Company Quick10K Filing
Tenet Healthcare
Closing Price ($) Shares Out (MM) Market Cap ($MM)
$0.00 105 $2,125
10-Q 2019-11-04 Quarter: 2019-09-30
10-Q 2019-08-05 Quarter: 2019-06-30
10-Q 2019-04-29 Quarter: 2019-03-31
10-K 2019-02-25 Annual: 2018-12-31
10-Q 2018-11-05 Quarter: 2018-09-30
10-Q 2018-08-06 Quarter: 2018-06-30
10-Q 2018-04-30 Quarter: 2018-03-31
10-K 2018-02-26 Annual: 2017-12-31
10-Q 2017-11-07 Quarter: 2017-09-30
10-Q 2017-08-07 Quarter: 2017-06-30
10-Q 2017-05-01 Quarter: 2017-03-31
10-K 2017-02-27 Annual: 2016-12-31
10-Q 2016-10-31 Quarter: 2016-09-30
10-Q 2016-08-01 Quarter: 2016-06-30
10-Q 2016-05-02 Quarter: 2016-03-31
10-K 2016-02-22 Annual: 2015-12-31
10-Q 2015-11-02 Quarter: 2015-09-30
10-Q 2015-08-03 Quarter: 2015-06-30
10-Q 2015-05-04 Quarter: 2015-03-31
10-K 2015-02-23 Annual: 2014-12-31
10-Q 2014-11-03 Quarter: 2014-09-30
10-Q 2014-08-04 Quarter: 2014-06-30
10-Q 2014-05-05 Quarter: 2014-03-31
10-K 2014-02-24 Annual: 2013-12-31
10-Q 2013-11-04 Quarter: 2013-09-30
10-Q 2013-08-06 Quarter: 2013-06-30
10-Q 2013-04-30 Quarter: 2013-03-31
10-K 2013-02-26 Annual: 2012-12-31
10-Q 2012-11-07 Quarter: 2012-09-30
10-Q 2012-08-07 Quarter: 2012-06-30
10-Q 2012-05-08 Quarter: 2012-03-31
10-K 2012-02-28 Annual: 2011-12-31
10-Q 2011-11-01 Quarter: 2011-09-30
10-Q 2011-08-02 Quarter: 2011-06-30
10-Q 2011-05-03 Quarter: 2011-03-31
10-K 2011-02-25 Annual: 2010-12-31
10-Q 2010-11-02 Quarter: 2010-09-30
10-Q 2010-08-03 Quarter: 2010-06-30
10-Q 2010-05-04 Quarter: 2010-03-31
10-K 2010-02-23 Annual: 2009-12-31
8-K 2020-01-14 Earnings, Regulation FD
8-K 2019-12-12 Regulation FD, Other Events, Exhibits
8-K 2019-11-06
8-K 2019-11-04 Earnings, Exhibits
8-K 2019-09-12 Enter Agreement, Off-BS Arrangement, Exhibits
8-K 2019-08-26 Enter Agreement, Off-BS Arrangement, Other Events, Exhibits
8-K 2019-08-16 Officers, Exhibits
8-K 2019-08-12 Regulation FD, Exhibits
8-K 2019-08-12 Regulation FD, Exhibits
8-K 2019-08-05 Earnings, Exhibits
8-K 2019-07-24 Earnings, Regulation FD, Exhibits
8-K 2019-06-19 Officers, Exhibits
8-K 2019-06-01 Officers
8-K 2019-05-02 Officers, Shareholder Vote, Exhibits
8-K 2019-04-29 Earnings, Exhibits
8-K 2019-02-27 Officers, Exhibits
8-K 2019-02-25 Earnings, Exhibits
8-K 2019-02-05 Enter Agreement, Off-BS Arrangement, Other Events, Exhibits
8-K 2019-01-28 M&A, Regulation FD, Exhibits
8-K 2019-01-22 Regulation FD, Exhibits
8-K 2019-01-22 Regulation FD, Exhibits
8-K 2019-01-03 Earnings, Amend Bylaw, Regulation FD, Exhibits
8-K 2018-11-27 Officers, Exhibits
8-K 2018-11-05 Earnings, Exhibits
8-K 2018-08-17 M&A, Regulation FD, Exhibits
8-K 2018-08-06 Earnings, Exhibits
8-K 2018-06-28 Officers
8-K 2018-05-25 Officers, Exhibits
8-K 2018-05-03 Shareholder Vote
8-K 2018-04-30 Earnings, Exhibits
8-K 2018-03-23 Enter Agreement, Shareholder Rights, Officers, Amend Bylaw, Regulation FD, Exhibits
8-K 2018-03-05 Enter Agreement, Leave Agreement, Shareholder Rights, Amend Bylaw, Regulation FD, Exhibits
8-K 2018-02-26 Earnings, Exhibits
8-K 2018-01-21 Amend Bylaw, Exhibits
8-K 2018-01-11 M&A, Regulation FD, Exhibits
8-K 2018-01-08 Regulation FD
THC 2019-09-30
Part I. Financial Information
Item 1. Financial Statements
Note 1. Basis of Presentation
Note 2. Accounts Receivable
Note 3. Contract Balances
Note 4. Assets and Liabilities Held for Sale
Note 5. Impairment and Restructuring Charges, and Acquisition-Related Costs
Note 6. Leases
Note 7. Long-Term Debt
Note 8. Guarantees
Note 9. Employee Benefit Plans
Note 10. Equity
Note 11. Net Operating Revenues
Note 12. Property and Professional and General Liability Insurance
Note 13. Claims and Lawsuits
Note 14. Redeemable Noncontrolling Interests in Equity of Consolidated Subsidiaries
Note 15. Income Taxes
Note 16. Earnings (Loss) per Common Share
Note 17. Fair Value Measurements
Note 18. Acquisitions
Note 19. Segment Information
Item 2. Management's Discussion and Analysis of Financial Condition and Results of Operations
Item 3. Quantitative and Qualitative Disclosures About Market Risk
Item 4. Controls and Procedures
Part II. Other Information
Item 1. Legal Proceedings
Item 1A. Risk Factors
Item 6. Exhibits
EX-31.A thc-20190930ex31a.htm
EX-31.B thc-20190930ex31b.htm
EX-32 thc-20190930ex32.htm

