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Gen Digital Inc
(NASDAQ:GEN) 

GEN stock logo

Gen Digital Inc. is a multinational software company co-headquartered in Tempe, Arizona and Prague, Czech Republic. The company provides cybersecurity software and services. Gen is a Fortune 500 company and a member of the S&P 500 stock-market index.

Founded: 1982
Full Time Employees: 55,000
Sector: Healthcare
Industry: Medical Care Facilities

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Quarterly
Annual
    Unit: USD2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 2018-03-31 2017-12-31 2017-09-30 2017-06-30 2017-03-31 2016-12-31 2016-09-30 2016-06-30 2016-03-31 2015-12-31 2015-09-30 2015-06-30 2015-03-31 2014-12-31 2014-09-30 2014-06-30 2014-03-31 2013-12-31 2013-09-30 2013-06-30 2013-03-31 2012-12-31 2012-09-30 2012-06-30 2012-03-31 2011-12-31 2011-09-30 2011-06-30 2011-03-31 2010-12-31 2010-09-30 2010-06-30 2010-03-31 2009-12-31 2009-09-30 2009-06-30 2009-03-31 2008-12-31 2008-09-30 2008-06-30 2008-03-31 2007-12-31 2007-09-30 2007-06-30 
                                                           
      net revenues
    919,061,000 938,653,000 956,259,000 1,092,250,000 1,135,437,000 1,123,705,000 1,145,052,000 1,161,640,000 1,185,947,000 1,217,271,000 1,272,360,000 1,301,072,000 1,327,880,000 1,315,452,000 1,341,276,000 1,389,132,000 1,402,860,000 1,418,994,000 1,438,358,000 1,472,218,000 1,440,721,000 1,416,027,000 1,419,475,000 1,343,001,000                                
      salaries, wages and benefits
    523,714,000 535,009,000 616,944,000 580,533,000 595,948,000 620,493,000 626,159,000 642,410,000 664,780,000 680,604,000 705,754,000 735,770,000 733,568,000 739,404,000 739,402,000 824,494,000 834,889,000 834,414,000 832,693,000 867,717,000 844,746,000 833,415,000 820,926,000 819,938,000                                
      other operating expenses
    303,152,000 309,664,000 317,274,000 340,481,000 360,340,000 339,441,000 332,528,000 342,538,000 354,101,000 371,064,000 370,555,000 384,160,000 394,255,000 375,587,000 372,295,000 342,257,000 351,553,000 350,828,000 350,161,000 361,097,000 365,268,000 332,918,000 348,236,000 348,285,000                                
      general and administrative costs
    50,499,000 45,172,000 39,769,000 39,617,000 37,447,000 35,930,000 35,562,000 35,532,000 34,778,000 35,482,000 39,046,000 39,875,000 42,988,000 40,732,000 41,187,000 45,122,000 46,063,000 46,545,000 45,026,000 48,427,000 44,763,000 46,110,000 44,983,000                                 
      lease expense
    85,677,000 86,247,000 96,395,000 98,020,000 98,398,000 100,018,000 94,586,000 94,061,000 32,311,000 32,366,000 32,111,000 33,071,000 34,521,000 38,670,000 38,234,000 36,100,000 36,448,000 35,512,000 36,968,000 37,316,000 37,243,000 37,655,000 38,959,000 36,419,000                                
      depreciation and amortization expense
    23,656,000 24,373,000 33,816,000 25,988,000 21,764,000 34,932,000 28,268,000 38,195,000 52,860,000 53,038,000 63,495,000 51,503,000 71,800,000 59,390,000 60,227,000 64,369,000 63,637,000 61,104,000 67,953,000 61,765,000 61,574,000 62,505,000 53,605,000 59,933,000                                
      interest expense
    33,374,000 33,918,000 31,907,000 36,240,000 38,802,000 37,099,000 52,975,000 51,516,000 115,051,000 115,695,000 117,955,000 115,037,000 125,909,000 124,431,000 124,288,000 124,754,000 127,691,000 131,812,000 133,860,000 135,181,000 131,573,000 128,538,000 126,385,000 121,313,000 -7,984,000 -8,009,000 -7,945,000 -8,039,000 -8,105,000 -8,744,000 -8,734,000 -8,675,000 -8,884,000 -8,790,000 -10,521,000 -9,565,000 -9,675,000 -9,711,000 -9,662,000 -9,946,000 -10,486,000 -10,086,000 -9,164,000 -7,284,000 -8,265,000 -8,417,000 -8,241,000 -8,090,000 -9,239,000 -9,207,000 -9,162,000 -9,653,000 -10,177,000 -9,914,000 -11,926,000 
      loss on early extinguishment of debt
    2,418,000 1,101,000 1,421,000 4,039,000 -2,558,000 2,460,000 -24,000  2,446,250  -501,000 10,286,000 -8,867,000  2,301,000  460,000 15,363,000 468,000     3,234,000                                
      investment income
    -915,000 -957,000 -961,000 -1,156,000 -1,218,000 -2,071,000 -2,143,000 -1,864,000 -1,976,000 -2,178,000 -1,631,000 -1,047,000 -1,231,000 -1,596,000 -1,392,000 -1,109,000 -945,000 -934,000 -658,000 -481,000 -477,000 -353,000 -431,000                                 
      other income
    -19,833,000 -53,507,000 -44,100,000 -84,832,000 -1,364,000 -131,811,000 -23,413,000                  -33,000 -26,000 7,000 52,000 299,000 -49,000 -32,000 -30,000 -52,000 -57,000 106,000 -29,000 -22,000 -123,000 -30,000 -324,000 1,744,000 9,000 583,000 -4,000 151,000 59,000  -60,000 48,000 -110,000 87,000     
      transaction costs
    7,583,000 15,561,000 5,543,000 5,591,000 3,337,000 12,941,000 8,823,000 1,261,000 5,386,000 11,361,000 3,112,000 12,095,000 6,463,000 1,056,000 3,781,000 3,025,000 -1,876,000 3,057,000 4,993,000 1,754,000 4,358,000 3,306,000 2,642,000 86,069,000                                
      long-lived asset impairments
    19,800,000 72,400,000 77,100,000 9,700,000  16,037,000 900,000  16,989,000 32,390,000 27,257,000 28,360,000 28,011,000 163,364,000                                          
      federal stimulus - covid-19 other income
    -54,178,250 -31,212,000 -185,500,000                                                     
      equity in net income of unconsolidated affiliates
    -1,358,000 -3,362,000 -3,576,000 127,000         48,000 -69,000 -88,000 -134,000 -538,250 -893,000 -497,000 -763,000   -360,000                                 
      income before income tax expense
    -19,352,000 -95,754,000  37,902,000                                                    
      income tax expense
    -2,550,000 176,000  -779,000    51,000 -439,750 -1,220,000 -886,000 347,000 -16,110,000 1,596,000 2,803,000 1,284,000    3,064,000                                    
      net income
    -16,802,000 -95,930,000 -29,316,000 38,681,000 -17,359,000 58,898,000 -8,983,000 -25,082,000 -108,986,000 -91,901,000 -62,857,000 -108,673,000 -155,017,000 -615,024,000 -105,550,000 -83,613,000 41,314,000 -52,379,000 -35,958,000 -71,028,000 -312,640,000 -60,942,000 -34,936,000  -64,000 643,000 -2,780,000 1,295,000 -3,002,000 -12,075,000 1,523,000 3,070,000 5,695,000 6,068,000 3,497,000 6,337,000 6,930,000 -232,611,000 10,571,000 11,844,000 10,841,000 -25,307,000 4,545,000 8,881,000 -161,316,000 9,052,000 9,079,000 10,867,000 10,265,000 9,576,000 8,924,000 8,444,000 7,184,000 6,864,000 -1,553,000 
      yoy
    -3.21% -262.87% 226.35% -254.22% -84.07% -164.09% -85.71% -76.92% -29.69% -85.06% -40.45% 29.97% -475.22% 1074.18% 193.54% 17.72% -113.21% -14.05% 2.93%  488400.00% -9577.76% 1156.69%  -97.87% -105.33% -282.53% -57.82% -152.71% -298.99% -56.45% -51.55% -17.82% -102.61% -66.92% -46.50% -36.08% 819.16% 132.59% 33.36% -106.72% -379.57% -49.94% -18.28% -1671.51% -5.47% 1.74% 28.69% 42.89% 39.51% -674.63%     
      qoq
    -82.49% 227.23% -175.79% -322.83% -129.47% -755.66% -64.19% -76.99% 18.59% 46.21% -42.16% -29.90% -74.79% 482.68% 26.24% -302.38% -178.88% 45.67% -49.37% -77.28% 413.01% 74.44%   -109.95% -123.13% -314.67% -143.14% -75.14% -892.84% -50.39% -46.09% -6.15% 73.52% -44.82% -8.56% -102.98% -2300.46% -10.75% 9.25% -142.84% -656.81% -48.82% -105.51% -1882.10% -0.30% -16.45% 5.86% 7.20% 7.31% 5.68% 17.54% 4.66% -541.98%  
      net income margin %
    -Infinity% -Infinity% -Infinity% Infinity% -Infinity% Infinity% -Infinity% -Infinity% -Infinity% -Infinity% -Infinity% -Infinity% -Infinity% -Infinity% -Infinity% -Infinity% Infinity% -Infinity% -Infinity% -Infinity% -Infinity% -Infinity% -Infinity% NaN% -Infinity% Infinity% -Infinity% Infinity% -Infinity% -Infinity% Infinity% Infinity% Infinity% Infinity% Infinity% Infinity% Infinity% -Infinity% Infinity% 5.32% 4.91% -12.10% 2.26% 4.69% -85.35% 4.81% 4.69% 5.74% 5.41% 5.25% 4.95% 4.67% 4.05% 4.25% -1.03% 
      less net loss attributable to noncontrolling interests
    9,129,000 33,137,000 7,311,000 -5,173,000 5,963,000 -12,801,000 4,164,000 9,819,000 24,288,250 33,773,000 23,245,000 40,135,000 65,776,000 241,200,000 40,394,000 32,852,000 -18,857,000 31,921,000  27,989,000    5,684,000                                
      net income attributable to genesis healthcare, inc.
    -7,673,000 -62,793,000 -22,005,000 33,508,000 -11,396,000 46,097,000             -22,973,000  -40,176,000 -28,952,000 -19,186,000                                 
      earnings per common share:
                                                           
      basic:
                                                           
      weighted-average shares outstanding for basic net income per share
    111,851 113,145 111,232 109,721 107,286 109,123                                                  
      basic net income per common share attributable to genesis healthcare, inc.
    -0.07 -0.55 -0.2 0.31 -0.1 0.42                                                  
      diluted:
                                                           
      weighted-average shares outstanding for diluted net income per share
    111,851 113,145 111,232 167,414 165,314 166,002                                                  
      diluted net income per common share attributable to genesis healthcare, inc.
    -0.07 -0.55 -0.2 0.24 -0.11 0.4                                                  
      income before income tax benefit
      -29,773,000  6,038,250 58,329,000             -32,933,000  -59,837,500 -77,707,000 -37,633,000                                 
      income tax benefit
      -457,000  -170,000 -569,000 -162,000          -4,934,500 -25,888,000 3,086,000  -6,698,250 -16,726,000 -4,419,000                                 
      goodwill and identifiable intangible asset impairments
            1,477,000 929,000 1,132,000   360,046,000                                          
      equity in net loss of unconsolidated affiliates
        -44,500 -93,000 -24,000 -61,000 26,500 -152,000 38,000 220,000                                            
      loss before income tax benefit
          -9,145,000          -44,775,500 -78,243,000                                      
      net loss attributable to genesis healthcare, inc.
          -4,819,000 -15,263,000 -41,569,500 -58,128,000 -39,612,000 -68,538,000 -89,241,000 -373,824,000 -65,156,000 -50,761,000 22,457,000 -20,458,000  -43,039,000    -112,566,000                                
      loss per common share:
                                                           
      basic and diluted:
                                                           
      weighted-average shares outstanding for loss from continuing operations per share
          106,846 103,715  102,489 100,596 98,252 94,217 94,940 93,273 91,880 89,873                                       
      other loss
           -16,917,000 -10,590,000 -20,207,000 -22,220,000 68,000 -7,129,000 2,379,000 4,190,000 9,034,000 -12,021,000 -5,173,000  12,000 6,122,000 38,000 50,000                                 
      loss before income tax expense
           -25,031,000 -66,297,500 -93,121,000 -63,743,000 -108,326,000 -171,165,000 -613,426,000 -102,700,000 -82,308,000    -67,926,000                                    
      customer receivership and other related charges
                                                           
      loss from continuing operations
            -65,857,750 -91,901,000 -62,857,000 -108,673,000 -155,055,000 -615,022,000 -105,503,000 -83,592,000 41,286,000 -52,355,000  -70,990,000                                    
      loss from discontinued operations, net of taxes
                -17,500   -21,000                                        
      net loss per common share:
                                                           
