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Universal Health Services Announces 2023 Second Quarter Financial Results

July 25, 2023 | Last Trade: US$204.31 3.19 -1.54
  • Consolidated Results of Operations, As Reported and As Adjusted  – Three-month periods ended June 30, 2023 and 2022:

KING OF PRUSSIA, Pa., July 25, 2023 /PRNewswire/ -- Universal Health Services, Inc. (NYSE: UHS) announced today that its reported net income attributable to UHS was $171.3 million, or $2.42 per diluted share, during the second quarter of 2023, as compared to $164.1 million, or $2.20 per diluted share, during the second quarter of 2022. Net revenues increased by 6.8% to $3.548 billion during the second quarter of 2023, as compared to $3.323 billion during the second quarter of 2022.

As reflected on the Schedule of Non-GAAP Supplemental Information ("Supplemental Schedule"), our adjusted net income attributable to UHS during the second quarter of 2023 was $179.4 million, or $2.53 per diluted share, as compared to $163.9 million, or $2.20 per diluted share, during the second quarter of 2022.  As reflected on the Supplemental Schedule, included in our reported results was an unrealized after-tax loss of $8.1 million, or $.11 per diluted share, ($10.5 million pre-tax) during the second quarter of 2023. The unrealized loss, which is included in "Other (income) expense, net", resulted from a decrease in the market value of certain equity securities. 

As calculated on the attached Supplemental Schedule, our earnings before interest, taxes, depreciation & amortization ("EBITDA net of NCI", NCI is net income attributable to noncontrolling interests), was $419.3 million during the second quarter of 2023, as compared to $384.5 million during the second quarter of 2022. Our adjusted earnings before interest, taxes, depreciation & amortization ("Adjusted EBITDA net of NCI"), which excludes the impact of other (income) expense, net, was $425.9 million during the second quarter of 2023, as compared to $382.6 million during the second quarter of 2022.

Consolidated Results of Operations, As Reported and As Adjusted  – Six-month periods ended June 30, 2023 and 2022:

Reported net income attributable to UHS was $334.4 million, or $4.70 per diluted share, during the first six months of 2023, as compared to $318.0 million, or $4.22 per diluted share, during the first six months 2022. Net revenues increased by 6.0% to $7.016 billion during the first six months of 2023, as compared to $6.616 billion during the comparable period of 2022.

As reflected on the Supplemental Schedule, our adjusted net income attributable to UHS during the first six months of 2023, was $346.9 million, or $4.87 per diluted share, as compared to $327.4 million, or $4.35 per diluted share, during the six-month period ended June 30, 2022. 

As reflected on the Supplemental Schedule, included in our reported results were unrealized after-tax losses of $12.5 million, or $.17 per diluted share, ($16.3 million pre-tax) during the first six months of 2023 and $9.4 million, or $.13 per diluted share, ($12.3 million pre-tax) during the first six months of 2022. These unrealized losses, which are included in "Other (income) expense, net", resulted from decreases in the market value of certain equity securities. 

As calculated on the attached Supplemental Schedule, our earnings before interest, taxes, depreciation & amortization ("EBITDA net of NCI"), was $826.6 million during the first six months of 2023, as compared to $752.9 million during the first six months of 2022. Our adjusted earnings before interest, taxes, depreciation & amortization ("Adjusted EBITDA net of NCI"), which excludes the impact of other (income) expense, net, was $846.9 million during the first six months of 2023, as compared to $762.1 million during the comparable period of 2022.

Acute Care Services – Three and six-month periods ended June 30, 2023 and 2022:

During the second quarter of 2023, at our acute care hospitals owned during both periods ("same facility basis"), adjusted admissions (adjusted for outpatient activity) increased by 7.7% while adjusted patient days increased by 6.9%, as compared to the second quarter of 2022. At these facilities, during the second quarter of 2023, net revenue per adjusted admission increased by 1.3% while net revenue per adjusted patient day increased by 2.0%, as compared to the second quarter of 2022. Net revenues generated from our acute care services, on a same facility basis, increased by 9.7% during the second quarter of 2023, as compared to the second quarter of 2022.

 During the six-month period ended June 30, 2023, at our acute care hospitals on a same facility basis, adjusted admissions increased by 9.1% while adjusted patient days increased by 5.2%, as compared to the first six months of 2022. At these facilities, during the first six months of 2023, net revenue per adjusted admission decreased by 3.3% while net revenue per adjusted patient day increased by 0.3%, as compared to the first six months of 2022. Net revenues generated from our acute care services, on a same facility basis, increased by 6.6% during the first six months of 2023, as compared to the comparable period of 2022.

Behavioral Health Care Services – Three and six-month periods ended June 30, 2023 and 2022:

During the second quarter of 2023, at our behavioral health care facilities on a same facility basis, adjusted admissions increased by 3.3% while adjusted patient days increased by 1.5%, as compared to the second quarter of 2022. At these facilities, during the second quarter of 2023, net revenue per adjusted admission increased by 4.4% and net revenue per adjusted patient day increased by 6.2%, as compared to the second quarter of 2022. Net revenues generated from our behavioral health care services, on a same facility basis, increased by 7.8% during the second quarter of 2023, as compared to the second quarter of 2022.

During the six-month period ended June 30, 2023, at our behavioral health care facilities on a same facility basis, adjusted admissions increased by 5.4% while adjusted patient days increased by 3.1%, as compared to the first six months of 2022. At these facilities, during the first six months of 2023, net revenue per adjusted admission increased by 3.3% and net revenue per adjusted patient day increased by 5.6%, as compared to the first six months of 2022. Net revenues generated from our behavioral health care services, on a same facility basis, increased by 8.7% during the first six months of 2023, as compared to the comparable period of 2022.

Net Cash Provided by Operating Activities and Liquidity:

Net Cash Provided by Operating Activities:

During the six-month period ended June 30, 2023, our net cash provided by operating activities was $654 million as compared to $478 million during the first six months of 2022. Included in the $176 million net increase in our net cash provided by operating activities was a favorable change of $119 million in other working capital accounts due primarily to the timing of disbursements for accrued compensation and accounts payable.

Liquidity:

As of June 30, 2023, we had $946 million of aggregate available borrowing capacity pursuant to our $1.2 billion revolving credit facility, net of outstanding borrowings and letters of credit.  

