Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Operating activities
Net income	$ 61.2	$ 38.5
Adjustments to reconcile net income to net cash provided by operations:
Depreciation and amortization	56.8	50.9
Amortization of debt issuance costs	0.8	0.8
Share-based compensation	62.0	15.9
(Gain)/loss on disposal and right-of-use asset write-downs	(0.3)	5.1
Provision for credit losses	0.6	1.3
Deferred income taxes	18.0	16.2
Non-cash lease expense	7.4	8.7
Other	0.8	1.6
Changes in operating assets and liabilities:
Accounts receivable and related party accounts receivable	(18.8)	(47.2)
Prepaid expenses and other assets	(19.8)	(11.8)
Accounts payable	4.5	1.9
Accrued compensation and benefits	34.3	(36.1)
Lease liabilities	(9.9)	(7.8)
Other liabilities	(8.9)	22.5
Customer liabilities and customer liabilities - related party	30.1	(10.0)
Net cash provided by operating activities	218.8	50.5
Investing activities
Purchases of property, equipment, and software	(33.4)	(42.3)
Acquisition of SCI, net of cash acquired and earn-out provision	0.0	(189.0)
Acquisition of RevWorks, net of contingent consideration	0.0	(5.0)
Acquisition of VisitPay, net of cash acquired	(294.7)	0.0
Proceeds from disposal of assets	2.6	0.0
Net cash used in investing activities	(325.5)	(236.3)
Financing activities
Payment of debt issuance costs	(1.9)	0.0
Payment of contingent consideration liability	(4.8)	0.0
Deferred payment related to acquisition of RevWorks	(12.5)	0.0
Inducement of preferred stock conversion	(105.0)	0.0
Exercise of vested stock options	6.3	11.0
Purchase of treasury stock	(29.5)	0.0
Shares withheld for taxes	(4.8)	(7.5)
Other	(0.1)	(5.8)
Net cash provided by financing activities	91.7	201.3
Effect of exchange rate changes in cash, cash equivalents and restricted cash	(0.6)	(0.7)
Net (decrease) increase in cash, cash equivalents and restricted cash	(15.6)	14.8
Cash, cash equivalents and restricted cash, at beginning of period	174.8	92.5
Cash, cash equivalents and restricted cash, at end of period	159.2	107.3
Supplemental disclosures of cash flow information
Accrued dividends payable to preferred stockholders	0.0	5.6
Property, equipment and software purchases not paid	25.7	10.9
Senior Term Loan
Financing activities
Issuance of senior secured debt, net of discount and borrowings on revolver	698.6	190.6
Repayment of senior secured debt and revolver	(484.6)	(17.0)
Senior Revolver
Financing activities
Issuance of senior secured debt, net of discount and borrowings on revolver	120.0	50.0
Repayment of senior secured debt and revolver	$ (90.0)	$ (20.0)