have one 5-year renewal option at fair market value lease rates (through 2031). Upon the December 31, 2021 expiration of the lease on Wellington Regional Medical Center, a wholly-owned subsidiary of ours exercised its fair market value renewal option and renewed the lease for a 5-year term scheduled to expire on December 31, 2026. Effective January 1, 2022, the annual fair market value lease rate for this hospital is $6.3 million (there is no longer a bonus rental component of the lease payment). Beginning on January 1, 2023, and thereafter on each January 1^st through 2026, the annual rent will increase by 2.50% on a cumulative and compounded basis.
[3]	We have seven 5-year renewal options at fair market value lease rates (2034 through 2068).
[4]	This facility is operated by a joint venture in which we are the managing, majority member and an unrelated third-party holds a minority ownership interest. The joint venture has three, 10-year renewal options at computed lease rates as stipulated in the lease (2041 through 2070) and two additional, 10-year renewal options at fair market values lease rates (2071 through 2090). Beginning in January, 2022, and thereafter in each January through 2040 (and potentially through 2070 if three, 10-year renewal options are exercised), the annual rental will increase by 2.75% on a cumulative and compounded basis.

Summary of Details of Hospitals Leased from Trust (Parenthetical) (Detail) $ in Millions	Jan. 01, 2022 USD ($) RenewalOption	Dec. 31, 2021
Maximum
Property Subject to or Available for Operating Lease [Line Items]
Real estate leases option to extend lease term		10 years
Minimum
Property Subject to or Available for Operating Lease [Line Items]
Real estate leases option to extend lease term		5 years
Subsequent Event \| McAllen Medical Center
Property Subject to or Available for Operating Lease [Line Items]
Renewal options term at existing lease rates	5 years
Subsequent Event \| McAllen Medical Center \| Maximum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at existing lease rates expiration year	2031
Subsequent Event \| Wellington Regional Medical Center
Property Subject to or Available for Operating Lease [Line Items]
Renewal options term at fair market lease rates	5 years
Real estate leases option to extend lease term	5 years
Lease expiration date	Dec. 31, 2026
Lease rent receivable \| $	$ 6.3
Percentage of annual rental increase on cumulative and compound basis	2.50%
Subsequent Event \| Wellington Regional Medical Center \| Maximum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2031
Subsequent Event \| Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services
Property Subject to or Available for Operating Lease [Line Items]
Renewal options term at fair market lease rates	5 years
Subsequent Event \| Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services \| Maximum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2068
Subsequent Event \| Aiken Regional Medical Center/Aurora Pavilion Behavioral Health Services \| Minimum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2034
Subsequent Event \| Canyon Creek Behavioral Health
Property Subject to or Available for Operating Lease [Line Items]
Renewal options term at fair market lease rates	5 years
Subsequent Event \| Canyon Creek Behavioral Health \| Maximum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2068
Subsequent Event \| Canyon Creek Behavioral Health \| Minimum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2034
Subsequent Event \| Clive Behavioral Health Hospital
Property Subject to or Available for Operating Lease [Line Items]
Renewal options term at fair market lease rates	10 years
Percentage of annual rental increase on cumulative and compound basis	2.75%
Operating leases additional renewal options term at fair market value lease rates	10 years
Number of lease renewal option exercised \| RenewalOption	3
Subsequent Event \| Clive Behavioral Health Hospital \| Maximum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2070
Operating leases additional renewal options at fair market value lease rates expiration year	2090
Subsequent Event \| Clive Behavioral Health Hospital \| Minimum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2041
Operating leases additional renewal options at fair market value lease rates expiration year	2071

Schedule of Disaggregates Revenue by Major Source (Detail) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

Disaggregation Of Revenue [Line Items]

Net revenues

$ 12,642,117

$ 11,558,897

$ 11,378,259

Percentage of Net Revenue

100.00%

Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 1,654,119

$ 1,690,591

$ 1,889,245

Percentage of Net Revenue

13.00%

15.00%

17.00%

Managed Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 1,362,962

$ 1,104,930

$ 1,047,759

Percentage of Net Revenue

11.00%

10.00%

9.00%

Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 1,291,692

$ 1,202,632

$ 1,207,649

Percentage of Net Revenue

10.00%

11.00%

Managed Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 1,947,263

$ 1,715,439

$ 1,678,641

Percentage of Net Revenue

15.00%

Managed Care (HMO and PPOs)

Disaggregation Of Revenue [Line Items]