Tenet Healthcare Earnings 2019-09-30

THC 10Q Quarterly Report

Balance SheetIncome StatementCash Flow

Comparables ($MM TTM)
Ticker M Cap Assets Liab Rev G Profit Net Inc EBITDA EV G Margin EV/EBITDA ROA
ENSG 3,158 2,322 1,644 2,177 449 104 191 3,400 21% 17.8 4%
HCSG 2,221 710 260 1,941 249 85 115 2,205 13% 19.2 12%
THC 2,125 23,207 21,028 18,213 0 344 2,221 16,188 0% 7.3 1%
SEM 2,110 7,107 5,267 5,278 644 186 573 5,384 12% 9.4 3%
MD 2,004 5,639 2,914 2,652 0 -125 154 1,964 0% 12.7 -2%
MGLN 1,612 3,078 1,744 7,226 5,110 13 205 2,065 71% 10.1 0%
BKD 1,265 7,459 6,593 4,250 955 -4 407 4,512 22% 11.1 -0%
NHC 1,262 1,315 554 993 0 74 141 1,251 0% 8.9 6%
TVTY 829 2,016 1,486 859 307 76 150 1,883 36% 12.5 4%
SGRY 383 4,891 4,532 1,797 437 -93 4 2,720 24% 771.5 -2%

Document
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
 
Form 10-Q
 
Quarterly report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the quarterly period ended September 30, 2019
 
OR
Transition report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the transition period from               to               
 
Commission File Number 1-7293
 
_________________________________________
 
TENET HEALTHCARE CORPORATION
(Exact name of Registrant as specified in its charter)
 
_________________________________________

Nevada
95-2557091
(State of Incorporation)
(IRS Employer Identification No.)

1445 Ross Avenue, Suite 1400
Dallas, TX 75202
(Address of principal executive offices, including zip code)
 
(469893-2200
(Registrant’s telephone number, including area code)
_________________________________________
Securities registered pursuant to Section 12(b) of the Act:
Title of each class
 
Trading symbol
 
Name of each exchange on which registered
Common stock
$0.05 par value
 
THC
 
New York Stock Exchange
6.875% Senior Notes due 2031
 
THC31
 
New York Stock Exchange

Indicate by check mark whether the Registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months, and (2) has been subject to such filing requirements for the past 90 days.   Yes x No ¨
 
Indicate by check mark whether the Registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T during the preceding 12 months.   Yes x No ¨
 
Indicate by check mark whether the Registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging growth company (each as defined in Exchange Act Rule 12b-2).
Large accelerated filer
x
 
 
Accelerated filer
¨
Non-accelerated filer
¨
 
 
 
 
 
 
 
 
 
 
Smaller reporting company
 
 
Emerging growth company
 
 

If an emerging growth company, indicate by check mark if the Registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ¨
 
Indicate by check mark whether the Registrant is a shell company (as defined in Exchange Act Rule 12b-2).   Yes  No x

At October 31, 2019, there were 103,895,190 shares of the Registrant’s common stock outstanding.
 


