In February 2016, the FASB issued ASU 2016-02 (Topic 842) "Leases." Topic 842 supersedes the lease requirements in Accounting Standards Codification Topic 840, "Leases." Under Topic 842, lessees are required to recognize assets and liabilities on the balance sheet for most leases and provide enhanced disclosures. Leases will be classified as either finance or operating.

We adopted Topic 842 effective January 1, 2019. We applied Topic 842 to all leases as of January 1, 2019 with comparative periods continuing to be reported under Topic 840. We have elected the practical expedient package to not reassess at adoption (i) expired or existing contracts for whether they are or contain a lease, (ii) the lease classification of any existing leases or (iii) initial indirect costs for existing leases. We have also elected the policy exemption that allows lessees to choose to not separate lease and non-lease components by class of underlying asset and are applying this expedient to all relevant asset classes.

We determine if an arrangement is or contains a lease at inception of the contract. Our right-of-use assets represent our right to use the underlying assets for the lease term and our lease liabilities represent our obligation to make lease payments arising from the leases. Right-of-use assets and lease liabilities are recognized at commencement date based on the present value of lease payments over the lease term. We use the implicit rate noted within the contract if known or determinable. If the implicit rate is not readily available, we use our estimated incremental borrowing rate, which is derived using a collateralized borrowing rate for the same currency and term as the associated lease. A right-of-use asset and lease liability is not recognized for leases with an initial term of 12 months or less and we recognize lease expense for these leases on a straight-line basis over the lease term within lease and rental expense.

Our operating leases are primarily for real estate, including certain acute care facilities, off-campus outpatient facilities, medical office buildings, and corporate and other administrative offices. Our real estate lease agreements typically have initial terms of five to 10 years. These real estate leases may include one or more options to renew, with renewals that can extend the lease term from five to 10 years. The exercise of lease renewal options is at our sole discretion. When determining the lease term, we included options to extend or terminate the lease when it is reasonably certain that we will exercise that option.

Five of our hospital facilities are held under operating leases with Universal Health Realty Income Trust with two hospital terms expiring in 2026, two expiring in 2033, and one expiring in 2040 (see Note 9 for additional disclosure). We also lease the real property of certain facilities (see Item 2. Properties for additional disclosure).

The components of lease expense for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands):

	Twelve months ended December 31,
	2021		2020		2019

Operating lease cost	$	77,420	$	73,841	$	72,098
Variable and short term lease cost (a)		41,443		42,218		35,711
Total lease and rental expense	$	118,863	$	116,059	$	107,809

Finance lease cost:
Amortization of property under capital lease	$	3,626	$	1,985	$	1,877
Interest on debt of property under capital lease		4,124		1,763		1,876
Total finance lease cost	$	7,750	$	3,748	$	3,753

(a) Includes equipment, month-to-month and leases with a maturity of less than 12 months.

Supplemental cash flow information related to leases for the years ended December 31, 2021, 2020 and 2019 are as follows (in thousands):

	Twelve months ended December 31,
	2021		2020		2019

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	118,433	$	115,270	$	107,239
Operating cash flows from finance leases	$	4,612	$	1,885	$	2,078
Financing cash flows from finance leases	$	2,849	$	2,586	$	1,959

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	95,805	$	69,678	$	383,857
Finance leases	$	28,600	$	37,029	$	-

Included in the $383.9 million of right-of-use assets obtained in exchange for operating lease obligations is $29.3 million of new and modified operating leases entered into during the year ended December 31, 2019.

Supplemental balance sheet information related to leases as of December 31, 2021 and 2020 are as follows (in thousands):

	December 31,			December 31,
	2021			2020

Operating Leases
Right of use assets-operating leases	$	367,477		$	336,513

Operating lease liabilities	$	64,484		$	59,796
Operating lease liabilities noncurrent		304,624			278,303
Total operating lease liabilities	$	369,108		$	338,099

Finance Leases
Property and equipment	$	102,940		$	75,611
Accumulated depreciation		(30,949	)		(28,595	)
Property and equipment, net	$	71,991		$	47,016

Current maturities of long-term debt	$	2,740		$	2,060
Long-term debt		76,591			50,845
Total finance lease liabilities	$	79,331		$	52,905

Weighted Average remaining lease term, years
Operating leases		9.1			10.9
Finance leases		20.8			8.1

Weighted Average discount rate
Operating leases		3.8	%		4.4	%
Finance leases		7.1	%		9.7	%

Future maturities of lease liabilities as of December 31, 2021 are as follows (in thousands):

	Operating Leases			Finance Leases
Year ending December 31,
2022	$	75,790		$	6,809
2023		67,994			6,993
2024		59,354			7,162
2025		52,098			6,047
2026		43,193			6,057
Later years		150,024			110,263
Total lease payments		448,453			143,331
less imputed interest		(79,345	)		(64,000	)
Total	$	369,108		$	79,331

We assumed $29 million and $37 million in finance lease obligations during 2021 and 2020, respectively. No finance lease were assumed during 2019. In the ordinary course of business, our facilities routinely lease equipment pursuant to new lease arrangements that will likely result in future lease and rental expense in excess of amounts indicated above.