Net revenues

$ 3,957,027

$ 3,426,937

$ 3,634,817

Percentage of Net Revenue

31.00%

30.00%

32.00%

UK Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 687,725

$ 584,000

$ 553,831

Percentage of Net Revenue

5.00%

Other Patient Revenue and Adjustments, Net

Disaggregation Of Revenue [Line Items]

Net revenues

$ 843,200

$ 745,344

$ 696,566

Percentage of Net Revenue

7.00%

6.00%

Other Non-patient Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 898,129

$ 1,089,024

$ 669,751

Percentage of Net Revenue

7.00%

9.00%

6.00%

Acute Care Hospital Services

Disaggregation Of Revenue [Line Items]

Net revenues

$ 7,108,254

$ 6,337,304

$ 6,164,560

Percentage of Net Revenue

100.00%

Acute Care Hospital Services | Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 1,292,205

$ 1,242,268

$ 1,336,200

Percentage of Net Revenue

18.00%

20.00%

22.00%

Acute Care Hospital Services | Managed Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 1,118,901

$ 869,488

$ 827,216

Percentage of Net Revenue

16.00%

14.00%

13.00%

Acute Care Hospital Services | Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 539,741

$ 551,551

$ 519,508

Percentage of Net Revenue

8.00%

9.00%

8.00%

Acute Care Hospital Services | Managed Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 618,727

$ 491,234

$ 560,029

Percentage of Net Revenue

9.00%

8.00%

9.00%

Acute Care Hospital Services | Managed Care (HMO and PPOs)

Disaggregation Of Revenue [Line Items]

Net revenues

$ 2,521,089

$ 2,146,018

$ 2,271,002

Percentage of Net Revenue

35.00%

34.00%

37.00%

Acute Care Hospital Services | UK Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 0

Percentage of Net Revenue

0.00%

Acute Care Hospital Services | Other Patient Revenue and Adjustments, Net

Disaggregation Of Revenue [Line Items]

Net revenues

$ 358,458

$ 248,047

$ 191,422

Percentage of Net Revenue

5.00%

4.00%

3.00%

Acute Care Hospital Services | Other Non-patient Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 659,133

$ 788,698

$ 459,183

Percentage of Net Revenue

9.00%

12.00%

7.00%

Behavioral Health Services

Disaggregation Of Revenue [Line Items]

Net revenues

^[1]

$ 5,503,644

$ 5,208,722

$ 5,210,063

Percentage of Net Revenue

100.00%

Behavioral Health Services | Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 361,914

$ 448,323

$ 553,045

Percentage of Net Revenue

7.00%

9.00%

11.00%

Behavioral Health Services | Managed Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 244,061

$ 235,442

$ 220,543

Percentage of Net Revenue

4.00%

5.00%

4.00%

Behavioral Health Services | Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 751,951

$ 651,081

$ 688,141

Percentage of Net Revenue

14.00%

12.00%

13.00%

Behavioral Health Services | Managed Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 1,328,536

$ 1,224,205

$ 1,118,612

Percentage of Net Revenue

24.00%

21.00%

Behavioral Health Services | Managed Care (HMO and PPOs)

Disaggregation Of Revenue [Line Items]

Net revenues

$ 1,435,938

$ 1,280,919

$ 1,363,815

Percentage of Net Revenue

26.00%

25.00%

26.00%

Behavioral Health Services | UK Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 687,725

$ 584,000

$ 553,831

Percentage of Net Revenue

12.00%

11.00%

Behavioral Health Services | Other Patient Revenue and Adjustments, Net

Disaggregation Of Revenue [Line Items]

Net revenues

$ 484,742

$ 497,297

$ 505,144

Percentage of Net Revenue

9.00%

10.00%

Behavioral Health Services | Other Non-patient Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 208,777

$ 287,455

$ 206,932

Percentage of Net Revenue

4.00%

6.00%

4.00%

Other

Disaggregation Of Revenue [Line Items]

Net revenues

$ 30,219

$ 12,871

$ 3,636

Other | Other Non-patient Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 30,219

$ 12,871

$ 3,636

[1]

Schedule of Disaggregates Revenue by Major Source (Parenthetical) (Detail) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

Disaggregation Of Revenue [Line Items]

Net revenues

$ 12,642,117

$ 11,558,897

$ 11,378,259

Acute Care Hospital Services

Disaggregation Of Revenue [Line Items]