      loss from continuing operations attributable to genesis healthcare, inc.
            -0.415 -0.57 -0.39 -0.7 -0.91 -3.94 -0.7 -0.55 0.25 -0.23  -0.48    -1.5                                
      provision for losses on accounts receivable
                23,709,000 25,187,000 23,985,000 23,528,000 26,039,000 25,602,000  26,493,000                                    
      customer receivership
                8,966,000 297,000 35,566,000                                         
      skilled healthcare and other loss contingency expense
                      13,566,000 1,626,000                                    
      income from discontinued operations, net of taxes
                  -47,000   -24,000 61,000 -38,000   -1,722,000 112,000                                
      weighted-average shares outstanding for basic and diluted loss from continuing operations per share
                     90,226  89,198 85,755                                   
      basic and diluted net loss per common share:
                                                           
      benefit from losses on accounts receivable
                      29,681,000  17,213,750 23,346,000 22,113,000                                 
      other (income) loss
                      -42,923,000                                     
      income from continuing operations
                      -36,019,000  -53,139,250 -60,981,000 -33,214,000  -64,000 643,000 -2,780,000 1,295,000             10,841,000 -25,307,000 4,545,000 8,881,000 -161,316,000 9,295,000          
      less net income attributable to noncontrolling interests
                      12,985,000                                     
      weighted-average shares outstanding for basic and diluted income from continuing operations per share
                      89,421   89,213 89,211 75,234                                
      basic and diluted net income per common share:
                                                           
      income from continuing operations attributable to genesis healthcare, inc.
                      -0.26  -0.47 -0.32 -0.2                                 
      (gain) loss on early extinguishment of debt
                        32,500 -3,104,000                                  
      skilled healthcare loss contingency expense
                         30,000,000                                  
      equity in net (income) loss of unconsolidated affiliates
                        -288,250 -640,000                                  
      gain from discontinued operations, net of taxes
                        -392,750 39,000                                  
      less net income (income) attributable to noncontrolling interests
                        13,356,000 31,990,000 15,750,000                                 
      income from discontinued operations
                        -0.005  -0.02                                 
      revenue:
                                                           
      net patient service revenue
                            209,559,000 207,811,000 206,172,000 206,513,000 196,473,000 211,658,000 212,905,000 218,114,000 218,443,000 215,854,000 216,607,000 218,659,000 213,674,000 216,409,000 214,801,000                 
      leased facility revenue
                            800,000 807,000 807,000 787,000 787,000 787,000 787,000 761,000 769,000 769,000 768,000 754,000 747,000 746,000 746,000                 
      expenses:
                                                           
      cost of services
                            179,337,000 176,689,000 178,529,000 180,309,000 170,730,000 184,627,000 186,376,000 190,137,000 185,385,000 182,243,000 180,215,000 183,131,000 177,021,000 173,548,000 171,249,000 175,461,000 175,224,000 168,579,000 162,007,000 151,705,000 152,324,000 152,457,000 154,257,000 148,804,000 148,333,000 145,749,000 142,252,000 142,144,000 131,931,000 120,826,000 113,494,000 
      rent cost of revenue
                            5,158,000 5,146,000 4,922,000 4,774,000 4,238,000 4,950,000 4,828,000 4,812,000 4,773,000 4,639,000 4,539,000 4,556,000 4,869,000 4,413,000 4,547,000 4,570,000 4,829,000 4,796,000 4,832,000 4,581,000 4,569,000 4,509,000 4,568,000 4,539,000 4,515,000 4,771,000 4,478,000 4,465,000    
      general and administrative
                            13,838,000 12,780,000 7,287,000 6,084,000 6,837,000 6,490,000 6,837,000 6,455,000 5,701,000 6,021,000 6,427,000 6,100,000 6,177,000 5,423,000 7,237,000 6,893,000 7,037,000 6,016,000 6,112,000 6,351,000 5,684,000 6,343,000 6,823,000 6,240,000 6,766,000 5,992,000 5,557,000 6,222,000 14,008,000 12,008,000 10,403,000 
      change in fair value of contingent consideration
                            -476,000 7,000 -121,000 14,000 -1,620,000 79,000 -2,244,000                         
      depreciation and amortization
                            6,082,000 6,120,000 6,034,000 6,085,000 5,375,000 6,130,000 6,130,000 6,219,000 6,276,000 6,258,000 6,591,000 6,275,000 6,193,000 6,459,000 6,432,000 6,145,000 6,806,000 6,305,000 5,992,000 5,944,000 5,950,000 6,014,000 5,867,000 5,477,000 5,444,000 5,301,000 5,073,000 5,160,000 5,068,000 4,420,000 4,239,000 
      governmental investigation expense
                              6,000,000                             
      impairment of long-lived assets
                              82,000   19,000,000        270,478,000                  
      loss on disposal of asset
                            18,250 68,000 5,000                             
      other (expenses) income:
                                                           
      interest income
                            219,000 173,000 302,000 43,000 48,000 63,000 112,000 112,000 110,000 125,000 132,000 145,000 161,000 170,000 208,000 175,000 263,000 260,000 196,000 228,000 250,000 285,000 420,000 191,000 174,000 169,000 123,000 214,000 289,000 384,000  
      equity in earnings of joint venture
                            221,000 568,000 92,000 546,000 480,000 508,000 472,000 489,000 526,000 461,000 490,000 471,000 372,000 472,000 557,000 554,000 345,000 746,000 678,000 797,000 521,000 746,000 751,000 733,000 754,000 624,000 718,000 391,000 329,000 381,000 353,000 
      debt modification/retirement costs
                             -21,000 -822,000  -1,308,000 -432,000 -1,088,000                         
      total other (expenses) income
                            -5,769,500 -7,315,000 -8,366,000 -7,398,000 -8,586,000 -8,654,000 -9,270,000 -8,104,000 -8,300,000 -8,429,000 -13,751,000                     
      income from continuing operations before benefit from income taxes
                            -249,000 493,000               18,719,000 -39,073,000 7,311,000 14,475,000 -157,474,000 11,715,000          
      benefit from income taxes
                            -38,250 -150,000       2,339,000 2,965,000 2,355,000 4,036,000 4,067,000 -15,259,000 6,584,000 8,124,000   2,766,000 5,594,000 3,842,000 2,420,000 5,736,000 6,298,000 6,195,000 2,561,000 5,830,000 5,466,000 5,330,000 4,801,000  
      loss from discontinued operations, net of tax
                                                           
      earnings per share, basic:
                                                           
      earnings per common share from continuing operations
                             0.02 -0.07 0.03             0.29 -0.68 0.12 0.24 -4.37 0.25          
      loss per share from discontinued operations
                                                           
      earnings per share
                            -0.005 0.02 -0.07 0.03           0.28 0.32 0.29 -0.68 0.12 0.24 -4.37 0.24          
      earnings per share, diluted:
                                                           
      weighted-average common shares outstanding, basic
                            38,125 38,207 38,098 37,972 37,533 37,499 37,646 37,557 37,389 37,431 37,400 37,285 37,145 37,164 37,154 37,079 36,988 36,997 36,983 36,962 36,914 36,927 36,904 36,881 36,573 36,578 36,558 36,551 27,062 36,236 23,436,598 
      weighted-average common shares outstanding, diluted
                            38,125 38,463 38,098 38,202 37,533 37,499 38,186 38,034 37,589 37,503 37,497 37,407 37,145 37,164 37,354 37,326 36,988 36,997 37,084 37,037 36,914 36,950 36,928 36,911 36,894 36,909 36,871 36,881 27,715 36,917 23,436,598 
      income from continuing operations before provision for income taxes
                              -4,125,000 2,636,000                            
      provision for income taxes
                              -1,345,000 1,341,000 1,455,000 -5,410,000 972,000 78,000                        
      income before provision for income taxes
                                -2,960,500 -17,485,000 2,495,000 3,148,000                        
      net income per share
                                -0.05 -0.32 0.04 0.08                        
      litigation settlement costs,
                                         -4,488,000                  
      debt retirement costs
                                     -168,000 -3,958,000        -7,010,000             
      income before benefit from income taxes
                                    6,314,500 9,033,000 5,852,000 10,373,000 -52,686,750 -247,870,000 17,155,000 19,968,000       14,815,000 17,165,000 16,460,000 12,137,000 14,754,000 13,910,000 4,396,750 11,665,000  
      income per share, basic
                                    0.16 0.16 0.09                     
      income per share, diluted
                                    0.15 0.16 0.09                     
      total other income (expenses)
                                       -8,978,000 -6,915,000 -9,192,000 -8,927,000         -7,226,000 -8,263,000 -8,524,000 -8,234,000 -8,826,000 -9,473,000 -9,314,000 -22,537,000 
      income per share
                                       0.17                    
      loss per share, basic
                                                           
      loss per share
                                        0.19 -6.26                  
      loss per share, diluted
                                                           
      revenue
                                           222,578,000 220,749,000 209,199,000 200,971,000 189,319,000 188,996,000 188,365,000 193,400,000 189,451,000 189,781,000 182,474,000 180,348,000 180,727,000 177,392,000 161,468,000 151,091,000 
      yoy
                                           17.57% 16.80% 11.06% 3.91% -0.07% -0.41% 3.23% 7.24% 4.83% 6.98% 13.01% 19.36%     
      qoq
                                           0.83% 5.52% 4.09% 6.15% 0.17% 0.33% -2.60% 2.08% -0.17% 4.00% 1.18% -0.21% 1.88% 9.86% 6.87%  
      total other incomes
                                           -9,541,000 -7,513,000 -9,071,000 -14,717,000 -6,263,000 -5,405,750 -7,327,000 -7,070,000         
      litigation settlement costs
                                             53,505,000              
      benefit for income taxes
                                            -1,351,500 -13,766,000             -556,000 
      income from discontinued operations, net of tax
                                                 -243,000          
      loss per common share from discontinued operations
                                                 -0.01          
      earnings per share data:
                                                           
      earnings per common share, basic
                                                  0.25 0.29        
      earnings per common share, diluted
                                                  0.25 0.29        
      premium on redemption of debt and write-off of related deferred financing costs
                                                          -11,648,000 
      change in fair value of interest rate hedge
                                                         -6,000  
      accretion on preferred stock
                                                          -2,583,000 
      net income attributable to common stockholders
                                                    10,265,000 9,576,000 8,924,000 8,444,000 7,184,000 6,864,000 -4,136,000 
      net income per common share, basic
                                                    0.185 0.26 0.24 0.23 0.25 0.19 -0.18 
      net income per common share, diluted
                                                    0.183 0.26 0.24 0.23 0.24 0.19 -0.18 
      other
                                                       222,000 86,000 -159,000  
      rent cost of sales
                                                        2,114,000 3,235,000 2,527,000 
      interest income and other
                                                          684,000 
      income before benefit for income taxes
                                                          -2,109,000 
    Balance Sheets:
    Quarterly
    Annual
      Unit: USD2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 2018-03-31 2017-12-31 2017-09-30 2017-06-30 2017-03-31 2016-12-31 2016-09-30 2016-06-30 2016-03-31 2015-12-31 2015-09-30 2015-06-30 2015-03-31 2014-12-31 2014-09-30 2014-06-30 2014-03-31 2013-12-31 2013-09-30 2013-06-30 2013-03-31 2012-12-31 2012-09-30 2012-06-30 2012-03-31 2011-12-31 2011-09-30 2011-06-30 2011-03-31 2010-12-31 2010-09-30 2010-06-30 2010-03-31 2009-12-31 2009-09-30 2009-06-30 2009-03-31 2008-12-31 2008-09-30 2008-06-30 2008-03-31 2007-12-31 2007-09-30 2007-06-30 
                                                             
        assets:
                                                             
        current assets:
                                                             