Table of Contents

TENET HEALTHCARE CORPORATION
TABLE OF CONTENTS

 
Page
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

i

Table of Contents

PART I. FINANCIAL INFORMATION
ITEM 1. FINANCIAL STATEMENTS

TENET HEALTHCARE CORPORATION AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
Dollars in Millions
(Unaudited)
 
 
September 30,
 
December 31,
 
 
2019
 
2018
ASSETS
 
 
 
 
Current assets:
 
 
 
 
Cash and cash equivalents
 
$
314

 
$
411

Accounts receivable
 
2,768

 
2,595

Inventories of supplies, at cost
 
311

 
305

Income tax receivable
 
18

 
21

Assets held for sale
 

 
107

Other current assets
 
1,378

 
1,197

Total current assets 
 
4,789

 
4,636

Investments and other assets
 
2,380

 
1,456

Deferred income taxes
 
252

 
312

Property and equipment, at cost, less accumulated depreciation and amortization
($5,645 at September 30, 2019 and $5,221 at December 31, 2018)
 
7,001

 
6,993

Goodwill
 
7,315

 
7,281

Other intangible assets, at cost, less accumulated amortization
($1,098 at September 30, 2019 and $1,013 at December 31, 2018)
 
1,620

 
1,731

Total assets 
 
$
23,357

 
$
22,409

LIABILITIES AND EQUITY
 
 
 
 
Current liabilities:
 
 
 
 
Current portion of long-term debt
 
$
165

 
$
182

Accounts payable
 
1,125

 
1,207

Accrued compensation and benefits
 
842

 
838

Professional and general liability reserves
 
230

 
216

Accrued interest payable
 
252

 
240

Liabilities held for sale
 

 
43

Other current liabilities
 
1,314

 
1,131

Total current liabilities 
 
3,928

 
3,857

Long-term debt, net of current portion
 
14,858

 
14,644

Professional and general liability reserves
 
671

 
666

Defined benefit plan obligations
 
495

 
521

Deferred income taxes
 
36

 
36

Other long-term liabilities
 
1,405

 
578

Total liabilities 
 
21,393

 
20,302

Commitments and contingencies
 


 


Redeemable noncontrolling interests in equity of consolidated subsidiaries
 
1,475

 
1,420

Equity:
 
 
 
 
Shareholders’ equity:
 
 
 
 
Common stock, $0.05 par value; authorized 262,500,000 shares; 152,118,277 shares issued at
September 30, 2019 and 150,897,143 shares issued at December 31, 2018
 
7

 
7

Additional paid-in capital
 
4,751

 
4,747

Accumulated other comprehensive loss
 
(216
)
 
(223
)
Accumulated deficit
 
(2,469
)
 
(2,236
)
Common stock in treasury, at cost, 48,346,277 shares at September 30, 2019
and 48,359,705 shares at December 31, 2018
 
(2,414
)
 
(2,414
)
Total shareholders’ deficit
 
(341
)
 
(119
)
Noncontrolling interests 
 
830

 
806

Total equity 
 
489

 
687

Total liabilities and equity 
 
$
23,357

 
$
22,409


See accompanying Notes to Condensed Consolidated Financial Statements.


Table of Contents

TENET HEALTHCARE CORPORATION AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
Dollars in Millions, Except Per-Share Amounts
(Unaudited) 
 
 
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
 
2019
 
2018
 
2019
 
2018
Net operating revenues 
 
$
4,568

 
$
4,489

 
$
13,673

 
$
13,694

Equity in earnings of unconsolidated affiliates
 
38

 
33

 
114

 
97

Operating expenses:
 
 
 
 
 
 
 
 
Salaries, wages and benefits
 
2,174

 
2,116

 
6,475

 
6,478

Supplies
 
760

 
726

 
2,254

 
2,248

Other operating expenses, net
 
1,042

 
1,094

 
3,160

 
3,181

Electronic health record incentives
 

 

