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Condensed Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified | 3 Months Ended
--- | ---
Mar. 31, 2012 | Mar. 31, 2011
Cash Flows from Operating Activities: |  |
Net income | $ 142,570 | $ 129,987
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation & amortization | 73,820 | 71,526
Stock based compensation expense | 5,486 | 3,954
Changes in assets & liabilities, net of effects from acquisitions and dispositions: |  |
Accounts receivable | (146,670) | (103,919)
Accrued interest | 13,280 | 12,875
Accrued and deferred income taxes | 75,471 | 68,994
Other working capital accounts | (48,074) | (27,056)
Other assets and deferred charges | 7,120 | 6,777
Other | (2,082) | 11,208
Accrued insurance expense, net of commercial premiums paid | 24,581 | 23,744
Payments made in settlement of self-insurance claims | (18,279) | (14,913)
Net cash provided by operating activities | 127,223 | 183,177
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (92,563) | (56,558)
Proceeds received from sale of assets and businesses | 53,461 | 991
Costs incurred for purchase and implementation of electronic health records application | (14,501) | (8,145)
Return of deposit on terminated purchase agreement | 6,500 | 0
Net cash used in investing activities | (47,103) | (63,712)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (70,942) | (136,403)
Additional borrowings | 0 | 73,500
Financing costs | 0 | (23,140)
Repurchase of common shares | (2,017) | (3,170)
Dividends paid | (4,832) | (4,876)
Issuance of common stock | 1,016 | 1,251
Profit distributions to noncontrolling interests | (2,575) | (4,025)
Net cash used in financing activities | (79,350) | (96,863)
Increase in cash and cash equivalents | 770 | 22,602
Cash and cash equivalents, beginning of period | 41,229 | 29,474
Cash and cash equivalents, end of period | 41,999 | 52,076
Supplemental Disclosures of Cash Flow Information: |  |
Interest paid | 25,945 | 37,130
Income taxes paid, net of refunds | $ 3,419 | $ 4,527

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- Definition The cash outflow for loan and debt issuance costs. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 18, 19, 20 -LegacyDoc This reference is SUPERSEDED by the Accounting Standards Codification effective for interim and annual periods ending after September 15, 2009. This reference is included to help users transition from the previous accounting hierarchy and will be removed from future versions of this taxonomy. Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3291-108585 + Details
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- Definition The cash outflow associated with the acquisition of long-lived, physical assets that are used in the normal conduct of business to produce goods and services and not intended for resale; includes cash outflows to pay for construction of self-constructed assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3213-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 15 -LegacyDoc This reference is SUPERSEDED by the Accounting Standards Codification effective for interim and annual periods ending after September 15, 2009. This reference is included to help users transition from the previous accounting hierarchy and will be removed from future versions of this taxonomy. Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 17 -Subparagraph c -LegacyDoc This reference is SUPERSEDED by the Accounting Standards Codification effective for interim and annual periods ending after September 15, 2009. This reference is included to help users transition from the previous accounting hierarchy and will be removed from future versions of this taxonomy. Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 + Details
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- Definition The cash inflow from the additional capital contribution to the entity. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3255-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 18 -LegacyDoc This reference is SUPERSEDED by the Accounting Standards Codification effective for interim and annual periods ending after September 15, 2009. This reference is included to help users transition from the previous accounting hierarchy and will be removed from future versions of this taxonomy. Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 19 -Subparagraph a -LegacyDoc This reference is SUPERSEDED by the Accounting Standards Codification effective for interim and annual periods ending after September 15, 2009. This reference is included to help users transition from the previous accounting hierarchy and will be removed from future versions of this taxonomy. Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 + Details
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- Definition The cash inflow from the sale of other tangible or intangible assets used to produce goods or deliver services not otherwise defined in the taxonomy. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3179-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 15 -LegacyDoc This reference is SUPERSEDED by the Accounting Standards Codification effective for interim and annual periods ending after September 15, 2009. This reference is included to help users transition from the previous accounting hierarchy and will be removed from future versions of this taxonomy. Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 16 -Subparagraph c -LegacyDoc This reference is SUPERSEDED by the Accounting Standards Codification effective for interim and annual periods ending after September 15, 2009. This reference is included to help users transition from the previous accounting hierarchy and will be removed from future versions of this taxonomy. Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 + Details
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