Net revenues

7,108,254

6,337,304

6,164,560

Acute Care Hospital Services | CARES Act and Other Grant Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

316,000

Behavioral Health Services

Disaggregation Of Revenue [Line Items]

Net revenues

^[1]

$ 5,503,644

5,208,722

$ 5,210,063

Behavioral Health Services | CARES Act and Other Grant Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 97,000

[1]

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
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-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9031-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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+ Details

Pension Plan - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Compensation And Retirement Disclosure [Abstract]
Amount of contributions to contributory plan	$ 69,800,000	$ 67,100,000	$ 56,300,000
Accumulated benefit obligation	116,000,000.0	123,200,000
Fair value of plan assets exceeded accumulated benefit obligation	11,300,000	$ 8,400,000
Estimated net loss that will be amortized from accumulated other comprehensive income over the next fiscal year	0
Estimated prior service cost that will be amortized from accumulated other comprehensive income over the next fiscal year	$ 0

Schedule of Reconciliation of Defined Benefit Pension Plan (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Compensation And Retirement Disclosure [Abstract]
Fair value of plan assets at beginning of year	$ 131,685	$ 120,287
Actual return (loss) on plan assets	2,771	18,169
Benefits paid	(6,389)	(6,260)
Administrative expenses	(707)	(511)
Fair value of plan assets at end of year	127,360	131,685	$ 120,287
Benefit obligation at beginning of year	123,237	117,556
Service cost	546	615	725
Interest cost	2,493	3,357	4,237
Benefits paid	(6,389)	(6,260)
Actuarial (gain) loss	(3,853)	7,969
Benefit obligation at end of year	116,034	123,237	$ 117,556
Other non-current assets	11,327	8,449
Total amounts recognized at end of year	$ 11,327	$ 8,449

Components of Net Periodic Pension Cost Benefit (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Compensation And Retirement Disclosure [Abstract]
Service cost	$ 546	$ 615	$ 725
Interest cost	2,493	3,357	4,237
Expected return on plan assets	(4,490)	(5,261)	(4,558)
Amortization of actuarial loss			1,533
Net periodic cost	$ (1,451)	$ (1,289)	$ 1,937

Schedule of Measurement Dates (Detail)	12 Months Ended
Schedule of Measurement Dates (Detail)	Dec. 31, 2021	Dec. 31, 2020
Benefit Obligation
Defined Benefit Plan Disclosure [Line Items]
Measurement Dates	Dec. 31, 2021	Dec. 31, 2020
Fair Value Of Plan Assets
Defined Benefit Plan Disclosure [Line Items]
Measurement Dates	Dec. 31, 2021	Dec. 31, 2020

Schedule of Weighted Average Assumptions (Detail)	12 Months Ended
Schedule of Weighted Average Assumptions (Detail)	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Compensation And Retirement Disclosure [Abstract]
Discount rate	2.52%	2.08%
Rate of compensation increase	4.00%	4.00%
Discount rate	2.08%	2.94%	4.03%
Expected long-term rate of return on plan assets	3.50%	4.50%	4.50%
Rate of compensation increase	4.00%	4.00%	4.00%

Schedule of Market Values of Pension Plan Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	$ 127,360	$ 131,685	$ 120,287
Equity Securities U.S. Large Cap
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	7,306	10,946
Equity Securities U.S. Mid Cap
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	2,014	3,403
Equity Securities U.S. Small Cap
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	1,913	3,581
Equity Securities International Developed
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	5,062	8,315
Equity Securities Emerging Markets
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	3,152	5,631
Fixed Income Securities Core Fixed Income
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	22,904	27,782
Fixed Income Securities Long Duration Fixed Income
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	84,277	68,886
Real Estate REIT Fund
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets		2,474
Cash Cash Equivalents
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	$ 732	$ 667

Schedule of Estimated Future Benefit Payments (Detail) $ in Thousands	Dec. 31, 2021 USD ($)
Compensation And Retirement Disclosure [Abstract]
2022	$ 6,994
2023	7,056
2024	7,057
2025	7,029
2026	6,973
2027-2031	33,438
Total	$ 68,547

Schedule of Plan Assets Category (Detail)	Dec. 31, 2021	Dec. 31, 2020
Defined Benefit Plan Disclosure [Line Items]
Asset Allocation	100.00%	100.00%
Equity Securities
Defined Benefit Plan Disclosure [Line Items]
Asset Allocation	15.00%	24.00%
Fixed Income Securities
Defined Benefit Plan Disclosure [Line Items]
Asset Allocation	84.00%	73.00%
Other
Defined Benefit Plan Disclosure [Line Items]
Asset Allocation	1.00%	3.00%

