Universal Health Services, Inc.

Good day and thank you for standing by. Welcome to the Universal Health Services fourth quarter and full year 2021 earnings call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. If you ask a question during the session, you'll need to press star 1 on your telephone. I would now like to hand the conference over to Steve Bilton. Please go ahead.

Thank you. Good morning. Mark Miller is also joining us this morning. We welcome you to this review of universal health services results for the fourth quarter ended December 31, 2021. During the conference call, we will be using words such as believes, expects, anticipates, estimates, and similar words that represent forecast 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, 2021. 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 for diluted share of $3 for the fourth quarter of 2021. After adjusting to 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 $2.95 for the quarter ended December 31, 2021. During the fourth quarter of 2021, our operations continued to be significantly impacted by the COVID-19 pandemic. Specifically, we experienced an increased wave of COVID patients in December 2021, which peaked in January of 2022. The negative impact resulting from this elevated level of COVID volumes was primarily a function of increased labor scarcity issues exacerbated by the large number of employees sidelined by the virus itself or quarantined due to exposure to the virus. In what was already a very tight labor market, these incremental labor challenges, in addition to pressuring our salaries and wages expenses, also suppressed patient volumes at our acute our acute care and behavioral health facilities while causing postponement of certain elective scheduled procedures at our acute care hospitals. Our net cash generated from operating activities was $884 million during the full year of 2021, which includes the unfavorable impact of $695 million of Medicare accelerated payments that were received during 2020 and repaid to the government during 2021. We spent $856 million on capital expenditures during the full year of 2021, which includes the construction costs related to a new 170-bed acute care hospital in Reno, Nevada that is scheduled to be completed and open next month. Our accounts receivable days outstanding decreased to 50 days during the year ended December 30, 2021, as compared to 55 days during 2020. At December 31, 2021, our ratio of debt to total capitalization increased to 40.8% as compared to 37.9% at December 31, 2020. As of December 31, 2021, we had $854 million of aggregate available borrowing capacity pursuant to our $1.2 billion revolving credit facility.

In our acute care segment, our ambulatory care development continued in 2021. We currently have 18 operational freestanding emergency departments and partnerships with national third party entities for further development of ambulatory surgery centers and home health operations in our existing markets. In conjunction with our ongoing development of primary care physician networks, these initiatives are meant to create a more fulsome care delivery system in each of our markets. Our new hospital in Reno, scheduled to open soon, will enhance our statewide presence in Nevada. Bed tower projects adding new capacities to hospitals in important markets are underway at Edinburgh Regional Medical Center in South Texas, Henderson Hospital in Las Vegas, and Inland Valley Medical Center in California. Planning is also underway on new acute care hospitals in West Henderson, Nevada, and Palm Beach Gardens in Florida. In our behavioral segment, two new de novo joint venture hospitals opened in 2021 in Clive, Iowa and Cape Girardeau, Missouri. Two more new hospitals have opened already in 2022 in Michigan, which is a partnership with Beaumont Health, and Wisconsin, and another is scheduled to open later in the year in Arizona in partnership with Honor Health. These de novo developments, along with an increased focus on outpatient development and telemedicine in our existing markets, is meant to also build out a more fulsome continuum of care in the behavioral segment as well.