 
(1
)
 
(1
)
Depreciation and amortization
 
205

 
204

 
627

 
602

Impairment and restructuring charges, and acquisition-related costs
 
46

 
46

 
101

 
123

Litigation and investigation costs
 
84

 
9

 
115

 
28

Net losses (gains) on sales, consolidation and deconsolidation of facilities
 
1

 
7

 
3

 
(111
)
Operating income 
 
294

 
320

 
1,053

 
1,243

Interest expense
 
(244
)
 
(249
)
 
(742
)
 
(758
)
Other non-operating expense, net
 
(3
)
 

 
(3
)
 
(2
)
Loss from early extinguishment of debt
 
(180
)
 

 
(227
)
 
(2
)
Income (loss) from continuing operations, before income taxes 
 
(133
)
 
71

 
81

 
481

Income tax expense
 
(20
)
 
(6
)
 
(67
)
 
(120
)
Income (loss) from continuing operations, before discontinued operations 
 
(153
)
 
65

 
14

 
361

Discontinued operations:
 
 
 
 
 
 
 
 
Income from operations
 
1

 

 
13

 
3

Income tax expense
 

 

 
(2
)
 

Income from discontinued operations 
 
1

 

 
11

 
3

Net income (loss)
 
(152
)
 
65

 
25

 
364

Less: Net income available to noncontrolling interests
 
80

 
74

 
259

 
248

Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders 
 
$
(232
)
 
$
(9
)
 
$
(234
)
 
$
116

Amounts available (attributable) to Tenet Healthcare Corporation common shareholders
 
 
 
 
 
 
 
 
Income (loss) from continuing operations, net of tax
 
$
(233
)
 
$
(9
)
 
$
(245
)
 
$
113

Income from discontinued operations, net of tax
 
1

 

 
11

 
3

Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders 
 
$
(232
)
 
$
(9
)
 
$
(234
)
 
$
116

Earnings (loss) per share available (attributable) to Tenet Healthcare Corporation common shareholders:
 
 
 
 
 
 
 
 
Basic
 
 
 
 
 
 
 
 
Continuing operations
 
$
(2.25
)
 
$
(0.09
)
 
$
(2.37
)
 
$
1.11

Discontinued operations
 
0.01

 

 
0.11

 
0.03

 
 
$
(2.24
)
 
$
(0.09
)
 
$
(2.26
)
 
$
1.14

Diluted
 
 
 
 
 
 
 
 
Continuing operations
 
$
(2.25
)
 
$
(0.09
)
 
$
(2.37
)
 
$
1.09

Discontinued operations
 
0.01

 

 
0.11

 
0.03

 
 
$
(2.24
)
 
$
(0.09
)
 
$
(2.26
)
 
$
1.12

Weighted average shares and dilutive securities outstanding (in thousands):
 
 
 
 
 
 
 
 
Basic
 
103,558

 
102,402

 
103,181

 
101,980

Diluted
 
103,558

 
102,402

 
103,181

 
103,802


See accompanying Notes to Condensed Consolidated Financial Statements.


2

Table of Contents

TENET HEALTHCARE CORPORATION AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OTHER COMPREHENSIVE INCOME
Dollars in Millions
(Unaudited)
 
 
 
Three Months Ended September 30,
 
Nine Months Ended September 30,
 
 
2019
 
2018
 
2019
 
2018
Net income (loss)
 
$
(152
)
 
$
65

 
$
25

 
$
364

Other comprehensive income (loss):
 
 
 
 
 
 
 
 
Amortization of net actuarial loss included in other non-operating expense, net
 
3

 
3

 
9

 
11

Sale of foreign subsidiary
 

 
37

 

 
37

Foreign currency translation adjustments
 

 

 

 
(3
)
Other comprehensive income before income taxes
 
3

 
40

 
9

 
45

Income tax benefit (expense) related to items of other comprehensive income (loss)
 

 
1

 
(2
)
 

Total other comprehensive income, net of tax
 
3

 
41

 
7

 
45

Comprehensive net income (loss)
 
(149
)
 
106

 
32

 
409

Less: Comprehensive income available to noncontrolling interests 
 
80

 
74

 
259

 
248

Comprehensive income available (loss attributable) to
   Tenet Healthcare Corporation common shareholders 
 
$
(229
)
 
$
32

 
$
(227
)
 
$
161


See accompanying Notes to Condensed Consolidated Financial Statements.