Stock Repurchase Program:

As of December 31, 2022, we had an aggregate remaining repurchase authorization of approximately $947 million pursuant to our stock repurchase program. Pursuant to the terms of our stock repurchase program, 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. 

During the second quarter of 2023, we have repurchased 758,578 shares at an aggregate cost of approximately $113.4 million (approximately $150 per share) pursuant to the program. During the first six months of 2023, we have repurchased approximately 1.4 million shares at an aggregate cost of approximately $192.1 million (approximately $136 per share) pursuant to the program.

As of June 30, 2023, we had an aggregate available repurchase authorization of approximately $755 million

Revised 2023 Operating Results Forecasts:

Based upon the operating trends and financial results experienced during the first six months of 2023, as indicated on the Revised Forecast table below, we are increasing the lower end of our guidance range for consolidated net revenues, earnings before interest, taxes, depreciation & amortization, and the impacts of other income/expense and net income attributable to noncontrolling interests ("Adjusted EBITDA, net of NCI"), and adjusted net income attributable to UHS per diluted share ("Adjusted EPS-diluted") for the year ended December 31, 2023. The higher end of the 2023 guidance range for these metrics is remaining substantially unchanged.

The tables below include our revised 2023 operating results forecasts for the year ended December 31, 2023, as well as our original 2023 operating results forecast which was previously disclosed on February 27, 2023.

 

Revised Forecast

 

Original Forecast

 

For the Year Ended

 

For the Year Ended

 

December 31, 2023

 

December 31, 2023

 

Low

High

 

Low

High

Net revenues

$14.130 billion

$14.330 billion

 

$14.044 billion

$14.314 billion

Adjusted EBITDA, net of NCI

$1.696 billion

$1.756 billion

 

$1.662 billion

$1.753 billion

Adjusted EPS – diluted

$9.85 per share

$10.50 per share

 

$9.50 per share

$10.50 per share

Adjusted EPS-diluted and Adjusted EBITDA net of NCI, are non-GAAP financial measures and should be examined in connection with net income determined in accordance with GAAP as presented in the consolidated financial statements and notes thereto in this report or in our filings with the Securities and Exchange Commission including our Report on Form 10-K for the year ended December 31, 2022 and our Form 10-Q for the quarter ended March 31, 2023. Please see the schedule of Supplemental Non-GAAP Disclosures - 2023 Revised Operating Results Forecast, as included herein for additional information and a reconciliation to the financial forecasts as computed in accordance with GAAP.  In addition, the 2023 revised forecasted amounts exclude the impact of certain future items, if applicable, including those as outlined below in General Information, Forward-Looking Statements and Risk Factors and Non-GAAP Financial Measures.

Conference call information:

We will hold a conference call for investors and analysts at 9:00 a.m. eastern time on July 26, 2023.  A live webcast of the call will be available on our website at www.uhs.com. To participate via telephone, please register in advance at this link.  

Upon registration, all telephone participants will receive a confirmation email detailing how to join the conference call, including the dial-in number along with a unique passcode and registrant ID that can be used to access the call. A replay of the call will be available for one full year following the live call.

General Information, Forward-Looking Statements and Risk Factors and Non-GAAP Financial Measures:

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since our inception into an esteemed Fortune 500 corporation, our annual revenues during 2022 were approximately $13.4 billion. UHS ranked #311 on the Fortune 500; and #434 on Forbes' list of America's Largest Public Companies. UHS was again recognized as one of the World's Most Admired Companies by Fortune.  

Our operating philosophy is as effective today as it was upon the Company's founding in 1979, enabling us to provide compassionate care to our patients and their loved ones.  Our strategy includes building or acquiring high quality hospitals in rapidly growing markets, investing in the people and equipment needed to allow each facility to thrive, and becoming the leading healthcare provider in each community we serve.

Headquartered in King of Prussia, PA, UHS has approximately 93,800 employees and, through its subsidiaries, operates 27 inpatient acute care hospitals, 331 inpatient behavioral health facilities, 42 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 39 states, Washington, D.C., the United Kingdom and Puerto Rico. It acts as the advisor to Universal Health Realty Income Trust, a real estate investment trust (NYSE:UHT).  For additional information visit www.uhs.com.

This press release contains forward-looking statements based on current management expectations.  Numerous factors, including those disclosed herein, those related to the potential impact of COVID-19 on our operations and financial results, those related to healthcare industry trends and those detailed in our filings with the Securities and Exchange Commission (as set forth in Item 2-Forward Looking Statements and Risk Factors in our Form 10-Q for the quarter ended March 31, 2023 and in Item 1A-Risk Factors, and Item 7-Forward-Looking Statements and Risk Factors, in our Form 10-K for the year ended December 31, 2022), may cause the results to differ materially from those anticipated in the forward-looking statements.  These statements are subject to risks and uncertainties and therefore actual results may differ materially.  Readers should not place undue reliance on such forward-looking statements which reflect management's view only as of the date hereof.  We undertake no obligation to revise or update any forward-looking statements, or to make any other forward-looking statements, whether as a result of new information, future events or otherwise. 

Many of the factors that could affect our future results are beyond our control or ability to predict, including, but not limited to:

  • The nationwide shortage of nurses and other clinical staff and support personnel has been a significant operating issue facing us and other healthcare providers. In some areas, the labor scarcity is putting a strain on our resources and staff, which has required us to utilize higher‑cost temporary labor and pay premiums above standard compensation for essential workers. These factors, which had a material unfavorable impact on our results of operations during 2022, could continue to have an unfavorable material impact on our results of operations for the foreseeable future.
  • The impact of the COVID-19 pandemic, which began in March, 2020, has had a material effect on our operations and financial results, at various times, since that time. We cannot predict if there will be future disruptions caused by the COVID‑19 pandemic.      
  • A significant portion of our revenues are derived from federal and state government programs including the Medicare and Medicaid programs. Payments from these programs are subject to statutory and regulatory changes, administrative rulings, interpretations and determinations, requirements for utilization review, and federal and state funding restrictions.  Changes to these programs, if adopted, could materially affect program payments which could materially impact our results of operations.
  • The increase in interest rates has substantially increased our borrowings costs and reduced our ability to access the capital markets on favorable terms.  Additional increases in interest rates could have a significant unfavorable impact on our future results of operations and the resulting effect on the capital markets could adversely affect our ability to carry out our strategy.       