        cash and cash equivalents
      212,071,000 200,995,000 251,651,000 23,502,000 12,097,000 34,837,000 11,857,000 14,464,000 20,865,000 23,170,000 78,932,000 57,705,000 54,525,000 50,591,000 64,745,000 51,793,000 51,408,000 53,840,000 46,678,000 52,204,000 61,543,000 59,671,000 82,963,000  3,629,000 10,536,000 7,960,000 4,205,000 4,177,000 2,595,000 2,019,000 5,149,000 2,003,000 3,199,000 5,572,000 9,881,000 16,017,000 16,442,000 15,015,000 940,000 4,192,000 3,200,000 157,000 2,107,000 3,528,000 3,235,000 12,174,000 7,453,000 2,047,000 4,327,000 3,713,000 3,992,000 5,012,000 325,000 2,333,000 
        restricted cash and equivalents
      49,998,000 45,437,000 62,664,000 47,285,000 63,101,000 42,807,000 32,600,000 31,921,000 73,762,000 48,675,000 6,949,000 6,451,000                                            
        restricted investments in marketable securities
      39,526,000 39,682,000 39,682,000 31,855,000 31,855,000 35,950,000 35,950,000 35,631,000 35,631,000 36,780,000 29,831,000                                             
        accounts receivable
      426,927,000 456,023,000 459,354,000 553,520,000 567,636,000 545,259,000 558,907,000 602,374,000 622,717,000 642,993,000 687,970,000 724,960,000 724,138,000 774,052,000 754,384,000 808,669,000 832,109,000 826,221,000 819,919,000 821,199,000 789,387,000 759,305,000 753,563,000 763,006,000                                
        prepaid expenses
      93,476,000 118,051,000 69,617,000 73,774,000 108,908,000 81,661,000 67,038,000 73,971,000 82,747,000 76,720,000 65,368,000 71,781,000 74,368,000 83,878,000 68,139,000 63,594,000 64,218,000 63,873,000 80,743,000 89,447,000 58,622,000 83,674,000 48,961,000 49,112,000 5,689,000 5,019,000 6,009,000 10,609,000 8,961,000 8,983,000 3,355,000 7,335,000 7,569,000 8,220,000 5,255,000 7,445,000 6,943,000 8,372,000 5,712,000 9,137,000 9,618,000 6,107,000 5,888,000 9,003,000 8,159,000 11,952,000 4,820,000 7,380,000 9,226,000 11,203,000 4,113,000 5,012,000 5,708,000 5,722,000 2,858,000 
        other current assets
      47,132,000 37,225,000 41,723,000 43,845,000 44,079,000 39,014,000 33,702,000 42,115,000 36,528,000 53,173,000 50,239,000 52,539,000 49,748,000 46,306,000 55,097,000 58,879,000 63,641,000 63,480,000 56,979,000 64,204,000 49,024,000 47,404,000 40,573,000 38,453,000 10,303,000 12,858,000 11,115,000 11,610,000 12,188,000 10,580,000 11,169,000 10,594,000 10,312,000 8,493,000 10,127,000 8,732,000 9,203,000 9,866,000 10,744,000 17,522,000 15,819,000 20,747,000 11,791,000 7,468,000 8,303,000 6,828,000 7,115,000 6,916,000 7,483,000 5,625,000 13,830,000 11,450,000 11,697,000 14,365,000 14,527,000 
        assets held for sale
          1,171,000 4,740,000 6,574,000 8,539,000 3,375,000 9,533,000 9,278,000 8,821,000    4,064,000 4,056,000                                       
        total current assets
      869,130,000 897,413,000 924,691,000 773,781,000 828,847,000 784,268,000 746,628,000 809,015,000 875,625,000 891,044,000 928,567,000 952,934,000 939,907,000 998,792,000 986,330,000 1,030,549,000 1,058,987,000 1,048,666,000 1,056,896,000 1,079,971,000 1,011,493,000 1,004,160,000 978,828,000 1,000,956,000 161,383,000 157,638,000 147,372,000 145,567,000 142,417,000 140,322,000 150,253,000 147,931,000 138,825,000 141,157,000 142,390,000 147,500,000 143,331,000 149,287,000 148,710,000 147,655,000 148,825,000 144,520,000 130,773,000 131,439,000 131,603,000 141,101,000 146,451,000 155,917,000 148,675,000 148,512,000 146,119,000 159,750,000 150,304,000 135,829,000 123,474,000 
        property and equipment
      984,712,000 1,018,939,000 831,333,000 853,793,000 962,105,000 957,218,000 673,911,000 679,749,000 2,887,554,000 2,919,584,000 3,017,243,000 3,212,156,000 3,413,599,000 3,470,946,000 3,670,151,000 3,709,242,000 3,765,393,000 3,944,620,000 3,957,245,000 3,981,879,000 4,085,247,000 3,965,527,000 3,995,294,000 3,947,941,000                           318,971,000 299,322,000 294,281,000 289,063,000 267,456,000 
        finance lease right-of-use assets, net of accumulated amortization of 16,328 and 23,401 at december 31, 2020 and december 31, 2019, respectively
      27,848,000                                                       
        operating lease right-of-use assets
      1,715,532,000 1,817,603,000 2,134,233,000 2,353,477,000 2,399,505,000 2,416,914,000 2,200,252,000 2,235,128,000                                                
        other long-term assets
      116,371,000 120,098,000 108,563,000 109,400,000 85,725,000 120,738,000 119,479,000 114,897,000 125,595,000 107,550,000 105,206,000 106,338,000 109,060,000 122,144,000 132,659,000 136,764,000 137,602,000 134,935,000 129,874,000 125,666,000 162,390,000 161,520,000 172,144,000 163,326,000                                
        deferred income taxes
      2,278,000 1,946,000 4,702,000 4,391,000 3,772,000 5,617,000 5,482,000 5,775,000 5,867,000 5,151,000 5,032,000 3,330,000 3,580,000 5,754,000 6,358,000 6,274,000 6,107,000 5,721,000 16,559,000 6,485,000 7,144,000 2,657,000 2,657,000 2,443,000 17,659,000 14,627,000 11,845,000 9,736,000 9,876,000 11,055,000 11,430,000 12,348,000 11,696,000 12,093,000 12,644,000 11,429,000 11,404,000 12,512,000 13,006,000 12,152,000 20,419,000 19,695,000 14,567,000 14,673,000 15,003,000 17,558,000 21,218,000 14,745,000 14,708,000   13,088,000 14,968,000 13,979,000 14,060,000 
        identifiable intangible assets, net of accumulated amortization of 81,387 and 76,243 at december 31, 2020 and december 31, 2019, respectively
      82,270,000                                                       
        goodwill
      85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 85,642,000 439,212,000 439,912,000 440,712,000 444,113,000 444,508,000 470,735,000 470,019,000 444,446,000 431,515,000 423,387,000 68,833,000 68,833,000 68,983,000 69,065,000 69,065,000 69,065,000 85,609,000 85,609,000 85,609,000 85,609,000 85,609,000 84,299,000 84,299,000 72,847,000 332,724,000 332,724,000 332,724,000 336,404,000 336,404,000 279,362,000 279,362,000 449,962,000 449,962,000 449,962,000 449,962,000 450,189,000 451,711,000 450,040,000 449,710,000 448,047,000 418,857,000 
        total assets
      4,062,246,000 4,214,625,000 4,366,334,000 4,488,981,000 4,662,140,000 4,674,147,000 4,642,580,000 4,779,923,000 4,263,623,000 4,391,374,000 4,544,817,000 4,771,539,000 4,787,865,000 4,926,928,000 5,514,788,000 5,688,509,000 5,779,201,000 5,886,587,000 5,933,018,000 6,005,750,000 6,091,470,000 6,121,361,000 6,103,378,000 6,031,356,000 650,956,000 649,897,000 643,961,000 644,814,000 643,416,000 661,912,000 684,974,000 684,516,000 682,636,000 684,586,000 689,133,000 696,482,000 695,000,000 693,888,000 939,015,000 941,111,000 937,730,000 935,336,000 926,459,000 859,020,000 856,242,000 1,030,786,000 1,034,294,000 1,030,224,000 1,013,842,000 1,007,302,000 992,261,000 986,473,000 970,107,000 952,056,000 884,792,000 
        liabilities and stockholders' deficit:
                                                             
        current liabilities:
                                                             
        current portion of long-term debt
      905,788,000 10,693,000 19,116,000                      12,456,000 13,173,000 10,198,000 10,172,000 7,630,000 17,446,000 12,306,000 13,460,000 13,338,000 14,493,000 11,925,000 5,273,000 4,414,000 6,287,000 6,588,000                 
        current portion of finance lease obligations
      2,949,000 2,958,000 2,947,000                                                     
        current portion of operating lease obligations
      2,071,841,000 126,974,000 135,853,000                                                     
        accounts payable
      211,357,000 190,264,000 210,870,000 195,356,000 238,384,000 254,443,000 230,474,000 241,065,000 234,786,000 239,514,000 251,644,000 259,360,000 285,637,000 241,145,000 233,089,000 254,891,000 258,616,000 223,961,000 211,127,000 224,850,000 233,801,000 201,800,000 205,586,000 218,565,000                                
        accrued expenses
      335,837,000 324,354,000 364,973,000 226,692,000 226,092,000 219,120,000 218,105,000 220,596,000 227,813,000 215,384,000 201,790,000 213,705,000 233,856,000 220,376,000 192,137,000 166,465,000 215,457,000 205,096,000 207,155,000 194,791,000 197,741,000 193,668,000 155,370,000 155,484,000                                
        accrued compensation
      162,870,000 145,439,000 147,281,000 154,058,000 153,698,000 153,488,000 155,639,000 164,299,000 172,726,000 165,309,000 156,773,000 168,834,000 167,368,000 163,727,000 161,396,000 189,477,000 181,841,000 185,916,000 225,382,000 246,828,000 185,054,000 222,689,000 226,745,000 255,881,000                                
        self-insurance reserves
      153,669,000 149,793,000 149,793,000 149,655,000 146,476,000 137,111,000 137,111,000 149,545,000 149,545,000 180,459,000 180,459,000 180,982,000 180,982,000 168,933,000 168,933,000 172,565,000 172,565,000 162,149,000 161,382,000 166,761,000 166,761,000 146,884,000 146,884,000 144,897,000                                
        current portion of liabilities held for sale
      403,000 400,000 394,000 728,000 368,000 1,020,000 1,257,000 1,763,000 639,000 2,123,000 2,110,000 2,097,000    997,000 988,000                                       
        total current liabilities
      3,844,714,000 950,875,000 1,031,227,000 977,694,000 1,071,170,000 1,027,239,000 964,059,000 977,194,000 912,212,000 922,977,000 904,256,000 859,401,000 899,194,000 5,502,595,000 784,566,000 824,043,000 857,560,000 811,298,000 816,654,000 844,420,000 798,665,000 780,363,000 750,362,000 791,675,000 115,292,000 120,113,000 109,451,000 98,652,000 97,788,000 110,489,000 105,498,000 102,189,000 104,303,000 110,012,000 105,221,000 92,469,000 98,378,000 91,602,000 91,144,000 89,312,000 96,040,000 87,512,000 98,236,000 91,727,000 86,931,000 86,435,000 87,255,000 88,737,000 94,115,000 88,757,000 81,509,000 87,653,000 95,182,000 82,933,000 71,443,000 
        long-term debt
      634,934,000 1,543,698,000 1,359,710,000 1,355,148,000 1,450,994,000 1,420,952,000 1,142,079,000 1,167,167,000 1,082,933,000 1,087,948,000 1,076,537,000 1,117,167,000 1,050,337,000 284,014,000 1,126,070,000 1,110,826,000 1,146,550,000 1,155,456,000 1,126,258,000 1,105,022,000 1,217,680,000 1,036,882,000 1,031,626,000 980,911,000                                
        finance lease obligations
      34,943,000 35,577,000 36,268,000 38,845,000 39,335,000 39,676,000 839,196,000 836,309,000                                                
        operating lease obligations
      159,711,000 2,199,826,000 2,476,384,000 2,632,831,000 2,681,403,000 2,697,496,000 2,250,790,000 2,279,493,000                                                
        liabilities held for sale
      18,271,000 18,373,000 24,043,000 44,913,000 19,789,000 45,314,000 55,038,000 102,235,000 25,942,000 105,807,000 118,929,000 126,901,000    68,805,000 69,057,000                                       
        other long-term liabilities
      141,765,000 200,165,000 99,305,000 64,704,000 69,905,000 76,125,000 82,478,000 90,879,000 126,247,000 99,559,000 101,494,000 118,323,000 119,484,000 133,854,000 138,963,000 145,966,000 103,435,000 105,070,000 130,898,000 133,769,000 133,111,000 132,553,000 127,605,000 129,428,000 12,660,000 12,641,000 12,471,000 12,296,000 12,367,000 12,480,000 14,259,000 15,047,000 15,477,000 15,605,000 17,503,000 17,935,000 17,773,000 16,499,000 16,446,000 16,923,000 15,984,000 16,933,000 16,035,000 12,478,000 12,426,000 12,694,000 14,405,000 14,117,000 14,064,000 15,413,000 23,077,000 24,496,000 21,810,000 21,277,000 20,168,000 
        commitments and contingencies
                                                             
        stockholders’ deficit:
                                                             