3

Table of Contents

TENET HEALTHCARE CORPORATION AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
Dollars in Millions
(Unaudited)
 
 
Nine Months Ended
September 30,
 
 
2019
 
2018
Net income
 
$
25

 
$
364

Adjustments to reconcile net income to net cash provided by operating activities:
 
 
 
 
Depreciation and amortization
 
627

 
602

Deferred income tax expense
 
57

 
110

Stock-based compensation expense
 
34

 
34

Impairment and restructuring charges, and acquisition-related costs
 
101

 
123

Litigation and investigation costs
 
115

 
28

Net losses (gains) on sales, consolidation and deconsolidation of facilities
 
3

 
(111
)
Loss from early extinguishment of debt
 
227

 
2

Equity in earnings of unconsolidated affiliates, net of distributions received
 
(6
)
 
9

Amortization of debt discount and debt issuance costs
 
25

 
33

Pre-tax income from discontinued operations
 
(13
)
 
(3
)
Other items, net
 
(14
)
 
(22
)
Changes in cash from operating assets and liabilities:
 
 

 
 

Accounts receivable
 
(174
)
 
(36
)
Inventories and other current assets
 
(98
)
 
73

Income taxes
 
(4
)
 
(14
)
Accounts payable, accrued expenses and other current liabilities
 
(37
)
 
(194
)
Other long-term liabilities
 
(15
)
 
(82
)
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements 
 
(136
)
 
(113
)
Net cash used in operating activities from discontinued operations, excluding income taxes
 
(4
)
 
(4
)
Net cash provided by operating activities 
 
713

 
799

Cash flows from investing activities:
 
 

 
 

Purchases of property and equipment — continuing operations
 
(492
)
 
(404
)
Purchases of businesses or joint venture interests, net of cash acquired
 
(23
)
 
(97
)
Proceeds from sales of facilities and other assets — continuing operations
 
44

 
498

Proceeds from sales of facilities and other assets — discontinued operations
 
17

 

Proceeds from sales of marketable securities, long-term investments and other assets
 
52

 
165

Purchases of equity investments
 
(14
)
 
(43
)
Other long-term assets
 
1

 
5

Other items, net
 
(11
)
 
(4
)
Net cash provided by (used in) investing activities
 
(426
)
 
120

Cash flows from financing activities:
 
 

 
 

Repayments of borrowings under credit facility
 
(1,880
)
 
(505
)
Proceeds from borrowings under credit facility
 
2,155

 
505

Repayments of other borrowings
 
(6,084
)
 
(238
)
Proceeds from other borrowings
 
5,718

 
15

Debt issuance costs
 
(63
)
 

Distributions paid to noncontrolling interests
 
(223
)
 
(217
)
Proceeds from sales of noncontrolling interests
 
15

 
14

Purchases of noncontrolling interests
 
(8
)
 
(643
)
Proceeds from exercise of stock options and employee stock purchase plan
 
4

 
15

Other items, net
 
(18
)
 
24

Net cash used in financing activities
 
(384
)
 
(1,030
)
Net decrease in cash and cash equivalents
 
(97
)
 
(111
)
Cash and cash equivalents at beginning of period
 
411

 
611

Cash and cash equivalents at end of period 
 
$
314

 
$
500

Supplemental disclosures:
 
 

 
 

Interest paid, net of capitalized interest
 
$
(705
)
 
$
(652
)
Income tax payments, net
 
$
(18
)
 
$
(24
)
 
See accompanying Notes to Condensed Consolidated Financial Statements.


4

Table of Contents

TENET HEALTHCARE CORPORATION
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS 

NOTE 1. BASIS OF PRESENTATION
 
Description of Business and Basis of Presentation
 
Tenet Healthcare Corporation (together with our subsidiaries, referred to herein as “Tenet,” “we” or “us”) is a diversified healthcare services company headquartered in Dallas, Texas. Through an expansive care network that includes USPI Holding Company, Inc. (“USPI”), at September 30, 2019, we operated 65 hospitals and approximately 500 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers, and other care sites and clinics. We also operate Conifer Health Solutions, through our Conifer Holdings, Inc. (“Conifer”) subsidiary, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other customers.
 
This quarterly report supplements our Annual Report on Form 10-K for the year ended December 31, 2018 (“Annual Report”). As permitted by the Securities and Exchange Commission for interim reporting, we have omitted certain notes and disclosures that substantially duplicate those in our Annual Report. For further information, refer to the audited Consolidated Financial Statements and notes included in our Annual Report. Unless otherwise indicated, all financial and statistical data included in these notes to our Condensed Consolidated Financial Statements relate to our continuing operations, with dollar amounts expressed in millions (except per-share amounts).
 
