Universal Health Services, Inc.

first quarter ended March 31, 2021. During the conference call, we'll be using words such as believes, expects, anticipates, estimates, and similar words that represent forecasts, projections, and forward-looking statements. For anyone not familiar with the risks and uncertainties inherent in these forward-looking statements, I recommend a careful reading of the section on risk factors, and forward-looking statements and risk factors in our Form 10-K for the year ended December 31, 2020. We'd like to highlight just a couple of developments and business trends before opening the call up to questions. As discussed in our press release last night, the company reported net income attributable to UHS per diluted share of $2.43 for the first quarter of 2021. After adjusting for the impact of the items reflected on the supplemental schedule as included with the press release, our adjusted net income attributable to UHS per diluted share was $2.44 for the quarter ended March 31, 2021. During the first quarter of 2021, we received approximately $188 million of additional CARES Act grant funds. While we continue to experience residual effects from the COVID-19 virus, the net impact on lost revenues and incremental expenses in 2021 has not been nearly as severe as it was in 2020. And consequently, we have begun the process of returning these $188 million in CARES Act funds to the federal government and expect that process to be completed shortly. As previously disclosed, we also returned $695 million of Medicare accelerated payments to the federal government in the first quarter of 2021. As I noted, during the first quarter of 2021, we continued to experience certain unfavorable impacts on our operations and financial results from the COVID-19 pandemic. Specifically, we experienced an increased wave of COVID patients in December 2020, which peaked in the first half of January 2021. The negative impact resulting from this elevated level of COVID volumes was primarily a function of accompanying declines in elective and scheduled procedures and both acute and behavioral patient days, along with increased expense pressures, particularly on salaries and wages and shortages of clinical personnel. Our cash generated from operating activities was $72 million during the first quarter of 2021 as compared to $502 million during the same period in 2020. The decline in cash provided by operating activities was driven by the aforementioned repayment of $695 million of Medicare accelerated payments. We spent $247 million on capital expenditures during the first quarter of 2021. Our accounts receivable days outstanding decreased to 50 days during the first quarter of 2021 as compared to 55 days in the fourth quarter of 2020 as we recovered from the billing and collection delays we experienced in the fourth quarter as a result of our previously disclosed information technology incident. At December 31, 2021, our ratio of debt to total capitalization declined to 35.7% as compared to 41.3% at March 31, 2020. In light of our expectation that COVID volumes are likely to continue a downward trajectory in 2021 as more vaccines become available and the accompanying pressures on our operations and financial results ease, Our board of directors approved the resumption of our regular quarterly dividend with the first quarterly payment of 20 cents per share made on March 31st. The board also approved the resumption of our share repurchase program in the second quarter of 2021. We were pleased with our first quarter 2021 operating results, which were just slightly ahead of our internal forecast. The pace of the recovery from the pandemic is still difficult to predict with precision, but we assume the COVID impact will generally ease at an increasing cadence throughout 2021, and we remain comfortable that we will achieve our full year 2021 earnings guidance. We are pleased to answer your questions at this time.

As a reminder, to ask a question, you will need to press star 1 on your telephone. To withdraw your question, press the pound key. Your first question is from Justin Lake with Wolf Research. Your line is open.

Hi, yeah, thanks. This is Perry Wong, dialing in for Justin. My question is around pricing. It looks like your pricing was up about 26%, which is notably higher than your peers. I was wondering if you could give any color on what's driving that increase. Was it mostly due to higher acuity from COVID cases, or is there any benefit from better commercial mix-up? Thanks.