        class a common stock
      111,000 111,000 111,000 108,000 108,000 108,000 107,000 104,000 101,000 101,000 101,000 98,000 97,000 94,000 80,000 77,000 75,000 74,000 74,000 74,000 74,000 74,000 74,000 74,000                                
        class b common stock
      1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 14,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000                                
        class c common stock,
      55,000 55,000 55,000 56,000 56,000 56,000 57,000 57,000 60,000 60,000 59,000 60,000 61,000 61,000 62,000 62,000 64,000 64,000 64,000 64,000 64,000 64,000                                  
        additional paid-in-capital
      247,472,000 243,697,000 242,108,000 247,876,000 248,594,000 249,063,000 248,287,000 254,384,000 270,408,000 267,882,000 266,210,000 284,365,000 290,573,000 296,378,000 295,100,000 297,618,000 305,358,000 302,747,000 298,536,000 296,948,000 295,359,000 293,330,000 298,899,000  382,718,000 381,818,000 380,808,000 378,992,000 378,756,000 378,071,000 377,439,000 377,125,000 376,027,000 374,846,000 373,653,000 372,463,000 371,753,000 370,593,000 370,405,000 369,216,000 368,582,000 367,245,000 366,278,000 365,416,000 365,126,000 364,561,000 364,016,000 366,992,000 366,565,000 366,078,000 365,661,000 365,355,000 365,051,000 364,841,000 364,688,000 
        accumulated deficit
      -1,069,259,000 -1,061,586,000 -998,793,000 -976,788,000 -1,010,296,000 -998,900,000 -1,044,997,000 -1,040,178,000 -1,609,828,000 -1,540,875,000 -1,482,747,000 -1,443,135,000 -1,374,597,000 -1,285,356,000 -911,532,000 -846,376,000 -795,615,000 -818,072,000 -797,614,000 -774,641,000 -731,602,000 -466,112,000 -437,160,000  -287,499,000 -287,435,000 -288,078,000 -285,297,000 -286,592,000 -283,589,000 -271,515,000 -273,038,000 -276,108,000 -281,803,000 -287,871,000 -287,751,000 -294,088,000 -301,018,000 -68,407,000 -78,978,000 -90,822,000 -101,663,000 -76,355,000 -80,900,000            
        accumulated other comprehensive income
      1,396,000 1,503,000 1,591,000 1,243,000 602,000 610,000 541,000 135,000          81,000 379,000 272,000 -218,000 327,000 318,000 631,000    28,000 28,000 23,000 26,000          -218,000 -365,000  -224,000 40,000           
        total stockholders’ deficit before noncontrolling interests
      -820,224,000 -816,219,000 -754,927,000 -727,504,000 -760,935,000 -749,062,000 -796,004,000 -785,497,000 -1,339,520,000 -1,273,396,000 -1,216,645,000 -1,159,187,000 -1,084,227,000 -988,956,000 -616,491,000 -548,818,000 -490,323,000 -515,090,000 -498,545,000 -477,267,000 -436,307,000 -172,301,000 -137,789,000                                 
        noncontrolling interests
      -342,023,000 -328,696,000 -315,354,000 -314,631,000 -321,630,000 -316,161,000 -336,975,000 -339,464,000 -705,346,000 -665,335,000 -631,101,000 -627,543,000 -595,905,000 -539,763,000 -298,553,000 -262,705,000 -239,865,000 -256,441,000 -224,163,000 -210,956,000 -183,080,000 -134,095,000 -106,753,000                                 
        total stockholders' deficit
      -1,162,247,000 -1,144,915,000 -1,070,281,000 -1,042,135,000 -1,082,565,000 -1,065,223,000 -1,132,979,000 -1,124,961,000 -2,044,866,000 -1,938,731,000 -1,847,746,000 -1,786,730,000 -1,680,132,000 -1,528,719,000 -915,044,000 -811,523,000 -730,188,000 -771,531,000 -722,708,000 -688,223,000 -619,387,000 -306,396,000 -244,542,000                                 
        total liabilities and stockholders’ deficit
      4,062,246,000 4,214,625,000 4,366,334,000 4,488,981,000 4,662,140,000 4,674,147,000 4,642,580,000 4,779,923,000 4,263,623,000 4,391,374,000 4,544,817,000 4,771,539,000 4,787,865,000 4,926,928,000 5,514,788,000 5,688,509,000 5,779,201,000 5,886,587,000 5,933,018,000 6,005,750,000 6,091,470,000 6,121,361,000 6,103,378,000 6,031,356,000                                
        finance lease right-of-use assets, net of accumulated amortization of 15,578 and 23,401 at september 30, 2020 and december 31, 2019, respectively
       28,635,000                                                      
        identifiable intangible assets, net of accumulated amortization of 80,126 and 76,243 at september 30, 2020 and december 31, 2019, respectively
       83,530,000                                                      
        finance lease right-of-use assets, net of accumulated amortization of 20,652 and 23,401 at june 30, 2020 and december 31, 2019, respectively
        32,956,000                                                     
        identifiable intangible assets, net of accumulated amortization of 78,864 and 76,243 at june 30, 2020 and december 31, 2019, respectively
        84,826,000                                                     
        finance lease right-of-use assets, net of accumulated amortization of 24,436 and 23,401 at march 31, 2020 and december 31, 2019, respectively
         33,791,000                                                    
        identifiable intangible assets, net of accumulated amortization of 77,553 and 76,243 at march 31, 2020 and december 31, 2019, respectively
         86,136,000                                                    
        current installments of long-term debt
         106,088,000 162,426,000 121,745,000 108,639,000 89,695,000 122,531,000 116,077,000 107,338,000 30,082,000 26,962,000 851,344,000 23,770,000 36,062,000 24,594,000 30,758,000 8,328,000 8,113,000 12,477,000 12,453,000 12,889,000 12,746,000                                
        current installments of finance lease obligations
         2,926,000 2,839,000 2,738,000 2,678,000 2,734,000                                                
        current installments of operating lease obligations
         142,191,000 140,887,000 137,574,000 110,156,000 107,497,000                                                
        finance lease right-of-use assets, net of accumulated amortization of 23,401 at december 31, 2019
          37,097,000                                                   
        identifiable intangible assets, net of accumulated amortization of 76,243 and 99,160 at december 31, 2019 and december 31, 2018, respectively
          87,446,000                                                   
        current installments of financing obligations
                                                             
        financing obligations
              2,001,000 1,947,000 1,983,000 1,930,000 1,878,000 2,908,020,000 1,777,000 1,660,000 1,613,000 1,566,000 1,431,000 1,230,000 989,000 1,026,000 1,062,000 1,098,000                                
        finance lease right-of-use assets, net of accumulated amortization of 22,420 at september 30, 2019
           37,685,000                                                  
        identifiable intangible assets, net of accumulated amortization of 73,610 and 99,160 at september 30, 2019 and december 31, 2018, respectively
           90,079,000                                                  
        finance lease right-of-use assets, net of accumulated amortization of 65,889 at june 30, 2019
            516,537,000                                                 
        identifiable intangible assets, net of accumulated amortization of 70,992 and 99,160 at june 30, 2019 and december 31, 2018, respectively
            92,397,000                                                 
        finance lease right-of-use assets, net of accumulated amortization of 66,460 at march 31, 2019
             523,167,000                                                
        identifiable intangible assets, net of accumulated amortization of 68,374 and 99,160 at march 31, 2019 and december 31, 2018, respectively
             95,015,000                                                
        identifiable intangible assets, net of accumulated amortization of 99,160 and 88,336 at december 31, 2018 and december 31, 2017, respectively
              119,082,000                                               
        capital lease obligations
              2,171,000 2,164,000 2,159,000 2,411,000 2,511,000 949,050,000 3,464,000 1,926,000 1,886,000 1,852,000 1,849,000 1,847,000 1,842,000 1,843,000 1,826,000 3,004,000                                
        accumulated other comprehensive loss
              -262,000 -565,000 -269,000 -576,000 -362,000 -134,000 -215,000 -215,000 -221,000               -47,000 -127,000 -211,000 -300,000 -388,000 -490,000 -519,000 -417,000 -207,000      -623,000 -1,127,000 -1,503,000 -1,842,000 -887,000 -997,000 -2,156,000 -753,000   
        identifiable intangible assets, net of accumulated amortization of 97,242 and 88,336 at september 30, 2018 and december 31, 2017, respectively
               125,386,000                                              
        identifiable intangible assets, net of accumulated amortization of 94,369 and 88,336 at june 30, 2018 and december 31, 2017, respectively
                131,091,000                                             
        investments in marketable securities
                 30,677,000                                            
        identifiable intangible assets, net of accumulated amortization of 93,127 and 88,336 at march 31, 2018 and december 31, 2017, respectively
                 138,186,000                                            
        restricted cash and investments in marketable securities
                  37,128,000 43,965,000 43,965,000 43,550,000 43,555,000 41,252,000 52,577,000 52,917,000 52,917,000 51,449,000 50,111,000 52,234,000                                
        identifiable intangible assets, net of accumulated amortization of 88,336 and 91,155 at december 31, 2017 and december 31, 2016, respectively
                  142,976,000                                           
        identifiable intangible assets, net of accumulated amortization of 84,073 and 91,155 at september 30, 2017 and december 31, 2016, respectively
                   147,239,000                                          
        identifiable intangible assets, net of accumulated amortization of 104,378 and 91,155 at june 30, 2017 and december 31, 2016, respectively
                    162,344,000                                         
        identifiable intangible assets, net of accumulated amortization of 97,929 and 91,155 at march 31, 2017 and december 31, 2016, respectively
                     168,793,000                                        
        identifiable intangible assets, net of accumulated amortization of 91,155 and 66,570 at december 31, 2016 and december 31, 2015, respectively
                      175,566,000                                       
        identifiable intangible assets, net of accumulated amortization of 87,033 and 66,570 at september 30, 2016 and december 31, 2015, respectively
                       185,779,000                                      
        identifiable intangible assets, net of accumulated amortization of 80,250 and 66,570 at june 30, 2016 and december 31, 2015, respectively
                        192,566,000                                     
        identifiable intangible assets, net of accumulated amortization of 73,458 and 66,570 at march 31, 2016 and december 31, 2015, respectively
                         203,080,000                                    
        identifiable intangible assets, net of accumulated amortization of 66,570 and 42,661 at december 31, 2015 and december 31, 2014, respectively
                          209,967,000                                   
        identifiable intangible assets, net of accumulated amortization of 62,550 and 42,661 at september 30, 2015 and december 31, 2014
                           219,028,000                                  
        identifiable intangible assets, net of accumulated amortization of 55,743 and 42,661 at june 30, 2015 and december 31, 2014
                            225,945,000                                 
        class c common stock
                            64,000 64,000                                
        cash and equivalents
                             95,708,000                                
        identifiable intangible assets, net of accumulated amortization of 48,507 at march 31, 2015 and 42,661 at december 31, 2014
                             233,181,000                                
        liabilities and stockholders’ deficit:
                                                             
        additional paid-in capital
                             298,369,000                                
        total stockholders’ deficit
                                                             
        assets
                                                             
        accounts receivables
                              124,103,000 114,598,000 110,443,000 109,407,000 107,215,000 107,109,000 122,280,000 112,505,000 107,245,000 109,152,000 108,792,000 110,013,000 99,764,000 102,095,000 104,233,000 107,904,000 98,777,000 94,771,000 98,370,000 98,188,000 96,610,000 101,528,000 101,124,000 119,423,000 115,211,000 113,496,000 111,215,000 126,208,000 112,919,000 101,438,000 89,696,000 
        property and equipment, less accumulated depreciation of 160,984 and 137,484 at december 31, 2014 and december 31, 2013, respectively
                              331,130,000                               
        leased facility assets, less accumulated depreciation of 4,904 and 4,432 at december 31, 2014 and december 31, 2013, respectively
                              8,944,000                               
        other assets:
                                                             
        notes receivable
                              1,800,000 2,117,000 2,350,000 131,000 520,000 784,000 1,276,000 1,531,000 2,055,000 2,886,000 3,952,000 4,349,000 5,092,000 5,862,000 6,626,000 6,445,000 5,877,000 6,675,000 8,109,000 7,247,000 8,060,000 9,440,000 11,496,000 7,801,000 4,448,000 4,838,000 5,205,000 4,875,000 5,102,000 5,533,000 5,992,000 
        deferred financing costs
                              7,318,000 8,043,000 8,600,000 8,470,000 9,189,000 8,060,000 6,394,000 5,717,000 6,355,000 6,995,000 7,437,000 9,013,000 9,837,000 10,688,000 11,514,000 12,339,000 13,165,000 13,991,000 15,127,000 12,004,000 13,425,000 14,847,000 16,268,000 9,390,000 10,184,000 10,977,000 11,771,000 12,566,000 11,869,000 12,504,000 12,768,000 
        intangible assets, less accumulated amortization of 4,957 and 4,640 at december 31, 2014 and december 31, 2013, respectively
                              18,491,000                               
        other assets
                              49,825,000 15,747,000 15,199,000 45,376,000 42,708,000 42,060,000 41,581,000 38,588,000 39,737,000 36,565,000 36,701,000 34,766,000 32,119,000 34,351,000 32,984,000 33,073,000 24,476,000 24,791,000 25,555,000 25,691,000 24,284,000 25,326,000 24,111,000 25,473,000 23,797,000 23,432,000 23,102,000 23,536,000 22,461,000 21,663,000 20,431,000 
        total other assets
                              149,499,000 149,917,000 151,055,000 150,464,000 149,761,000 149,144,000 160,182,000 159,580,000 163,153,000 163,670,000 166,299,000 165,257,000 165,375,000 157,442,000 409,012,000 410,027,000 401,583,000 410,154,000 414,300,000 349,788,000 351,428,000 526,775,000 530,174,000 521,949,000 518,701,000 522,936,000 527,171,000 527,401,000 525,522,000 527,164,000 493,862,000 
        liabilities and stockholders’ equity
                                                             