We believe that adjusted net income attributable to UHS, adjusted net income attributable to UHS per diluted share, EBITDA net of NCI and Adjusted EBITDA net of NCI, which are non-GAAP financial measures ("GAAP" is Generally Accepted Accounting Principles in the United States of America), are helpful to our investors as measures of our operating performance. In addition, we believe that, when applicable, comparing and discussing our financial results based on these measures, as calculated, is helpful to our investors since it neutralizes the effect of material items impacting our net income attributable to UHS, such as, changes in the market value of shares of certain equity securities and other potential material items that are nonrecurring or non-operational in nature including, but not limited to, impairments of goodwill, long-lived and intangible assets, reserves for various matters including settlements, legal judgments and lawsuits, costs related to extinguishment of debt, gains/losses on sales of assets and businesses, potential impacts of non-ordinary acquisitions, divestitures, joint ventures or other strategic transactions, and other amounts that may be reflected in the current or prior year financial statements that relate to prior periods. To obtain a complete understanding of our financial performance these measures should be examined in connection with net income attributable to UHS, as determined in accordance with GAAP, and as presented in the condensed consolidated financial statements and notes thereto in this report or in our other filings with the Securities and Exchange Commission including our Report on Form 10-Q for the quarter ended March 31, 2023 and our Report on Form 10-K for the year ended December 31, 2022. Since the items included or excluded from these measures are significant components in understanding and assessing financial performance under GAAP, these measures should not be considered to be alternatives to net income as a measure of our operating performance or profitability. Since these measures, as presented, are not determined in accordance with GAAP and are thus susceptible to varying calculations, they may not be comparable to other similarly titled measures of other companies. Investors are encouraged to use GAAP measures when evaluating our financial performance.

Universal Health Services, Inc.

Consolidated Statements of Income

(in thousands, except per share amounts)

(unaudited)

        
 

Three months

 

Six months

 

ended June 30,

 

ended June 30,

 

2023

 

2022

 

2023

 

2022

        

Net revenues

$3,548,138

 

$3,323,407

 

$7,015,656

 

$6,616,363

        

Operating charges:

       

   Salaries, wages and benefits

1,770,271

 

1,691,472

 

3,523,606

 

3,383,742

   Other operating expenses

938,314

 

867,885

 

1,817,265

 

1,688,819

   Supplies expense

380,294

 

354,993

 

760,283

 

726,066

   Depreciation and amortization

143,744

 

143,850

 

285,365

 

287,634

   Lease and rental expense

35,387

 

31,773

 

70,309

 

63,811

 

3,268,010

 

3,089,973

 

6,456,828

 

6,150,072

        

Income from operations

280,128

 

233,434

 

558,828

 

466,291

        

Interest expense, net

48,831

 

25,676

 

99,707

 

47,349

Other (income) expense, net

6,602

 

(1,972)

 

20,325

 

9,229

        

Income before income taxes

224,695

 

209,730

 

438,796

 

409,713

        

Provision for income taxes

55,393

 

50,949

 

107,119

 

99,911

        

Net income

169,302

 

158,781

 

331,677

 

309,802

        

Less:  Net income (loss) attributable to

       

noncontrolling interests ("NCI")

(2,011)

 

(5,281)

 

(2,751)

 

(8,173)

        

Net income attributable to UHS

$171,313

 

$164,062

 

$334,428

 

$317,975

        
        
        
        

Basic earnings per share attributable to UHS (a)

$2.44

 

$2.22

 

$4.75

 

$4.27

        

Diluted earnings per share attributable to UHS (a)

$2.42

 

$2.20

 

$4.70

 

$4.22

Universal Health Services, Inc.

Footnotes to Consolidated Statements of Income

(in thousands, except per share amounts)

(unaudited)

        
 

Three months

 

Six months

(a) Earnings per share calculation:

ended June 30,

 

ended June 30,

 

2023

 

2022

 

2023

 

2022

Basic and diluted:

       

Net income attributable to UHS

$171,313

 

$164,062

 

$334,428

 

$317,975

Less: Net income attributable to unvested restricted share grants

(61)

 

(164)

 

(190)

 

(413)

Net income attributable to UHS - basic and diluted

$171,252

 

$163,898

 

$334,238

 

$317,562

        

Weighted average number of common shares - basic

70,073

 

73,682

 

70,304

 

74,356

        

Basic earnings per share attributable to UHS:

$2.44

 

$2.22

 

$4.75

 

$4.27

        

Weighted average number of common shares

70,073

 

73,682

 

70,304

 

74,356

Add: Other share equivalents

766

 

753

 

859

 

882

Weighted average number of common shares and equiv. - diluted

70,839

 

74,435

 

71,163

 

75,238

        

Diluted earnings per share attributable to UHS:

$2.42

 

$2.20

 

$4.70

 

$4.22

Universal Health Services, Inc.

Schedule of Non-GAAP Supplemental Information ("Supplemental Schedule")

For the Three Months ended June 30, 2023 and 2022

(in thousands, except per share amounts)

(unaudited)

        

Calculation of Earnings/Adjusted Earnings Before Interest, Taxes, Depreciation and Amortization
("EBITDA/Adjusted EBITDA net of NCI")

        
 

Three months ended

 

% Net

 

Three months ended

 

% Net

 

June 30, 2023

 

revenues

 

June 30, 2022

 

revenues

        

Net income attributable to UHS

$171,313

   

$164,062

  

   Depreciation and amortization

143,744

   

143,850

  

   Interest expense, net

48,831

   

25,676

  

   Provision for income taxes

55,393

   

50,949

  

EBITDA net of NCI

$419,281

 

11.8 %

 

$384,537

 

11.6 %

        

Other (income) expense, net

6,602

   

(1,972)

  

Adjusted EBITDA net of NCI

$425,883

 

12.0 %

 

$382,565

 

11.5 %

        

Net revenues

$3,548,138

   

$3,323,407

  
        
        
        

Calculation of Adjusted Net Income Attributable to UHS

        
 

Three months ended

 

Three months ended

 

June 30, 2023

 

June 30, 2022

   

Per

   

Per

 

Amount

 

Diluted Share

 

Amount

 

Diluted Share

        

Net income attributable to UHS

$171,313

 

$2.42

 

$164,062

 

$2.20

Plus/minus after-tax adjustments:

       

Unrealized loss (gain) on equity securities

8,051

 

0.11

 

(153)

 

-

Subtotal adjustments

8,051

 

0.11

 

(153)

 

-

Adjusted net income attributable to UHS

$179,364

 

$2.53

 

$163,909

 

$2.20

Universal Health Services, Inc.