Effective January 1, 2019, we adopted the Financial Accounting Standards Board (“FASB”) Accounting Standards Update (“ASU”) 2016-02, “Leases (Topic 842)” (“ASU 2016-02”) using the modified retrospective transition approach as of the period of adoption. Our financial statements for periods prior to January 1, 2019 were not modified for the application of the new lease accounting standard. The main difference between the guidance in ASU 2016-02 and previous accounting principles generally accepted in the United States of America (“GAAP”) is the recognition of lease assets and lease liabilities on the balance sheet by lessees for those leases classified as operating leases under previous GAAP. Upon adoption of ASU 2016-02, we recorded $822 million of right-of-use assets, net of deferred rent, associated with operating leases in investments and other assets in our condensed consolidated balance sheet, $147 million of current liabilities associated with operating leases in other current liabilities in our condensed consolidated balance sheet and $715 million of long-term liabilities associated with operating leases in other long-term liabilities in our condensed consolidated balance sheet. We also recognized $1 million of cumulative effect adjustment that decreased accumulated deficit at January 1, 2019.

Although the Condensed Consolidated Financial Statements and related notes within this document are unaudited, we believe all adjustments considered necessary for a fair presentation have been included and are of a normal recurring nature. In preparing our financial statements in conformity with GAAP, we are required to make estimates and assumptions that affect the amounts reported in our Condensed Consolidated Financial Statements and these accompanying notes. We regularly evaluate the accounting policies and estimates we use. In general, we base the estimates on historical experience and on assumptions that we believe to be reasonable given the particular circumstances in which we operate. Actual results may vary from those estimates. Financial and statistical information we report to other regulatory agencies may be prepared on a basis other than GAAP or using different assumptions or reporting periods and, therefore, may vary from amounts presented herein. Although we make every effort to ensure that the information we report to those agencies is accurate, complete and consistent with applicable reporting guidelines, we cannot be responsible for the accuracy of the information they make available to the public.
 
Operating results for the three and nine month periods ended September 30, 2019 are not necessarily indicative of the results that may be expected for the full year. Reasons for this include, but are not limited to: overall revenue and cost trends, particularly the timing and magnitude of price changes; fluctuations in contractual allowances and cost report settlements and valuation allowances; managed care contract negotiations, settlements or terminations and payer consolidations; trends in patient accounts receivable collectability and associated implicit price concessions; fluctuations in interest rates; levels of malpractice insurance expense and settlement trends; impairment of long-lived assets and goodwill; restructuring charges; losses, costs and insurance recoveries related to natural disasters and other weather-related occurrences; litigation and investigation costs; acquisitions and dispositions of facilities and other assets; gains (losses) on sales, consolidation and deconsolidation of facilities; income tax rates and deferred tax asset valuation allowance activity; changes in estimates of accruals for annual incentive compensation; the timing and amounts of stock option and restricted stock unit grants to employees and directors; gains (losses) from early extinguishment of debt; and changes in occupancy levels and patient volumes. Factors that affect service mix, revenue mix, patient volumes and, thereby, the results of operations at our hospitals and related healthcare facilities include, but are not limited to: changes in federal and state healthcare regulations; the business environment, economic conditions and demographics of local communities in which we operate; the number of uninsured and

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underinsured individuals in local communities treated at our hospitals; seasonal cycles of illness; climate and weather conditions; physician recruitment, satisfaction, retention and attrition; advances in technology and treatments that reduce length of stay; local healthcare competitors; managed care contract negotiations or terminations; the number of patients with high-deductible health insurance plans; hospital performance data on quality measures and patient satisfaction, as well as standard charges for services; any unfavorable publicity about us, or our joint venture partners, that impacts our relationships with physicians and patients; and the timing of elective procedures. These considerations apply to year-to-year comparisons as well.
 
Net Operating Revenues

We recognize net operating revenues in the period in which we satisfy our performance obligations under contracts by transferring services to our customers. Net operating revenues are recognized in the amounts we expect to be entitled to, which are the transaction prices allocated for the distinct services. Net operating revenues for our Hospital Operations and other and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact with Uninsured Patients (“Compact”) and other uninsured discount and charity programs. Net operating revenues for our Conifer segment primarily consist of revenues from providing revenue cycle management services to healthcare systems, as well as individual hospitals, physician practices, self-insured organizations, health plans and other entities.