        accounts payable and accrued liabilities
                              65,349,000 64,739,000 57,868,000 51,250,000 57,179,000 53,660,000 50,799,000 51,967,000 48,780,000 58,018,000 53,192,000 51,556,000 52,897,000 49,259,000 48,772,000 48,002,000 50,898,000 46,526,000 58,312,000 53,809,000 49,355,000 45,068,000 51,605,000 49,256,000 55,478,000 45,373,000 49,265,000 55,645,000 59,218,000 50,721,000 46,752,000 
        employee compensation and benefits
                              37,487,000 42,201,000 41,385,000 37,230,000 32,979,000 39,383,000 42,393,000 36,762,000 42,185,000 37,501,000 40,104,000 35,640,000 41,067,000 36,056,000 35,784,000 34,621,000 39,400,000 32,691,000 30,535,000 28,987,000 29,753,000 31,372,000 32,193,000 31,698,000 30,825,000 33,106,000 29,056,000 27,835,000 29,629,000 25,618,000 21,734,000 
        long-term liabilities:
                                                             
        insurance liability risks
                              29,356,000 28,075,000 29,232,000 31,027,000 29,534,000 27,035,000 26,020,000 24,994,000 27,396,000 27,051,000 29,437,000 31,442,000 30,567,000 30,846,000 32,588,000 33,546,000 25,474,000 25,313,000 25,130,000 26,283,000 27,407,000 29,898,000 30,223,000 31,369,000 30,654,000 32,799,000 32,755,000 31,104,000 24,248,000 27,149,000 26,779,000 
        long-term debt, less current portion
                              398,389,000 394,644,000 400,036,000 409,076,000 411,495,000 417,363,000 433,207,000 438,206,000 435,629,000 439,047,000 451,452,000 470,273,000 471,069,000 485,847,000 486,639,000                 
        total liabilities
                              555,697,000 555,473,000 551,190,000 551,051,000 551,184,000 567,367,000 578,984,000 580,436,000 582,805,000 591,715,000 603,613,000 612,119,000 617,787,000 624,794,000 637,396,000 651,042,000 660,150,000 670,081,000 636,498,000 574,690,000 580,820,000 595,278,000 608,886,000 606,488,000 601,739,000 604,996,000 600,058,000 604,659,000 595,638,000 584,234,000 523,981,000 
        commitments and contingencies — note 13
                                                             
        stockholders’ equity:
                                                             
        class a common stock, 175,000 shares authorized, 0.001 par value per share...
                              24,000 25,000 25,000 24,000 24,000 24,000 24,000 24,000 23,000 23,000 22,000 22,000 21,000 21,000 21,000 21,000 21,000 21,000 21,000 21,000 20,000 20,000 20,000 20,000 20,000 20,000 19,000 19,000 19,000 19,000  
        class b common stock, 30,000 shares authorized, 0.001 par value per share...
                              16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 17,000 17,000 17,000 17,000 17,000 17,000 17,000 17,000 17,000 17,000 17,000 17,000 17,000 17,000 17,000 18,000 18,000 18,000 18,000  
        total stockholders’ equity
                              95,259,000 94,424,000 92,771,000 93,763,000 92,232,000 94,545,000 105,990,000 104,080,000 99,831,000 92,871,000 85,520,000 84,363,000 77,213,000 69,094,000 301,619,000 290,069,000 277,580,000 265,255,000 289,961,000 284,330,000 275,422,000 435,508,000 425,408,000 423,736,000 412,103,000 402,306,000 392,203,000 381,814,000 374,469,000 367,822,000 360,811,000 
        total liabilities and stockholders’ equity
                              650,956,000 649,897,000 643,961,000 644,814,000 643,416,000 661,912,000 684,974,000 684,516,000 682,636,000 684,586,000 689,133,000 696,482,000 695,000,000 693,888,000 939,015,000 941,111,000 937,730,000 935,336,000 926,459,000 859,020,000 856,242,000 1,030,786,000 1,034,294,000 1,030,224,000 1,013,842,000 1,007,302,000 992,261,000 986,473,000 970,107,000 952,056,000 884,792,000 
        property and equipment, less accumulated depreciation of 155,097 and 137,484 at september 30, 2014 and december 31, 2013, respectively
                               333,285,000                              
        leased facility assets, less accumulated depreciation of 4,791 and 4,432 at september 30, 2014 and december 31, 2013, respectively
                               9,057,000                              
        intangible assets, less accumulated amortization of 4,879 and 4,640 at september 30, 2014 and december 31, 2013, respectively
                               18,569,000                              
        restricted assets
                               31,462,000 30,246,000                             
        commitments and contingencies — note 8
                                                             
        property and equipment, less accumulated depreciation of 149,175 and 137,484 at june 30, 2014 and december 31, 2013, respectively
                                336,360,000                             
        leased facility assets, less accumulated depreciation of 4,674 and 4,432 at june 30, 2014 and december 31, 2013, respectively
                                9,174,000                             
        intangible assets, less accumulated amortization of 4,799 and 4,640 at june 30, 2014 and december 31, 2013, respectively
                                18,648,000                             
        property and equipment, less accumulated depreciation of 143,366 and 137,484 at march 31, 2014 and december 31, 2013, respectively
                                 339,490,000                            
        leased facility assets, less accumulated depreciation of 4,555 and 4,432 at march 31, 2014 and december 31, 2013, respectively
                                 9,293,000                            
        intangible assets, less accumulated amortization of 4,720 and 4,640 at march 31, 2014 and december 31, 2013, respectively
                                 18,728,000                            
        property and equipment, less accumulated depreciation of 137,484 and 118,141 at december 31, 2013 and december 31, 2012, respectively
                                  341,822,000                           
        leased facility assets, less accumulated depreciation of 4,432 and 3,935 at december 31, 2013 and december 31, 2012, respectively
                                  9,416,000                           
        intangible assets, less accumulated amortization of 4,640 and 4,218 at december 31, 2013 and december 31, 2012, respectively
                                  18,807,000                           
        property and equipment, less accumulated depreciation of 135,885 and 118,141 at september 30, 2013 and december 31, 2012, respectively
                                   362,908,000                          
        leased facility assets, less accumulated depreciation of 4,310 and 3,935 at september 30, 2013 and december 31, 2012, respectively
                                   9,538,000                          
        intangible assets, less accumulated amortization of 4,465 and 4,218 at september 30, 2013 and december 31, 2012, respectively
                                   18,983,000                          
        commitments and contingencies — note 7
                                                             
        property and equipment, less accumulated depreciation of 129,990 and 118,141 at june 30, 2013 and december 31, 2012, respectively
                                    364,877,000                         
        leased facility assets, less accumulated depreciation of 4,186 and 3,935 at june 30, 2013 and december 31, 2012, respectively
                                    9,662,000                         
        intangible assets, less accumulated amortization of 4,382 and 4,218 at june 30, 2013 and december 31, 2012, respectively
                                    21,871,000                         
        property and equipment, less accumulated depreciation of 124,068 and 118,141 at march 31, 2013 and december 31, 2012, respectively
                                     367,219,000                        
        leased facility assets, less accumulated depreciation of 4,062 and 3,935 at march 31, 2013 and december 31, 2012, respectively
                                     9,786,000                        
        intangible assets, less accumulated amortization of 4,300 and 4,218 at march 31, 2013 and december 31, 2012, respectively
                                     21,953,000                        
        property and equipment, less accumulated depreciation of 118,141 and 95,954 at december 31, 2012 and december 31, 2011, respectively
                                      370,745,000                       
        leased facility assets, less accumulated depreciation of 3,935 and 3,398 at december 31, 2012 and december 31, 2011, respectively
                                      9,913,000                       
        intangible assets, less accumulated amortization of 4,218 and 7,060 at december 31, 2012 and december 31, 2011, respectively
                                      22,035,000                       
        property and equipment, less accumulated depreciation of 112,885 and 95,954 at september 30, 2012 and december 31, 2011, respectively
                                       369,716,000                      
        leased facility assets, less accumulated depreciation of 3,805 and 3,398 at september 30, 2012 and december 31, 2011, respectively
                                       10,043,000                      
        intangible assets, less accumulated amortization of 4,131 and 7,060 at september 30, 2012 and december 31, 2011, respectively
                                       22,122,000                      
        property and equipment, less accumulated depreciation of 107,090 and 95,954 at june 30, 2012 and december 31, 2011, respectively
                                        370,266,000                     
        leased facility assets, less accumulated depreciation of 3,670 and 3,398 at june 30, 2012 and december 31, 2011, respectively
                                        10,178,000                     
        intangible assets, less accumulated amortization of 4,034 and 7,060 at june 30, 2012 and december 31, 2011, respectively
                                        22,219,000                     
        property and equipment, less accumulated depreciation of 101,844 and 95,954 at march 31, 2012 and december 31, 2011, respectively
                                         373,412,000                    
        leased facility assets, less accumulated depreciation of 3,535 and 3,398 at march 31, 2012 and december 31, 2011, respectively
                                         10,313,000                    
        intangible assets, less accumulated amortization of 3,937 and 7,060 at march 31, 2012 and december 31, 2011, respectively
                                         22,316,000                    
        property and equipment, less accumulated depreciation of 95,954 and 76,017 at december 31, 2011 and december 31, 2010, respectively
                                          375,502,000                   
        leased facility assets, less accumulated depreciation of 3,398 at december 31, 2011
                                          10,792,000                   
        intangible assets, less accumulated amortization of 7,060 and 15,646 at december 31, 2011 and december 31, 2010, respectively
                                          22,413,000                   
        deferred income tax assets
                                          11,615,000                   
        property and equipment, less accumulated depreciation of 90,165 and 76,017 at september 30, 2011 and december 31, 2010, respectively
                                           376,290,000                  
        leased facility assets, less accumulated depreciation of 3,283 at september 30, 2011
                                           10,869,000                  
        intangible assets, less accumulated amortization of 6,772 and 15,646 at september 30, 2011 and december 31, 2010, respectively
                                           22,452,000                  
        property and equipment, less accumulated depreciation of 84,431 and 76,017 at june 30, 2011 and december 31, 2010, respectively
                                            370,284,000                 
        leased facility assets, less accumulated depreciation of 3,144 at june 30, 2011
                                            11,009,000                 
        intangible assets, less accumulated amortization of 6,488 and 15,646 at june 30, 2011 and december 31, 2010, respectively
                                            25,164,000                 
        property and equipment, less accumulated depreciation of 81,787 and 76,017 at march 31, 2011 and december 31, 2010, respectively
                                             383,429,000                
        intangible assets, less accumulated amortization of 6,206 and 15,646 at march 31, 2011 and december 31, 2010, respectively
                                             25,446,000                
        current portion of long-term debt and capital leases
                                             6,689,000 5,742,000 8,295,000 9,389,000 8,931,000 7,823,000 9,995,000 3,457,000 7,783,000 7,812,000 10,278,000 3,188,000 4,173,000 6,335,000 6,594,000 2,957,000 
        long-term debt and capital leases, less current portion
                                             501,430,000 514,221,000 536,010,000 492,797,000 441,014,000 450,856,000 462,518,000 475,180,000 471,643,000 462,449,000 468,027,000 462,717,000 461,406,000 452,101,000 452,875,000 405,591,000 
        property and equipment, less accumulated depreciation of 76,017 and 59,448 at december 31, 2010 and december 31, 2009, respectively
                                              387,322,000               
        intangible assets, less accumulated amortization of 15,646 and 14,413 at december 31, 2010 and december 31, 2009, respectively
                                              25,341,000               
        property and equipment, less accumulated depreciation of 75,072 and 59,448 at september 30, 2010 and december 31, 2009, respectively
                                               380,662,000              
        intangible assets, less accumulated amortization of 15,875 and 14,413 at september 30, 2010 and december 31, 2009, respectively
                                               28,293,000              
        property and equipment, less accumulated depreciation of 69,615 and 59,448 at june 30, 2010 and december 31, 2009, respectively
                                                381,386,000             
        intangible assets, less accumulated amortization of 15,063 and 14,413 at june 30, 2010 and december 31, 2009, respectively
                                                29,105,000             
        property and equipment, less accumulated depreciation of 64,564 and 59,448 at march 31, 2010 and december 31, 2009, respectively
                                                 377,793,000            
        intangible assets, less accumulated amortization of 15,241 and 14,413 at march 31, 2010 and december 31, 2009, respectively
                                                 25,484,000            
        property and equipment, less accumulated depreciation of 59,448 and 40,118 at december 31, 2009 and december 31, 2008, respectively
                                                  373,211,000           
        intangible assets, less accumulated amortization of 14,413 and 10,490 at december 31, 2009 and december 31, 2008, respectively
                                                  26,297,000           
        (accumulated deficit) retained earnings
                                                  -89,781,000           
        property and equipment, less accumulated depreciation of 54,416 and 40,118 at september 30, 2009 and december 31, 2008, respectively
                                                   362,910,000          
        intangible assets, less accumulated amortization of 13,495 and 10,490 at september 30, 2009 and december 31, 2008, respectively
                                                   27,200,000          
        retained earnings
                                                   71,533,000 62,482,000 58,210,000 47,343,000 37,078,000 27,502,000 18,578,000 10,134,000 2,944,000  
        property and equipment, less accumulated depreciation of 49,448 and 40,118 at june 30, 2009 and december 31, 2008, respectively
                                                    357,669,000         
        intangible assets, less accumulated amortization of 12,493 and 10,490 at june 30, 2009 and december 31, 2008, respectively
                                                    28,337,000         
        property and equipment, less accumulated depreciation of 44,585 and 40,118 at march 31, 2009 and december 31, 2008, respectively
                                                     352,358,000        
        intangible assets, less accumulated amortization of 11,492 and 10,490 at march 31, 2009 and december 31, 2008, respectively
                                                     29,323,000        
        property and equipment, less accumulated depreciation of 40,118 and 23,519 at december 31, 2008 and 2007, respectively
                                                      346,466,000       
        intangible assets, less accumulated amortization of 10,490 and 6,840 at december 31, 2008 and 2007, respectively
                                                      30,310,000       
        non-current income tax receivable
                                                        2,288,000 2,288,000 2,288,000 1,882,000 1,882,000 
        deferred income tax
                                                      457,000    2,297,000   
        deferred income taxes, current
                                                       13,861,000 13,248,000     
        property and equipment, less accumulated depreciation of 35,674 and 23,519 at september 30, 2008 and december 31, 2007 respectively
                                                       335,854,000      
        intangible assets, less accumulated amortization of 9,490 and 6,840 at september 30, 2008 and december 31,2007 respectively
                                                       31,145,000      
        non-current income taxes receivable
                                                       2,288,000      
        deferred income taxes, non-current
                                                       67,000 1,153,000     
        preferred stock, 25,000 shares authorized, 0.001 par value per share...
                                                             