Schedule of Non-GAAP Supplemental Information ("Supplemental Schedule")

For the Six Months ended June 30, 2023 and 2022

(in thousands, except per share amounts)

(unaudited)

        

Calculation of Earnings/Adjusted Earnings Before Interest, Taxes, Depreciation and Amortization
("EBITDA/Adjusted EBITDA net of NCI")

        
 

Six months ended

 

% Net

 

Six months ended

 

% Net

 

June 30, 2023

 

revenues

 

June 30, 2022

 

revenues

        

Net income attributable to UHS

$334,428

   

$317,975

  

   Depreciation and amortization

285,365

   

287,634

  

   Interest expense, net

99,707

   

47,349

  

   Provision for income taxes

107,119

   

99,911

  

EBITDA net of NCI

$826,619

 

11.8 %

 

$752,869

 

11.4 %

        

Other (income) expense, net

20,325

   

9,229

  

Adjusted EBITDA net of NCI

$846,944

 

12.1 %

 

$762,098

 

11.5 %

        

Net revenues

$7,015,656

   

$6,616,363

  
        
        
        

Calculation of Adjusted Net Income Attributable to UHS

        
 

Six months ended

 

Six months ended

 

June 30, 2023

 

June 30, 2022

   

Per

   

Per

 

Amount

 

Diluted Share

 

Amount

 

Diluted Share

        

Net income attributable to UHS

$334,428

 

$4.70

 

$317,975

 

$4.22

Plus/minus after-tax adjustments:

       

Unrealized loss on equity securities

12,512

 

0.17

 

9,384

 

0.13

Subtotal adjustments

12,512

 

0.17

 

9,384

 

0.13

Adjusted net income attributable to UHS

$346,940

 

$4.87

 

$327,359

 

$4.35

Universal Health Services, Inc.

Condensed Consolidated Balance Sheets

(in thousands)

(unaudited)

       
   

June 30,

  

December 31,

   

2023

  

2022

Assets

      

Current assets:

      

    Cash and cash equivalents

 

$

79,451

 

$

102,818

    Accounts receivable, net

  

2,103,478

  

2,017,722

    Supplies

  

215,380

  

218,517

    Other current assets

  

226,405

  

198,283

          Total current assets

  

2,624,714

  

2,537,340

       

Property and equipment

  

11,441,608

  

11,085,852

Less: accumulated depreciation

  

(5,413,892)

  

(5,167,394)

   

6,027,716

  

5,918,458

       

Other assets:

      

    Goodwill

  

3,929,722

  

3,909,456

    Deferred income taxes

  

109,773

  

68,397

    Right of use assets-operating leases

  

446,618

  

454,650

    Deferred charges

  

5,858

  

6,264

    Other

  

587,908

  

599,623

Total Assets

 

$

13,732,309

 

$

13,494,188

       

Liabilities and Stockholders' Equity

      

Current liabilities:

      

    Current maturities of long-term debt

 

$

111,357

 

$

81,447

    Accounts payable and other liabilities

  

1,843,379

  

1,760,588

    Operating lease liabilities

  

73,649

  

67,776

    Federal and state taxes

  

6,962

  

4,608

          Total current liabilities

  

2,035,347

  

1,914,419

       

Other noncurrent liabilities

  

571,206

  

487,669

Operating lease liabilities noncurrent

  

387,709

  

395,522

Long-term debt

  

4,605,075

  

4,726,533

       

Redeemable noncontrolling interest

  

4,213

  

4,695

       

UHS common stockholders' equity

  

6,087,182

  

5,920,582

Noncontrolling interest

  

41,577

  

44,768

          Total equity

  

6,128,759

  

5,965,350

       

Total Liabilities and Stockholders' Equity

 

$

13,732,309

 

$

13,494,188

Universal Health Services, Inc.

Consolidated Statements of Cash Flows

(in thousands)

(unaudited)

    
 

Six months

 

ended June 30,

 

2023

 

2022

    

Cash Flows from Operating Activities:

   

  Net income

$331,677

 

$309,802

  Adjustments to reconcile net income to net

   

   cash provided by operating activities:

   

   Depreciation & amortization

285,365

 

287,634

   (Gain) loss on sale of assets and businesses

(6,250)

 

1,084

   Stock-based compensation expense

43,062

 

41,640

  Changes in assets & liabilities, net of effects from

   

   acquisitions and dispositions:

   

   Accounts receivable

(82,078)

 

(89,729)

   Accrued interest

(107)

 

1,329

   Accrued and deferred income taxes

(32,695)

 

(34,260)

   Other working capital accounts

20,216

 

(98,811)

   Medicare accelerated payments and deferred CARES Act and other grants

2,741

 

5,339

   Other assets and deferred charges

32,746

 

30,278

   Other

15,471

 

(15,763)

   Accrued insurance expense, net of commercial premiums paid

95,157

 

97,570

   Payments made in settlement of self-insurance claims

(51,604)

 

(58,066)

          Net cash provided by operating activities

653,701

 

478,047

    

Cash Flows from Investing Activities:

   

   Property and equipment additions

(336,664)

 

(407,962)

   Proceeds received from sales of assets and businesses

23,688

 

10,232

   Acquisition of businesses and property

(3,728)

 

(12,485)

   (Outflows) inflows from foreign exchange contracts that hedge our net U.K. investment

(31,305)

 

84,535

   Decrease in capital reserves of commercial insurance subsidiary

0

 

100

          Net cash used in investing activities

(348,009)

 

(325,580)

    

Cash Flows from Financing Activities:

   

   Repayments of long-term debt

(93,557)

 

(226,854)

   Additional borrowings

0

 

700,000

   Financing costs

(293)

 

(2,387)

   Repurchase of common shares

(209,756)

 

(565,182)

   Dividends paid

(28,263)

 

(29,641)

   Issuance of common stock

6,598

 

6,661

   Profit distributions to noncontrolling interests

(4,735)

 

(5,323)

   Purchase (sale) of ownership interests by (from) minority members

407

 

(1,307)

          Net cash used in financing activities

(329,599)

 

(124,033)

    

   Effect of exchange rate changes on cash, cash equivalents and restricted cash

2,377

 

(5,457)

Decrease (increase) in cash, cash equivalents and restricted cash

(21,530)

 

22,977

Cash, cash equivalents and restricted cash, beginning of period

200,837

 

178,934

Cash, cash equivalents and restricted cash, end of period

$179,307

 

$201,911

    

Supplemental Disclosures of Cash Flow Information:

   

  Interest paid

$97,297

 

$43,796

    

  Income taxes paid, net of refunds

$133,840

 

$145,448

    

  Noncash purchases of property and equipment

$100,461

 

$112,420

Universal Health Services, Inc.