Net Patient Service Revenues—We report net patient service revenues at the amounts that reflect the consideration we expect to be entitled to in exchange for providing patient care. These amounts are due from patients, third-party payers (including managed care payers and government programs) and others, and they include variable consideration for retroactive revenue adjustments due to settlement of audits, reviews and investigations. Generally, we bill our patients and third-party payers several days after the services are performed or shortly after discharge. Revenues are recognized as performance obligations are satisfied.

Conifer Revenues—Our Conifer segment recognizes revenue from its contracts when Conifer’s performance obligations are satisfied, which is generally as services are rendered. Revenue is recognized in an amount that reflects the consideration to which Conifer expects to be entitled.

Cash and Cash Equivalents
 
We treat highly liquid investments with original maturities of three months or less as cash equivalents. Cash and cash equivalents were $314 million and $411 million at September 30, 2019 and December 31, 2018, respectively. At September 30, 2019 and December 31, 2018, our book overdrafts were $287 million and $288 million, respectively, which were classified as accounts payable.
 
At September 30, 2019 and December 31, 2018, $204 million and $177 million, respectively, of total cash and cash equivalents in the accompanying Condensed Consolidated Balance Sheets were intended for the operations of our captive insurance subsidiaries, and $2 million and $8 million, respectively, of total cash and cash equivalents in the accompanying Condensed Consolidated Balance Sheets were intended for the operations of our health plan-related businesses.
 
Also at September 30, 2019 and December 31, 2018, we had $69 million and $135 million, respectively, of property and equipment purchases accrued for items received but not yet paid. Of these amounts, $50 million and $114 million, respectively, were included in accounts payable.

During the nine months ended September 30, 2019 and 2018, we entered into non-cancellable capital (finance) leases of $91 million and $94 million, respectively.
 

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Other Intangible Assets
 
The following tables provide information regarding other intangible assets, which are included in the accompanying Condensed Consolidated Balance Sheets at September 30, 2019 and December 31, 2018: 
 
 
Gross
Carrying
Amount
 
Accumulated
Amortization
 
Net Book
Value
At September 30, 2019:
 
 
 
 
 
 
Capitalized software costs
 
$
1,637

 
$
(927
)
 
$
710

Trade names
 
102

 

 
102

Contracts
 
875

 
(90
)
 
785

Other
 
104

 
(81
)
 
23

Total 
 
$
2,718

 
$
(1,098
)
 
$
1,620

 
 
Gross
Carrying
Amount
 
Accumulated
Amortization
 
 Net Book
Value
At December 31, 2018:
 
 
 
 
 
 
Capitalized software costs
 
$
1,667

 
$
(858
)
 
$
809

Trade names
 
102

 

 
102

Contracts
 
871

 
(76
)
 
795

Other
 
104

 
(79
)
 
25

Total 
 
$
2,744

 
$
(1,013
)
 
$
1,731


 
Estimated future amortization of intangibles with finite useful lives at September 30, 2019 is as follows: 
 
 
 
 
Three Months
Ending
 
Years Ending
 
Later Years
 
 
 
 
December 31,
 
 
 
Total
 
2019
 
2020
 
2021
 
2022
 
2023
 
Amortization of intangible assets
 
$
938

 
$
45

 
$
132

 
$
117

 
$
104

 
$
95

 
$
445


 
We recognized amortization expense of $138 million and $134 million in the accompanying Condensed Consolidated Statements of Operations for the nine months ended September 30, 2019 and 2018, respectively.

Investments in Unconsolidated Affiliates

We control 237 of the facilities within our Ambulatory Care segment and, therefore, consolidate their results. We account for many of the facilities our Ambulatory Care segment operates (111 of 348 at September 30, 2019), as well as additional companies in which our Hospital Operations and other segment holds ownership interests, under the equity method as investments in unconsolidated affiliates and report only our share of net income as equity in earnings of unconsolidated affiliates in the accompanying Condensed Consolidated Statements of Operations. Summarized financial information for these equity method investees is included in the following table; among the equity method investees are four North Texas hospitals in which we held minority interests that were operated by our Hospital Operations and other segment through the divestiture of these investments effective March 1, 2018. For investments acquired during the reporting periods, amounts reflect 100% of the investee’s results beginning on the d