        intangible assets
                                                        31,941,000 32,838,000 34,092,000 35,408,000 32,565,000 
        deferred income tax, non-current
                                                             
        preferred stock, no shares authorized at december 31, 2007 and 50 shares authorized, 25 shares class a convertible shares and 25 class b shares at december 31, 2006
                                                             
        class a, 0.001 par value per share...
                                                             
        class b, 0.001 par value per share...
                                                             
        common stock, no shares authorized at december 31, 2007 and 25,350 shares authorized, 0.001 par value per share...
                                                             
        preferred stock, no shares authorized at september 30, 2007 (unaudited) and 50 shares authorized, 25 shares class a convertible shares and 25 class b shares at december 31, 2006
                                                             
        common stock, no shares authorized at september 30, 2007 (unaudited) and 25,350 shares authorized, 0.001 par value per share...
                                                             
        preferred stock, 50,000 shares authorized, 25,000 class a convertible shares and 25,000 class b shares.
                                                             
        preferred stock, 25,000,000 shares authorized, 0.001 par value per share...
                                                             
        common stock, 25,350,000 shares authorized, 0.001 par value per share...
                                                             
        class a common stock, 175,000,000 shares authorized, 0.001 par value per share...
                                                            19,000 
        class b common stock, 30,000,000 shares authorized, 0.001 par value per share...
                                                            18,000 
        retained deficit
                                                            -3,914,000 
      Cashflow Statements:
      Quarterly
      Annual
        Unit: USD2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 2018-03-31 2017-12-31 2017-09-30 2017-06-30 2017-03-31 2016-12-31 2016-09-30 2016-06-30 2016-03-31 2015-12-31 2015-09-30 2015-06-30 2015-03-31 2014-12-31 2014-09-30 2014-06-30 2014-03-31 2013-12-31 2013-09-30 2013-06-30 2013-03-31 2012-12-31 2012-09-30 2012-06-30 2012-03-31 2011-12-31 2011-09-30 2011-06-30 2011-03-31 2010-12-31 2010-09-30 2010-06-30 2010-03-31 2009-12-31 2009-09-30 2009-06-30 2009-03-31 2008-12-31 2008-09-30 2008-06-30 2008-03-31 2007-12-31 2007-09-30 
                                                              
          cash flows from operating activities
                                                              
          net income
        -16,802,000 -95,930,000 -29,316,000 38,681,000 -17,359,000    -108,986,000   -108,673,000 -155,017,000   -83,613,000   -35,958,000 -71,028,000 -312,640,000 -60,942,000   -64,000 643,000 -2,781,000 1,295,000 -3,002,000 -12,075,000 1,523,000 3,070,000 5,695,000 6,068,000 3,497,000 6,337,000 6,930,000 -232,611,000 10,571,000 11,844,000 10,841,000 -25,308,000 4,545,000 8,881,000 -161,316,000 9,053,000 8,215,000 10,867,000 10,265,000 9,576,000 8,924,000 8,444,000 7,184,000 6,864,000 
          adjustments to reconcile net income to net cash from operating activities:
                                                              
          non-cash interest and leasing arrangements
        6,695,000 6,424,000 6,023,000 5,901,000 6,117,000 7,376,000 8,596,000 5,222,000 17,065,000 16,112,000 16,138,000 22,878,000  18,827,000 15,835,000 16,387,000  22,589,000 22,650,000 24,989,000 24,275,000 21,920,000 24,192,000 23,413,000                               
          other non-cash gain
        -19,834,000 -53,507,000 -44,100,000 -84,832,000 -1,364,000 -131,811,000                                                 
          share based compensation
        1,155,000 1,600,000 1,831,000 1,894,000 1,596,000 1,878,000 1,748,000 2,087,000 2,088,000 2,175,000 2,130,000 2,427,000  2,439,000 2,481,000 2,286,000  3,579,000 1,590,000 1,590,000 620,000 1,949,000 530,000 25,373,000                               
          depreciation and amortization expense
        23,656,000 24,373,000 33,816,000 25,988,000 21,764,000 34,932,000 28,268,000 38,195,000 52,860,000 53,038,000                                             
          reduction in the carrying amount of operating lease right-of-use assets
        25,106,000 25,152,000 31,561,000 31,506,000                                                   
          recovery for losses on accounts receivable
        -523,000                                                      
          equity in net income of unconsolidated affiliates
        -1,358,000 -3,362,000 -3,576,000 127,000          -69,000 -88,000 -134,000  -893,000 -497,000 -763,000  -640,000                                 
          benefit for deferred taxes
        -293,000 3,051,000 -422,000 -1,331,000 1,595,000 -660,000   -1,170,000         -25,955,000 -417,000 4,415,000                                   
          loss on early extinguishment of debt
        1,812,000 260,000 354,000 1,328,000  367,000    9,300,000     12,246,000                                     
          long-lived asset impairments
        19,800,000 72,400,000 77,100,000 9,700,000 16,037,000   16,989,000 32,391,000 27,257,000 28,360,000                                           
          changes in assets and liabilities:
                                                              
          accounts receivable
        13,347,000 6,193,000 98,650,000 7,321,000 -18,869,000 3,199,000 40,441,000 20,974,000 17,841,000 25,681,000 23,856,000 -870,000  -35,671,000 -12,178,000 -4,723,000  -33,305,000 -42,212,000 -60,866,000 -42,398,000 -23,531,000   -13,268,000 -7,892,000 -7,538,000 -5,105,000 -5,968,000 12,509,000 -12,888,000 -8,149,000 -320,000 -2,172,000 -661,000 -12,140,000 2,509,000 -428,000 1,734,000 -13,114,000 -6,646,000 1,157,000 -4,984,000 -4,035,000 904,000 -1,629,000 -3,789,000 -11,322,000 -4,900,000 -5,658,000 9,607,000 -14,717,000 -14,123,000 -12,701,000 
          accounts payable and other accrued expenses and other
        6,703,000 -19,806,000 24,374,000 7,277,000 -13,725,000 -12,322,000 -32,105,000 -18,759,000 -9,861,000 -21,898,000 -30,131,000 -10,026,000  15,069,000 -3,000,000 16,563,000  4,373,000 -1,267,000 37,839,000 11,901,000 -5,277,000 -22,000,000 44,606,000                               
          medicare advance payments
        -999,000                                                     
          operating lease obligations
        -24,891,000 -25,167,000 -27,610,000 -28,511,000 -26,999,000 -24,586,000 -20,478,000 -21,567,000                                               
          net cash from operating activities
        34,573,000 -59,439,000 325,347,000 15,250,000 -22,924,000 -20,323,000 23,935,000 12,146,000 4,518,000 2,597,000 17,556,000 -6,087,000 53,097,000 -1,769,000 24,497,000 44,630,000 33,059,000 11,787,000 -931,000 24,446,000 13,567,000 2,780,000   -5,138,000 10,245,000 15,477,000 5,737,000 11,089,000 23,043,000 9,308,000 4,481,000 11,740,000 16,816,000 15,142,000 -1,022,000 33,189,000 20,961,000 33,355,000 11,875,000 31,160,000 -34,373,000 20,373,000 18,138,000 29,490,000 16,631,000 20,812,000 7,964,000 20,340,000 15,967,000 24,670,000 2,036,000 16,240,000 6,547,000 
          cash flows from investing activities:
                                                              
          capital expenditures
        -13,576,000 -9,944,000 -10,818,000 -21,278,000 -15,681,000 -10,496,000 -13,021,000 -23,529,000 -9,831,000 -14,170,000 -10,690,000 -16,461,000 -15,641,000 -14,624,000 -14,596,000 -19,245,000 -22,328,000 -22,893,000 -21,654,000 -26,243,000 -20,230,000 -28,635,000   -3,738,000 -2,982,000 -2,711,000 -3,550,000 -3,459,000 -3,996,000 -3,580,000 -2,401,000 -7,009,000 -5,416,000 -3,622,000 -3,475,000 -5,182,000 -4,893,000 -3,656,000 -2,567,000 -4,575,000 -4,769,000 -8,694,000 -9,698,000 -11,973,000 -10,255,000 -8,499,000 -10,428,000 -15,156,000 -13,226,000 -12,311,000 -8,933,000 -9,000,000 -7,771,000 
          free cash flows
        20,997,000 -69,383,000 314,529,000 -6,028,000 -38,605,000 -30,819,000 10,914,000 -11,383,000 -5,313,000 -11,573,000 6,866,000 -22,548,000 37,456,000 -16,393,000 9,901,000 25,385,000 10,731,000 -11,106,000 -22,585,000 -1,797,000 -6,663,000 -25,855,000   -8,876,000 7,263,000 12,766,000 2,187,000 7,630,000 19,047,000 5,728,000 2,080,000 4,731,000 11,400,000 11,520,000 -4,497,000 28,007,000 16,068,000 29,699,000 9,308,000 26,585,000 -39,142,000 11,679,000 8,440,000 17,517,000 6,376,000 12,313,000 -2,464,000 5,184,000 2,741,000 12,359,000 -6,897,000 7,240,000 -1,224,000 
          purchases of marketable securities
        -24,795,000 -18,303,000 -23,828,000 -12,359,000 -22,420,000 -20,627,000 -12,569,000 -14,700,000 -16,116,000 -23,491,000 -24,034,000 -16,009,000  -6,354,000 -8,278,000 -8,039,000  -3,853,000 -21,070,000 -13,922,000 -56,397,000 -5,683,000                                 
          proceeds on maturity or sale of marketable securities
        8,604,000 12,291,000 23,569,000 19,416,000 14,449,000 36,208,000 12,260,000 8,257,000 18,267,000 17,828,000 17,383,000 15,702,000  30,998,000 7,291,000 7,921,000  6,740,000 32,809,000 13,465,000 21,611,000 2,280,000 7,265,000 10,158,000                               
          purchases of assets
        -197,467,000 -700,000 -9,146,000 -339,185,000 -252,475,000              -1,895,000                                 
          sales of assets
        40,878,000 10,791,000 46,437,000 161,408,000 20,174,000 103,259,000 55,373,000 79,000,000      -36,000    1,051,000    1,263,000                               
          restricted deposits
        -138,000   749,000 -2,596,000            -2,253,000                                     
          investments in joint venture
        -584,000 -50,000 -2,000,000 -14,886,000              76,000                                     
          loan provided to joint venture
        -9,000,000                                                   
          notes receivable and other investment additions
                                                              