Supplemental Statistical Information

(unaudited)

          
       

 % Change

 

 % Change

       

3 Months ended

 

6 Months ended

Same Facility:

      

6/30/2023

 

6/30/2023

          

Acute Care Hospitals

         

Revenues

      

9.7 %

 

6.6 %

Adjusted Admissions

      

7.7 %

 

9.1 %

Adjusted Patient Days

      

6.9 %

 

5.2 %

Revenue Per Adjusted Admission

      

1.3 %

 

-3.3 %

Revenue Per Adjusted Patient Day

      

2.0 %

 

0.3 %

          

Behavioral Health Hospitals

         

Revenues

      

7.8 %

 

8.7 %

Adjusted Admissions

      

3.3 %

 

5.4 %

Adjusted Patient Days

      

1.5 %

 

3.1 %

Revenue Per Adjusted Admission

      

4.4 %

 

3.3 %

Revenue Per Adjusted Patient Day

      

6.2 %

 

5.6 %

          

UHS Consolidated

  

Second Quarter Ended

 

Six Months Ended

   

6/30/2023

 

6/30/2022

 

6/30/2023

 

6/30/2022

          

Revenues

  

$3,548,138

 

$3,323,407

 

$7,015,656

 

$6,616,363

EBITDA net of NCI

  

$419,281

 

$384,537

 

$826,619

 

$752,869

EBITDA Margin net of NCI

  

11.8 %

 

11.6 %

 

11.8 %

 

11.4 %

Adjusted EBITDA net of NCI

  

$425,883

 

$382,565

 

$846,944

 

$762,098

Adjusted EBITDA Margin net of NCI

  

12.0 %

 

11.5 %

 

12.1 %

 

11.5 %

          

Cash Flow From Operations

  

$362,948

 

$32,614

 

$653,701

 

$478,047

Days Sales Outstanding

  

54

 

50

 

54

 

50

Capital Expenditures 

  

$167,912

 

$207,960

 

$336,664

 

$407,962

          

Debt

      

$4,716,432

 

$4,665,409

UHS' Shareholders Equity

      

$6,087,182

 

$5,814,660

Debt / Total Capitalization

      

43.7 %

 

44.5 %

Debt / EBITDA net of NCI (1)

      

2.83

 

2.81

Debt / Adjusted EBITDA net of NCI (1)

     

2.70

 

2.81

Debt / Cash From Operations (1)

      

4.03

 

3.76

          

(1) Latest 4 quarters.

         

Universal Health Services, Inc.

Acute Care Hospital Services

For the Three and Six Months ended

June 30, 2023 and 2022

(in thousands)

                 

Same Facility Basis - Acute Care Hospital Services

                
                 
  

Three months ended

 

Three months ended

 

Six months ended

 

Six months ended

  

June 30, 2023

 

June 30, 2022

 

June 30, 2023

 

June 30, 2022

  

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

Net revenues

 

$1,953,269

 

100.0 %

 

$1,779,801

 

100.0 %

 

$3,842,349

 

100.0 %

 

$3,604,498

 

100.0 %

Operating charges:

                

Salaries, wages and benefits

 

828,503

 

42.4 %

 

799,804

 

44.9 %

 

1,639,056

 

42.7 %

 

1,611,447

 

44.7 %

Other operating expenses

 

548,713

 

28.1 %

 

469,560

 

26.4 %

 

1,041,113

 

27.1 %

 

904,030

 

25.1 %

Supplies expense

 

323,746

 

16.6 %

 

292,303

 

16.4 %

 

640,002

 

16.7 %

 

602,385

 

16.7 %

Depreciation and amortization

 

91,511

 

4.7 %

 

89,980

 

5.1 %

 

178,438

 

4.6 %

 

181,744

 

5.0 %

Lease and rental expense

 

23,639

 

1.2 %

 

20,204

 

1.1 %

 

47,231

 

1.2 %

 

40,909

 

1.1 %

Subtotal-operating expenses

 

1,816,112

 

93.0 %

 

1,671,851

 

93.9 %

 

3,545,840

 

92.3 %

 

3,340,515

 

92.7 %

Income from operations

 

137,157

 

7.0 %

 

107,950

 

6.1 %

 

296,509

 

7.7 %

 

263,983

 

7.3 %

Interest expense, net

 

(503)

 

(0.0) %

 

478

 

0.0 %

 

(1,080)

 

(0.0) %

 

1,116

 

0.0 %

Other (income) expense, net

 

0

 

-

 

221

 

0.0 %

 

6,213

 

0.2 %

 

422

 

0.0 %

Income before income taxes

 

$137,660

 

7.0 %

 

$107,251

 

6.0 %

 

$291,376

 

7.6 %

 

$262,445

 

7.3 %

                 
                 
                 

All Acute Care Hospital Services

                
                 
  

Three months ended

 

Three months ended

 

Six months ended

 

Six months ended

  

June 30, 2023

 

June 30, 2022

 

June 30, 2023

 

June 30, 2022

  

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

Net revenues

 

$2,003,079

 

100.0 %

 

$1,875,516

 

100.0 %

 

$3,976,611

 

100.0 %

 

$3,787,832

 

100.0 %

Operating charges:

                

Salaries, wages and benefits

 

836,331

 

41.8 %

 

829,040

 

44.2 %

 

1,680,291

 

42.3 %

 

1,672,946

 

44.2 %

Other operating expenses

 

590,616

 

29.5 %

 

532,504

 

28.4 %

 

1,134,916

 

28.5 %

 

1,014,582

 

26.8 %

Supplies expense

 

327,650

 

16.4 %

 

302,728

 