Schedule of Asset Allocation Policy and Ranges for Overall Risk and Return Objectives of Portfolio (Detail)	Dec. 31, 2021	Dec. 31, 2020
Defined Benefit Plan Disclosure [Line Items]
Assets allocation	100.00%	100.00%
Equity Funds
Defined Benefit Plan Disclosure [Line Items]
Assets allocation	15.00%	24.00%
Permitted Range, minimum	10.00%
Permitted Range, maximum	30.00%
Fixed Income Funds
Defined Benefit Plan Disclosure [Line Items]
Assets allocation	84.00%	73.00%
Permitted Range, minimum	70.00%
Permitted Range, maximum	90.00%
Other
Defined Benefit Plan Disclosure [Line Items]
Assets allocation	1.00%	3.00%
Permitted Range, minimum	0.00%
Permitted Range, maximum	10.00%

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

12 Months Ended

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

Segment Reporting Information [Line Items]

Gross inpatient revenues

$ 46,449,556

$ 40,281,027

$ 38,531,825

Gross outpatient revenues

21,647,468

17,236,319

18,733,333

Total net revenues

12,642,117

11,558,897

11,378,259

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

1,293,313

1,252,083

1,066,337

Allocation of corporate overhead

Income before income taxes

1,293,313

1,252,083

1,066,337

Total assets

13,093,543

13,476,879

11,668,250

Acute Care Hospital Services

Segment Reporting Information [Line Items]

Gross inpatient revenues

36,522,155

30,562,093

28,430,922

Gross outpatient revenues

20,633,921

16,272,520

17,666,629

Total net revenues

7,108,254

6,337,304

6,164,560

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

734,666

693,427

713,410

Allocation of corporate overhead

(233,298)

(223,921)

(230,166)

Income before income taxes

501,368

469,506

483,244

Total assets

5,534,912

4,927,456

4,405,643

Behavioral Health Services

Segment Reporting Information [Line Items]

Gross inpatient revenues

^[1]

9,927,401

9,718,934

10,100,903

Gross outpatient revenues

^[1]

1,013,547

963,799

1,066,704

Total net revenues

^[1]

5,503,644

5,208,722

5,210,063

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

^[1]

1,025,557

1,023,257

900,965

Allocation of corporate overhead

^[1]

(172,512)

(170,849)

(166,571)

Income before income taxes

^[1]

853,045

852,408

734,394

Total assets

^[1]

7,250,427

7,044,617

6,910,790

Other

Segment Reporting Information [Line Items]

Total net revenues

30,219

12,871

3,636

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

(466,910)

(464,601)

(548,038)

Allocation of corporate overhead

405,810

394,770

396,737

Income before income taxes

(61,100)

(69,831)

(151,301)

Total assets

$ 308,204

$ 1,504,806

$ 351,817

[1]

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

12 Months Ended

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

Segment Reporting Information [Line Items]

Net revenues

$ 12,642,117

$ 11,558,897

$ 11,378,259

Total assets

13,093,543

13,476,879

11,668,250

Provision for asset impairment

14,391

97,631

Behavioral Health Services

Segment Reporting Information [Line Items]

Net revenues

^[1]

5,503,644

5,208,722

5,210,063

Total assets

^[1]

7,250,427

7,044,617

6,910,790

Behavioral Health Services | Located in U.K.

Segment Reporting Information [Line Items]

Net revenues

688,000

584,000

554,000

Total assets

$ 1,351,000

1,334,000

$ 1,270,000

Trade Names | Real Property Assets | Behavioral Health Services

Segment Reporting Information [Line Items]

Provision for asset impairment

$ 98,000

[1]

- Definition

Sum of the carrying amounts as of the balance sheet date of all assets that are recognized. Assets are probable future economic benefits obtained or controlled by an entity as a result of past transactions or events.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 210
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-Paragraph 1
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Valuation and Qualifying Accounts (Detail) - Valuation Allowance for Deferred Tax Assets - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Valuation and Qualifying Accounts Disclosure [Line Items]
Balance at beginning of period	$ 68,003	$ 75,277	$ 79,264
Charges to costs and expenses (income)	(5,647)	(7,274)	(3,987)
Balance at end of period	$ 62,356	$ 68,003	$ 75,277