          other
        1,653,000 -2,404,000 -245,000 32,000 -485,000 15,000 392,000 28,000 58,000 38,000 126,000 -1,099,000  -575,000 628,000 -537,000  1,491,000 1,997,000 -366,000 484,000 1,695,000 -951,000 912,000                               
          net cash from investing activities
        12,042,000 -192,176,000 31,666,000 114,936,000 6,031,000 -230,826,000 41,211,000 -203,419,000 66,753,000 -19,795,000 -17,215,000 -17,867,000  6,929,000 63,772,000 -21,301,000  -37,862,000 -19,293,000 58,117,000 -185,551,000 -39,066,000 -35,157,000 6,290,000 -3,738,000 -2,886,000 -1,651,000 -3,550,000 9,484,000 -3,996,000 -3,580,000 -2,401,000 -7,009,000 -5,416,000 -3,625,000 -3,475,000 -15,204,000 -18,540,000 -3,656,000 -2,517,000 -7,864,000 -4,769,000 -54,074,000 -9,698,000 -15,336,000 -11,839,000 -7,297,000 -11,696,000 -14,731,000 -19,609,000 -25,248,000 -8,789,000 -10,468,000 -59,142,000 
          cash flows from financing activities:
                                                              
          borrowings under revolving credit facilities
        1,014,900,000 1,046,420,000 1,391,198,000 1,093,643,000 1,139,000,000 1,150,000,000 1,209,000,000 1,163,000,000 1,604,439,000 1,239,716,000 1,307,284,000 440,000,000                                           
          repayments under revolving credit facilities
        -1,014,900,000 -1,046,420,000 -1,477,110,000 -1,143,692,000 -1,112,199,000 -1,135,531,000 -1,188,258,000 -1,194,676,000 -1,588,940,000 -1,233,420,000 -1,280,706,000 -445,749,000                                           
          proceeds from issuance of long-term debt
        854,000 193,828,000 26,693,000 7,339,000 57,632,000 310,341,000 170,565,000 10,424,000 1,361,000 492,000 561,894,000  6,392,000    171,151,000 115,114,000 67,872,000 134,100,000 1,101,000 360,000,000     69,805,000                        
          repayment of long-term debt
        -24,292,000 -25,997,000 -51,838,000 -89,654,000 -65,713,000 -43,947,000 -85,499,000 -4,467,000 -82,014,000 -4,639,000 -6,255,000 -451,169,000  -10,399,000 -95,305,000 -4,094,000  -172,990,000 -136,216,000 -127,717,000 -6,296,000 -9,527,000                                 
          repayment of finance lease obligations
        -728,000 -735,000 -730,000 -712,000 -672,000 -702,000 -696,000 -575,000                                               
          debt issuance and settlement costs
                                                              
          contributions from noncontrolling interests
        544,000    8,531,000 18,500,000                                               
          distributions to noncontrolling interests and stockholders
        -2,086,000 -1,334,000 -1,164,000 -1,123,000 -1,561,000 -1,648,000 -1,406,000 -1,138,000 -652,000 -792,000 -566,000 -15,000  -1,222,000 -428,000 -30,000  -357,000 -300,000 -240,000                                   
          net cash from financing activities
        -30,933,000 183,777,000 -113,190,000 -134,439,000 14,630,000 282,427,000 -66,859,000 147,501,000 -57,095,000 2,226,000   -55,254,000 -19,314,000 -75,317,000 -22,944,000 -21,741,000 33,237,000 14,698,000 -91,902,000 173,856,000 12,994,000 27,659,000 4,352,000 1,969,000 -4,783,000 -10,071,000 -2,159,000 -18,991,000 -18,471,000 -8,858,000 1,066,000 -5,927,000 -13,773,000 -15,826,000 -1,639,000 -18,410,000 -994,000 -15,624,000 -12,610,000  42,185,000 31,751,000 -9,861,000 -13,861,000 -14,121,000 -8,794,000 9,138,000 -7,889,000 4,256,000 299,000 5,733,000 -1,085,000 50,587,000 
          net increase in cash, cash equivalents and restricted cash and equivalents
        15,682,000 -67,838,000   -2,263,000 31,278,000 -1,713,000 -43,772,000 14,176,000 -14,972,000 20,965,000 63,469,000                                           
          cash, cash equivalents and restricted cash and equivalents:
                                                              
          beginning of period
        125,806,000 142,276,000 58,638,000  51,408,000  61,543,000 87,548,000                               
          end of period
        15,682,000 -67,838,000 243,823,000 121,553,000 -2,263,000 31,278,000 -1,713,000 98,504,000 14,176,000 -14,972,000 20,965,000 122,107,000  -14,154,000 12,952,000 51,793,000  7,162,000 -5,526,000 52,204,000 1,872,000 -23,292,000 -12,745,000 95,708,000                               
          supplemental cash flow information:
                                                              
          interest paid
        28,890,000 25,637,000 22,900,000 31,815,000 34,832,000 27,214,000 45,923,000 45,620,000 101,087,000 99,714,000 101,438,000 91,393,000  107,328,000 110,528,000 107,373,000  109,437,000 112,616,000 111,456,000 108,134,000 107,942,000 105,139,000 94,948,000                               
          net taxes paid
        441,000 573,000 466,000 1,430,000 -1,176,000 1,062,000 529,000 1,081,000 1,408,000 -1,085,000 1,020,000 3,084,000                                           
          federal and state stimulus - covid-19 other income
                                                              
          non-cash investing and financing activities:
                                                              
          finance lease obligations, net write-down due to lease activity
        84,000 55,000   472,000 -798,740,000                                                 
          assets subject to finance lease obligations, net write-down due to lease activity
        -80,000 -29,000                                                     
          operating lease obligations, net (write-down) gross-up due to lease activity
        -70,357,000 -260,268,000                                                     
          assets subject to operating leases, net write-down (gross-up) due to lease activity
        60,835,000 222,382,000                                                     
          financing obligations, net write-down due to lease activity
                                                            
          assets subject to financing obligations, net write-down due to lease activity
                                                            
          debt issuance costs
         -3,165,000 -239,000 -240,000 -1,857,000 -4,617,000 -3,708,000 -352,000 -126,000 -16,552,000  -1,735,000    -7,615,000 -2,510,000 -2,316,000 -1,417,000 -1,000                                 
          federal stimulus - covid-19 other income
         31,213,000                                                     
          provision (recovery) for losses on accounts receivable
          -161,000 201,000                                                   
          net decrease in cash, cash equivalents and restricted cash and equivalents
           -4,253,000                                                   
          finance lease obligations, net gross up (write-down) due to lease activity
           309,000                                                   
          assets subject to finance lease obligations, net (gross-up) write-down due to lease activity
           -310,000 1,077,764,000 -601,327,000                                                 
          operating lease obligations, net gross-up due to lease activity
           -18,757,000 14,218,000 493,242,000 2,408,557,000                                               
          assets subject to operating leases, net (gross-up) due to lease activity
           14,320,000 -9,294,000 -249,712,000 -2,264,702,000                                               
          (recovery) provision for losses on accounts receivable
                                                              
          goodwill and identifiable intangible asset impairments
                1,477,000 929,000                                             
          gain on early extinguishment of debt
                                                              
          notes receivable and other investment reductions
                                                              
          debt settlement costs
                501,000 -986,000                                           
          operating lease right-of-use asset amortization
             26,721,000 29,955,000 29,574,000                                               
          provision for losses on accounts receivable
             -259,000 -61,000 -685,000                23,392,000                               
          equity in net loss of unconsolidated affiliates
             -93,000 -24,000 -61,000                                               
          net loss
              -8,983,000 -25,082,000                -118,250,000                               
          adjustments to reconcile net loss to net cash from operating activities:
                                                              
          other non-cash (gains) charges
               -16,917,000 29,440,000 -20,208,000                                             
          provision for deferred taxes
               -835,000                                               
          finance lease obligations, net (write-down) gross-up due to lease activity
               -131,842,000                                               
          assets subject to finance lease obligations, net write-down (gross-up) due to lease activity
               61,512,000                                               
          financing obligations, net (write-down) gross-up due to lease activity
               -2,734,940,000 8,008,000                                              
          assets subject to financing obligations, net write-down (gross-up) due to lease activity
               1,718,507,000 2,792,000                                              
          benefit from losses on accounts receivable
                -3,625,000   -1,524,000    23,528,000   29,681,000 26,493,000 31,692,000 23,320,000                                 
          customer receivership and other related charges
                                                              
          proceeds from tenant improvement draws under lease arrangements
                     903,000 5,180,000  48,000 610,000 499,000 887,000 1,938,000 95,000                               
          capital lease obligations, net (write-down) gross-up due to lease activity
                14,135,000                                              
          assets subject to capital lease obligations, net write-down (gross-up) due to lease activity
                -14,135,000                                              
          equity in net income (income) of unconsolidated affiliates
                   220,000                                           
          capital lease obligations and assets
                                                              
          financing obligations
                  -130,935,000 5,152,000  7,019,000 2,527,000 8,733,000  21,005,000 4,067,000 3,861,000 56,489,000 1,021,000 22,797,000 3,682,000                               
          financing obligation assets
                                                              
          other non-cash charges
                   68,000    9,034,000                                       
          depreciation and amortization
                   51,503,000  59,390,000 60,227,000 64,369,000  61,104,000 67,953,000 61,765,000 61,576,000 62,494,000 53,616,000 60,077,000 5,994,000 6,120,000 6,035,000 6,085,000 6,226,000 6,130,000 6,047,000 6,219,000 6,276,000 6,258,000 6,591,000 6,275,000 6,193,000 6,459,000 6,432,000 6,145,000 6,806,000 6,305,000 5,992,000 5,944,000 5,950,000 6,014,000 5,867,000 5,477,000 5,444,000 5,301,000 5,073,000 5,160,000 5,068,000 4,419,000 
          benefit from deferred taxes
                   250,000    933,000      -13,408,000                                 
          net cash provided (used in) by financing activities
                   87,423,000                                           
          capital lease obligations
                   -18,194,000                                           
          consolidated statement of operations data:
                                                              
          net revenues
                                                              
          expenses
                                                              
          income before income tax (benefit) expense
                                                              
          income tax (benefit) expense
                                                              
          income from continuing operations
                                                              
          income from discontinued operations, net of taxes
                                                              
          less net income (income) attributable to noncontrolling interests
                                                              
          net income attributable to genesis healthcare, inc.
                                                              
          loss per common share:
                                                              
          weighted-average shares used for eps calculation
                                                              
          basic
                                                              
          diluted
                                                              
          net income per common share attributable to genesis healthcare, inc.:
                                                              
          other financial data:
                                                              
          net cash from investing activities, net of capital expenditures
                                                              
          balance sheet data:
                                                              
          cash and cash equivalents
                                                              
          working capital
                                                              
          property and equipment and leased facility assets
                                                              
          total assets
                                                              
          long-term debt, including current installments
                                                              
          capital lease obligations, including current installments
                                                              
          financing obligations, including current installments
                                                              
          stockholders' (deficit) equity
                                                              
          other non-cash charges and gains
                     2,378,000    -5,174,000 -42,922,000 12,000 9,387,000 -3,105,000                                 
          customer receivership
                     298,000                                         
          net change in restricted cash and equivalents
                     -2,701,000 -153,000 -1,643,000  20,596,000 -8,190,000 8,578,000 22,572,000 -6,828,000                                 
          purchases of inpatient assets, net of cash acquired
                         -38,817,000 -68,704,000 -778,000                                   
          borrowings under revolving credit facility
                     127,000,000 175,000,000 176,000,000  195,000,000 243,000,000 224,000,000 275,000,000 223,000,000 220,000,000 146,500,000                               
          repayments under revolving credit facility
                     -139,350,000 -170,300,000 -200,000,000  -152,000,000 -205,000,000 -254,000,000 -227,000,000 -201,000,000                                 
          net decrease in cash and cash equivalents
                         7,162,000                                     
          cash and cash equivalents:
                                                              
          net taxes refunded
                     61,000 -68,000 -1,803,000                                       
          capital leases
                     -14,909,000    13,444,000                                 
          sale of investment in joint venture
                      242,000  1,010,000    26,358,000                               
          net increase in cash and cash equivalents
                      12,952,000 385,000    -9,339,000 1,872,000                                  
          net taxes (refunded) paid
                         4,207,000 196,000 -14,180,000                                   
          non-cash financing activities:
                                                              
          assumption of long-term debt
                            111,000 110,166,000 326,610,000                               
          sales of inpatient assets
                           76,373,000                                   
          equity in net (income) loss of unconsolidated affiliates
                                                              
          long-lived asset impairment
                                                              
          transaction costs
                                                              
          issuance of stock
                                                              
          taxes paid
                            1,910,000 5,314,000 7,752,000 5,917,000                               
          sale of investment in joint ventures
                                                             
          distributions to noncontrolling interests
                             -2,517,000                                 
          cash and equivalents:
                                                              
          cash flows from operating activities:
                                                              
          total adjustments
                               115,768,000                               
          purchase of marketable securities
                                                              
          net increase in cash and equivalents
                               8,160,000                               
          supplemental disclosure of cash flow information:
                                                              