16.1 %

 

655,710

 

16.5 %

 

624,155

 

16.5 %

Depreciation and amortization

 

94,304

 

4.7 %

 

95,004

 

5.1 %

 

187,630

 

4.7 %

 

189,538

 

5.0 %

Lease and rental expense

 

24,035

 

1.2 %

 

20,482

 

1.1 %

 

48,189

 

1.2 %

 

41,334

 

1.1 %

Subtotal-operating expenses

 

1,872,936

 

93.5 %

 

1,779,758

 

94.9 %

 

3,706,736

 

93.2 %

 

3,542,555

 

93.5 %

Income from operations

 

130,143

 

6.5 %

 

95,758

 

5.1 %

 

269,875

 

6.8 %

 

245,277

 

6.5 %

Interest expense, net

 

(503)

 

(0.0) %

 

478

 

0.0 %

 

(1,080)

 

(0.0) %

 

1,116

 

0.0 %

Other (income) expense, net

 

119

 

0.0 %

 

221

 

0.0 %

 

7,132

 

0.2 %

 

422

 

0.0 %

Income before income taxes

 

$130,527

 

6.5 %

 

$95,059

 

5.1 %

 

$263,823

 

6.6 %

 

$243,739

 

6.4 %

 

We believe that providing our results on a "Same Facility" basis (which is a non-GAAP measure), which includes the operating results for facilities and businesses operated in both the current year and prior year periods, is helpful to our investors as a measure of our operating performance. Our Same Facility results also neutralize (if applicable), the effect of material items that are nonrecurring or non-operational in nature including items such as, but not limited to, reserves for various matters, settlements, legal judgments and lawsuits, cost related to extinguishment of debt, gains/losses on sales of assets and businesses, impairments of goodwill, long-lived and intangible assets and other amounts that may be reflected in the current or prior year financial statements that relate to prior periods. Our Same Facility basis results exclude from net revenues and other operating expenses, provider tax assessments incurred in each period. However, these provider tax assessments are included in net revenues and other operating expenses as reflected in the table under All Acute Care Hospital Services. The provider tax assessments had no impact on the income before income taxes as reflected on the above tables since the amounts offset between net revenues and other operating expenses. To obtain a complete understanding of our financial performance, the Same Facility results should be examined in connection with our net income as determined in accordance with GAAP and as presented herein and the condensed consolidated financial statements and notes thereto as contained in our Form 10-K for the year ended December 31, 2022 and Form 10-Q for the quarter ended March 31, 2023.

                   

The All Acute Care Hospital Services table summarizes the results of operations for all our acute care operations during the periods presented. These amounts include: (i) our acute care results on a same facility basis, as indicated above; (ii) the impact of provider tax assessments which increased net revenues and other operating expenses but had no impact on income before income taxes, and; (iii) certain other amounts including the results of facilities acquired or opened during the last twelve months.

Universal Health Services, Inc.

Behavioral Health Care Services

For the Three and Six Months ended

June 30, 2023 and 2022

(in thousands)

                 

Same Facility - Behavioral Health Care Services

                
                 
  

Three months ended

 

Three months ended

 

Six months ended

 

Six months ended

  

June 30, 2023

 

June 30, 2022

 

June 30, 2023

 

June 30, 2022

  

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

Net revenues

 

$1,517,005

 

100.0 %

 

$1,407,147

 

100.0 %

 

$2,976,724

 

100.0 %

 

$2,737,959

 

100.0 %

Operating charges:

                

Salaries, wages and benefits

 

843,222

 

55.6 %

 

767,333

 

54.5 %

 

1,649,168

 

55.4 %

 

1,513,493

 

55.3 %

Other operating expenses

 

296,203

 

19.5 %

 

274,146

 

19.5 %

 

573,572

 

19.3 %

 

542,694

 

19.8 %

Supplies expense

 

53,773

 

3.5 %

 

52,373

 

3.7 %

 

106,103

 

3.6 %

 

101,991

 

3.7 %

Depreciation and amortization

 

46,554

 

3.1 %

 

45,280

 

3.2 %

 

91,555

 

3.1 %

 

90,762

 

3.3 %

Lease and rental expense

 

11,203

 

0.7 %

 

10,415

 

0.7 %

 

21,785

 

0.7 %

 

20,676

 

0.8 %

Subtotal-operating expenses

 

1,250,955

 

82.5 %

 

1,149,547

 

81.7 %

 

2,442,183

 

82.0 %

 

2,269,616

 

82.9 %

Income from operations

 

266,050

 

17.5 %

 

257,600

 

18.3 %

 

534,541

 

18.0 %

 

468,343

 

17.1 %

Interest expense, net

 

993

 

0.1 %

 

1,360

 

0.1 %

 

2,071

 

0.1 %

 

2,587

 

0.1 %

Other (income) expense, net

 

(733)

 

(0.0) %

 

(643)

 

(0.0) %

 

(1,309)

 

(0.0) %

 

(758)

 

(0.0) %

Income before income taxes

 

265,790

 

17.5 %

 

$256,883

 

18.3 %

 

$533,779

 

17.9 %

 

$466,514

 

17.0 %

                 
                 
                 

All Behavioral Health Care Services

                
                 
  

Three months ended

 

Three months ended

 

Six months ended

 

Six months ended

  

June 30, 2023

 

June 30, 2022

 

June 30, 2023

 

June 30, 2022

  

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

 

Amount

 

% of Net
Revenues

Net revenues

 

$1,542,194

 

100.0 %

 

$1,433,920

 

100.0 %

 

$3,032,683

 

100.0 %

 

$2,800,387

 

100.0 %

Operating charges:

                

Salaries, wages and benefits

 

844,308

 

54.7 %

 

773,966

 

54.0 %

 

1,654,094

 

54.5 %

 

1,527,852

 

54.6 %

Other operating expenses

 

322,518

 

20.9 %

 

299,782

 

20.9 %

 

627,750

 

20.7 %

 

598,249

 

21.4 %

Supplies expense

 

53,837

 

3.5 %

 

52,655

 

3.7 %

 

106,325

 

3.5 %

 

102,832

 

3.7 %

Depreciation and amortization

 

46,778

 

3.0 %

 

45,863

 

3.2 %

 

92,397

 

3.0 %

 

91,942

 

3.3 %

Lease and rental expense

 

11,255

 