          change in fair value of contingent consideration
                                -476,000 7,000 -121,000 14,000 -1,620,000 79,000                         
          benefit from doubtful accounts
                                3,763,000 3,737,000 3,720,000 2,905,000 5,638,000     1,740,000 1,787,000 1,775,000 2,035,000 1,037,000 1,938,000 2,457,000 2,191,000 2,232,000 2,599,000 2,595,000 2,707,000 1,648,000 4,881,000 1,803,000 3,185,000 3,377,000 2,097,000 1,428,000 2,642,000 959,000 
          non-cash stock-based compensation
                                1,810,000 1,013,000 875,000 571,000 763,000 601,000 331,000 1,303,000 1,183,000 1,196,000 1,208,000 1,163,000 1,174,000 247,000 1,189,000 998,000 1,346,000 981,000 862,000 360,000 530,000 610,000 608,000 520,000 438,000 510,000 306,000 304,000 240,000 136,000 
          excess tax benefits from stock-based payment arrangements
                                        242,000 54,000 -14,000 -295,000              
          gain on disposal of property and equipment
                                                              
          amortization of deferred financing costs
                                742,000 723,000 903,000 900,000 768,000 779,000 685,000 638,000 640,000 530,000 818,000 825,000 851,000 826,000 825,000 826,000 825,000 923,000 723,000 1,421,000 1,422,000 1,421,000 1,074,000 794,000 793,000 794,000 795,000 686,000 636,000 583,000 
          deferred income taxes
                                -7,000 -899,000 -444,000 918,000 1,755,000 -6,364,000 3,603,000 477,000 2,475,000 1,384,000 -1,162,000 793,000 59,000 -21,262,000 40,000 10,077,000 3,333,000 -4,923,000 1,052,000 484,000 1,642,000 5,214,000 -779,000 -111,000 177,000 380,000 -432,000 -784,000 3,377,000 -808,000 
          amortization of discount on debt
                                134,000 134,000 141,000 141,000 186,000 235,000 237,000 238,000 318,000 156,000 288,000 144,000 168,000                  
          debt retirement costs
                                        168,000                     
          impairment of long-lived assets
                                                             
          changes in operating assets and liabilities:
                                                              
          payments on notes receivable
                                449,000 446,000 220,000 507,000 1,009,000 885,000 642,000 777,000 817,000 817,000 739,000 743,000 -798,000 2,226,000 927,000 959,000 1,446,000 1,507,000 950,000 943,000 2,052,000 1,828,000         
          other current and non-current assets
                                -864,000 -764,000 4,280,000 -2,276,000 -3,558,000 -1,394,000 -31,000 -1,611,000 -2,037,000 1,257,000 284,000 -1,456,000 3,837,000 -4,587,000 9,212,000 -1,007,000 1,465,000 -8,349,000 -691,000 -597,000 3,983,000 -267,000 2,111,000 3,944,000 1,635,000 -437,000 1,304,000 -393,000   
          accounts payable and accrued liabilities
                                -585,000 7,053,000 6,969,000 -5,671,000 3,752,000 1,696,000 -1,207,000 1,973,000 -7,750,000 2,952,000 -4,027,000 -1,303,000 3,526,000 -766,000 1,215,000 -3,482,000 4,762,000 -10,082,000 4,217,000 2,799,000 4,890,000 -5,553,000 3,960,000 -5,509,000 7,108,000 -2,939,000 -5,244,000 1,998,000 18,083,000 4,218,000 
          employee compensation and benefits
                                -3,945,000 536,000 2,430,000 3,309,000 -4,154,000 -3,330,000 4,949,000 -5,277,000 4,060,000 -1,489,000 4,121,000 -5,609,000 4,781,000 329,000 1,604,000 -5,348,000 6,369,000 2,229,000 1,462,000 -879,000 -1,850,000 -730,000 289,000 694,000 -2,092,000 2,869,000 1,930,000 -2,352,000 3,420,000 3,961,000 
          insurance liability risks
                                943,000 -863,000 -419,000 2,231,000 809,000 2,678,000 2,065,000 2,206,000 -1,544,000 -90,000 -1,060,000 1,057,000 450,000 -884,000 -1,635,000 538,000 310,000 -2,090,000 -2,753,000 143,000 -1,783,000 -879,000 -1,939,000 667,000 -2,342,000 202,000 -193,000 1,843,000 -2,578,000 40,000 
          other long-term liabilities
                                495,000 162,000 298,000 -87,000 1,505,000 -1,858,000 1,311,000 -366,000 -203,000 -1,983,000 -1,094,000 132,000 1,279,000 -248,000 -838,000 847,000 -146,000 2,605,000 -1,672,000 52,000 356,000 493,000 288,000 53,000 650,000 1,879,000 476,000 392,000 -10,014,000 1,109,000 
          cash flows from investing activities
                                                              
          additions to property and equipment
                                -3,738,000 -2,982,000 -2,711,000 -3,550,000 -3,459,000 -3,996,000 -3,580,000 -2,401,000 -7,009,000 -5,416,000 -3,622,000 -3,475,000 -5,182,000 -4,893,000 -3,656,000 -2,567,000 -4,575,000 -4,769,000 -8,694,000 -9,698,000 -11,973,000 -10,255,000 -8,499,000 -10,428,000 -15,156,000 -13,226,000 -12,311,000 -8,933,000 -9,000,000 -7,771,000 
          acquisitions
                                                            
          proceeds from sale of property and equipment
                                           400,000               
          proceeds from sale of investments
                                                              
          proceeds from the sale of home health agency
                                                             
          proceeds from the sale of land
                                                             
          cash flows from financing activities
                                                              
          borrowings under line of credit
                                74,000,000 67,500,000 78,500,000 78,500,000 109,499,000 89,083,000 76,000,000 89,000,000 72,500,000 72,000,000 149,000,000 13,500,000 21,500,000 11,000,000 55,500,000 19,500,000 52,500,000 54,500,000 48,000,000 78,000,000 -12,000,000 2,000,000 12,000,000 -5,000,000 6,000,000 2,000,000 10,000,000  48,000,000 
          repayments under line of credit
                                -68,000,000 -70,335,000 -85,000,000 -78,057,000 -87,942,000 -126,583,000 -77,000,000 -84,000,000 -73,000,000 -82,000,000 -103,500,000 -13,500,000 -21,500,000 -25,000,000 -67,500,000 -38,500,000 -8,500,000 -118,500,000 -55,000,000           
          repayments of long-term debt
                                -3,106,000 -1,759,000 -2,654,000 -2,087,000 -107,934,000 -57,934,000 -5,391,000 -3,730,000 -4,415,000 -3,514,000 -156,307,000 -1,187,000                   
          cash paid for financing costs
                                                              
          proceeds from exercise of stock options
                                316,000                             
          taxes paid related to net share settlement of equity awards
                                -1,574,000 -3,000 -9,000 -334,000 -81,000 34,000 -18,000 -204,000 -3,000 -2,000 -19,000 -210,000 40,000 -59,000                 
          increase in cash and cash equivalents
                                -6,907,000 2,576,000 3,755,000 28,000 1,582,000 576,000 -3,130,000 3,146,000 -1,196,000 -2,373,000   -425,000 1,427,000   992,000 3,043,000 -1,950,000 -1,421,000 293,000 -8,939,000 4,721,000 5,406,000       
          cash and cash equivalents at beginning of period
                                4,177,000 2,003,000 16,017,000 4,192,000 3,528,000 2,047,000  5,012,000  
          cash and cash equivalents at end of period
                                -6,907,000 2,576,000 3,755,000 4,205,000 1,582,000 576,000 -3,130,000 5,149,000 -1,196,000 -2,373,000 -4,309,000 9,881,000 -425,000 1,427,000 14,075,000 940,000 992,000 3,043,000 -1,950,000 2,107,000 293,000 -8,939,000 4,721,000 7,453,000  614,000 -279,000 3,992,000  -2,008,000 
          loss on disposal of assets
                                 68,000                             
          debt modification/retirement costs
                                 21,000    432,000                         
          impairment of long lived assets
                                                             
          proceeds from maturity of investments
                                                             
          payment of financing costs
                                 -186,000 -1,856,000 -181,000  -2,877,000                         
          exercise of stock options
                                            26,000               
          disposal of fixed assets
                                                 -1,708,000             
          acquisition of healthcare facilities and businesses, net of cash acquired
                                            -10,372,000                  
          proceeds from divestitures
                                                              
          provision for doubtful accounts
                                      3,114,000 2,983,000                       
          loss on disposal of property and equipment
                                                              
          cash paid for purchase of previously leased facilities
                                                              
          disposal of property and equipment
                                         24,000    3,000 290,000               
          additions to deferred financing costs
                                         -257,000       214,000      -1,383,000  -319,000 
          acquisition of home health licenses
                                             -350,000               
          decrease in cash and cash equivalents
                                           -6,136,000    -3,252,000          614,000 -279,000 -1,020,000  -2,008,000 
          net income from continuing operations
                                                10,841,000 -25,308,000 4,545,000 8,881,000 -161,316,000          
          net income from discontinued operations
                                                             
          tax benefit from reversal of accrual for uncertain tax positions
                                                    -624,000          
          write-off of deferred financing costs
                                                            
          proceeds from sale of land
                                                              
          repayments of long-term debt and capital leases
                                            -18,396,000 -935,000 -939,000 -931,000 -3,304,000 -2,029,000 -251,128,000 -2,861,000 -2,861,000 -2,121,000 -2,842,000 -2,862,000       
          issuance of debt
                                                              
          cash flows from discontinued operations
                                                             
          proceeds from issuance long-term debt
                                                              
          amortization of discount and accretion on debt
                                              152,000 140,000  148,000             
          acquisition of healthcare facilities and businesses
                                                             
          (gain) loss on disposal of asset
                                                              
          goodwill impairment charge
                                                              
          acquistion of healthcare facilities and businesses
                                                              
          proceeds from disposal of property and equipment
                                                              
          fees paid for early extinguishment of debt
                                                              
          change in the fair value of acquisition-related contingent consideration
                                                              
          change in the fair value of acquistion-related contingent consideration
                                                              
          loss on disposal of asset
                                                    1,000 60,000       
          amortization of discount on senior subordinated notes
                                                   27,000 27,000 27,000 26,000 27,000 27,000 26,000 27,000 27,000 27,000 31,000 
          change in other assets
                                                              
          premium on redemption of debt and write-off of deferred financing costs
                                                              
          change in fair value of interest rate hedge
                                                            7,000 
          non-current income tax receivable
                                                              
          acquisition of healthcare facilities
                                                    -3,363,000   -308,000 -9,460,000   -1,210,000 -50,583,000 
          changes in other assets
                                                       -1,604,000  315,000 -14,000 -344,000 -689,000 -1,247,000 
          cash distributed related to the onex transaction
                                                            
          proceeds from ipo, net of expenses
                                                              
          supplemental cash flow information
                                                              
          cash paid for:
                                                              
          interest expense, net of capitalized interest
                                                      3,932,000 11,691,000  11,556,000     
          income taxes
                                                      10,051,000 572,000 2,817,000 5,436,000     
          non-cash activities:
                                                              
          conversion of accounts receivable into notes receivable
                                                      4,950,000 5,307,000     
          change in notes receivable
                                                       336,000       
          operating activities
                                                              
          (gain) loss on sale of assets
                                                              
          investing activities
                                                              
          financing activities
                                                              
          repayments on long-term debt and capital leases
                                                        -2,889,000 -1,767,000 -1,701,000 -2,884,000 -2,060,000 2,894,000 
          additions to deferred financing costs of new debt
                                                              
          proceeds from the issuance of new common stock
                                                              
          cash and cash equivalents at beginning of year
                                                              
          cash and cash equivalents at end of year
                                                              
          interest, net of capitalized interest
                                                              
          insurance premium financed
                                                        -182,000      
          loss on sale of assets
                                                              
          write-off of deferred financing costs and premium on early redemption of debt
                                                             
          principal payments on notes receivable
                                                              
          principal payments on (additions to) notes receivable
                                                          669,000 488,000   
          reorganization expenses
                                                              
          cumulative effect of a change in accounting principle
                                                              
          gain on sale of assets
                                                              
          forgiveness of stockholder loan
                                                              
          other current assets
                                                            2,684,000 -2,271,000 
          net cash paid for reorganization costs
                                                              
          borrowings (repayments) under line of credit
                                                              
          repayments on long-term debt through refinancing
                                                              
          redemption of preferred stock
                                                              
          purchase of treasury stock
                                                              
          proceeds from exercise of warrants and cash settlement of stock options
                                                              
          dividends paid
                                                              
          proceeds from capital contributions related to the onex transaction
                                                              
          proceeds from sale of interest rate hedge
                                                              
          purchase of interest rate hedge
                                                              
          supplemental disclosure of non-cash investing and financing activities:
                                                              
          reclassification of accounts receivable to notes receivable
                                                              
          (additions to) principal payments on notes receivable
                                                              
          premium paid for redemption of debt
                                                             
          proceeds from initial public offering of common stock, net of expenses
                                                             12,000 
          (additions) principal payments on notes receivable