0.7 %

 

10,973

 

0.8 %

 

21,923

 

0.7 %

 

21,793

 

0.8 %

Subtotal-operating expenses

 

1,278,696

 

82.9 %

 

1,183,239

 

82.5 %

 

2,502,489

 

82.5 %

 

2,342,668

 

83.7 %

Income from operations

 

263,498

 

17.1 %

 

250,681

 

17.5 %

 

530,194

 

17.5 %

 

457,719

 

16.3 %

Interest expense, net

 

993

 

0.1 %

 

1,366

 

0.1 %

 

2,204

 

0.1 %

 

2,731

 

0.1 %

Other (income) expense, net

 

(1,188)

 

(0.1) %

 

(643)

 

(0.0) %

 

(2,059)

 

(0.1) %

 

(758)

 

(0.0) %

Income before income taxes

 

263,693

 

17.1 %

 

$249,958

 

17.4 %

 

$530,049

 

17.5 %

 

$455,746

 

16.3 %

 

We believe that providing our results on a "Same Facility" basis (which is a non-GAAP measure), which includes the operating results for facilities and businesses operated in both the current year and prior year periods, is helpful to our investors as a measure of our operating performance. Our Same Facility results also neutralize (if applicable), the effect of material items that are nonrecurring or non-operational in nature including items such as, but not limited to, reserves for various matters, settlements, legal judgments, lawsuits and reserves established in connection with the government's investigation of our behavioral health care facilities, cost related to extinguishment of debt, gains/losses on sales of assets and businesses, impairments of goodwill, long-lived and intangible assets and other amounts that may be reflected in the current or prior year financial statements that relate to prior periods. Our Same Facility basis results exclude from net revenues and other operating expenses, provider tax assessments incurred in each period. However, these provider tax assessments are included in net revenues and other operating expenses as reflected in the table under All Behavioral Health Care Services. The provider tax assessments had no impact on the income before income taxes as reflected on the above tables since the amounts offset between net revenues and other operating expenses. To obtain a complete understanding of our financial performance, the Same Facility results should be examined in connection with our net income as determined in accordance with GAAP and as presented herein and in the condensed consolidated financial statements and notes thereto as contained in our Form 10-K for the year ended December 31, 2022 and Form 10-Q for the quarter ended March 31, 2023.

                   

The All Behavioral Health Care Services table summarizes the results of operations for all our behavioral health care facilities during the periods presented. These amounts include: (i) our behavioral health results on a same facility basis, as indicated above; (ii) the impact of provider tax assessments which increased net revenues and other operating expenses but had no impact on income before income taxes, and; (iii) certain other amounts including the results of facilities acquired or opened during the last twelve months as well as the results of certain facilities that were closed or restructured during the past year.

Universal Health Services, Inc.

Selected Hospital Statistics

For the Three Months ended

June 30, 2023 and 2022

             

AS REPORTED:

            
             
             
  

ACUTE

 

BEHAVIORAL HEALTH

  

6/30/23

 

6/30/22

 

%  change

 

6/30/23

 

6/30/22

 

%  change

             

Hospitals owned and leased

 

27

 

28

 

-3.6 %

 

331

 

333

 

-0.6 %

Average licensed beds

 

6,624

 

6,971

 

-5.0 %

 

24,189

 

24,340

 

-0.6 %

Average available beds

 

6,452

 

6,799

 

-5.1 %

 

24,089

 

24,240

 

-0.6 %

Patient days

 

384,373

 

375,955

 

2.2 %

 

1,588,575

 

1,574,715

 

0.9 %

Average daily census

 

4,223.8

 

4,131.4

 

2.2 %

 

17,456.9

 

17,304.6

 

0.9 %

Occupancy-licensed beds

 

63.8 %

 

59.3 %

 

7.6 %

 

72.2 %

 

71.1 %

 

1.5 %

Occupancy-available beds

 

65.5 %

 

60.8 %

 

7.7 %

 

72.5 %

 

71.4 %

 

1.5 %

Admissions

 

79,100

 

76,713

 

3.1 %

 

119,656

 

116,627

 

2.6 %

Length of stay

 

4.9

 

4.9

 

-0.8 %

 

13.3

 

13.4

 

-0.9 %

             

Inpatient revenue

 

$10,960,845

 

$9,706,731

 

12.9 %

 

$2,670,370

 

$2,561,553

 

4.2 %

Outpatient revenue

 

7,515,780

 

6,206,039

 

21.1 %

 

281,036

 

268,489

 

4.7 %

Total patient revenue

 

18,476,625

 

15,912,770

 

16.1 %

 

2,951,406

 

2,830,042

 

4.3 %

Other revenue

 

240,899

 

202,975

 

18.7 %

 

73,926

 

75,359

 

-1.9 %

Gross hospital revenue

 

18,717,524

 

16,115,745

 

16.1 %

 

3,025,332

 

2,905,401

 

4.1 %

Total deductions

 

16,714,445

 

14,240,229

 

17.4 %

 

1,483,138

 

1,471,481

 

0.8 %

Net hospital revenue

 

$2,003,079

 

$1,875,516

 

6.8 %

 

$1,542,194

 

$1,433,920

 

7.6 %

             
             

SAME FACILITY:

            
             
  

ACUTE

 

BEHAVIORAL HEALTH

  

6/30/23

 

6/30/22

 

%  change

 

6/30/23

 

6/30/22

 

%  change

             

Hospitals owned and leased

 

27

 

27

 

0.0 %

 

330

 

330

 

0.0 %

Average licensed beds

 

6,624

 

6,689

 

-1.0 %

 

24,063

 

23,991

 

0.3 %

Average available beds

 

6,452

 

6,517

 

-1.0 %

 

23,963

 

23,891

 

0.3 %

Patient days

 

384,373

 

362,044

 

6.2 %

 

1,578,277

 

1,559,048

 

1.2 %

Average daily census

 

4,223.8

 

3,978.5

 

6.2 %

 

17,343.7

 

17,132.4

 

1.2 %

Occupancy-licensed beds

 

63.8 %

 

59.5 %

 

7.2 %

 

72.1 %

 

71.4 %

 

0.9 %

Occupancy-available beds

 

65.5 %

 

61.0 %

 

7.2 %

 

72.4 %

 

71.7 %

 

0.9 %

Admissions

 

79,100

 

73,927

 

7.0 %

 

118,778

 

115,271

 

3.0 %

Length of stay

 

4.9

 

4.9

 

-0.8 %

 

13.3

 

13.5

 

-1.8 %

Universal Health Services, Inc.

Selected Hospital Statistics

For the Six Months ended

June 30, 2023 and 2022

             
             

AS REPORTED:

            
             
             
  

ACUTE

 

BEHAVIORAL HEALTH

  

6/30/23

 

6/30/22

 

%  change

 

6/30/23

 

6/30/22

 

%  change

             

Hospitals owned and leased

 

27

 

28

 

-3.6 %

 

331

 

333

 

-0.6 %

Average licensed beds

 

6,711

 

6,860

 

-2.2 %

 

24,210

 

24,291

 

-0.3 %

Average available beds

 

6,539

 

6,688

 

-2.2 %

 

24,110

 

24,191

 

-0.3 %

Patient days

 

788,626

 

781,907

 

0.9 %

 

3,161,147

 

3,081,066

 

2.6 %

Average daily census

 

4,357.0

 

4,319.9

 

0.9 %

 

17,464.9

 

17,022.5

 

2.6 %

Occupancy-licensed beds

 

64.9 %

 

63.0 %

 

3.1 %

 

72.1 %

 

70.1 %

 

2.9 %

Occupancy-available beds

 

66.6 %

 

64.6 %

 

3.2 %

 

72.4 %

 

70.4 %

 

2.9 %

Admissions

 

159,226

 

152,002

 

4.8 %

 

240,216

 

229,060

 

4.9 %

Length of stay

 

5.0

 

5.1

 

-3.7 %

 

13.2

 

13.5

 

-2.2 %

             

Inpatient revenue

 

$22,362,336

 

$19,945,962

 

12.1 %

 

$5,298,360

 

$4,998,027

 

6.0 %

Outpatient revenue

 

14,811,896

 

11,981,578

 

23.6 %

 

553,407

 

525,602

 

5.3 %

Total patient revenue

 

37,174,232

 

31,927,540

 

16.4 %

 

5,851,767

 

5,523,629

 

5.9 %

Other revenue

 

462,892

 

387,456

 

19.5 %

 

139,244

 

142,056

 

-2.0 %

Gross hospital revenue

 

37,637,124

 

32,314,996

 

16.5 %

 

5,991,011

 

5,665,685

 

5.7 %

Total deductions

 

33,660,513

 

28,527,164

 

18.0 %

 

2,958,328

 

2,865,298

 

3.2 %

Net hospital revenue

 

$3,976,611

 

$3,787,832

 

5.0 %

 

$3,032,683

 

$2,800,387

 

8.3 %

             
             

SAME FACILITY:

            
             
  

ACUTE

 

BEHAVIORAL HEALTH

  

6/30/23

 

6/30/22

 

%  change

 

6/30/23

 

6/30/22

 

%  change

             

Hospitals owned and leased

 

27

 

27

 

0.0 %

 

330

 

330

 

0.0 %

Average licensed beds

 

6,538

 

6,578

 

-0.6 %

 

24,024

 

23,939

 

0.4 %

Average available beds

 

6,366

 

6,406

 

-0.6 %

 

23,924

 

23,839

 

0.4 %

Patient days

 

776,943

 

752,308

 

3.3 %

 

3,136,187

 

3,047,895

 

2.9 %

Average daily census

 

4,292.5

 

4,156.4

 

3.3 %

 

17,327.0

 

16,839.2

 

2.9 %

Occupancy-licensed beds

 

65.7 %

 

63.2 %

 

3.9 %

 

72.1 %

 

70.3 %

 

2.5 %

Occupancy-available beds

 

67.4 %

 

64.9 %

 

3.9 %

 

72.4 %

 

70.6 %

 

2.5 %

Admissions

 

156,837

 

146,434

 

7.1 %

 

237,799

 

226,006

 

5.2 %

Length of stay

 

5.0

 

5.1

 

-3.6 %

 

13.2

 

13.5

 

-2.2 %

Universal Health Services, Inc.

Supplemental Non-GAAP Disclosures

2023 Revised Operating Results Forecast

(in thousands, except per share amounts)

          
          
   

Forecast For The Year Ending December 31, 2023

     

% Net

   

% Net

   

Low

 

revenues

 

High

 

revenues

Net revenues

  

$14,130,000

   

$14,330,000

  
          

Adjusted net income attributable to UHS (a)

 

$693,483

   

$739,143

  
          

 Depreciation and amortization

  

584,725

   

584,725

  

 Interest expense

  

198,996

   

198,996

  

 Other (income) expense, net

  

1,353

   

1,353

  

 Provision for income taxes

  

217,796

   

232,136

  

Adjusted EBITDA net of NCI (b)

  

$1,696,353

 

12.0 %

 

$1,756,353

 

12.3 %

          

Adjusted net income attributable to UHS, per diluted share (a)

$9.85

   

$10.50

  
          

Shares used in computing diluted earnings per share

70,332

   

70,322

  
 

(a) Adjusted net income attributable to UHS/per diluted share are non-GAAP financial measures.  The 2023 forecasted amounts exclude the impact of future items, if applicable, that are nonrecurring or non-operational in nature including items such as pre-tax unrealized gains/losses resulting from changes in the market value of shares of certain equity securities, and other potential material items including, but not limited to, reserves for various matters including settlements, legal judgments and lawsuits, potential impacts of non-ordinary course acquisitions, divestitures, joint ventures or other strategic transactions, costs related to extinguishment of debt, gains/losses on sales of assets and businesses, impairments of goodwill, long-lived and intangible assets, other amounts that may be reflected in the current financial statements that relate to prior periods, and the impact of share repurchases that differ from our forecasted assumptions. It is also subject to certain conditions including those as set forth in General Information, Forward-Looking Statements and Risk Factors and Non-GAAP Financial Measures.

           

(b) Adjusted EBITDA net of NCI is a non-GAAP financial measure.  To obtain a complete understanding of our financial performance, Adjusted EBITDA net of NCI should be examined in connection with net income determined in accordance with GAAP as presented in the consolidated financial statements and notes thereto in this report or in our filings with the Securities and Exchange Commission including in our Form 10-K for the year ended December 31, 2022 and Form 10-Q for the quarter ended March 31, 2023.

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