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Supplemental Condensed Consolidating Financial Information (Details 3) (USD $) In Thousands, unless otherwise specified | 9 Months Ended
--- | ---
Sep. 30, 2012 | Sep. 30, 2011
Cash Flows from Operating Activities: |  |
Net cash provided by operating activities | $ 535,006 | $ 562,502
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (282,191) | (195,404)
Proceeds received from sale of assets and businesses | 56,194 | 23,682
Acquisition of property and businesses | (25,092) | (8,599)
Costs incurred for purchase and implementation of electronic health records application | (41,854) | (27,874)
Return of deposit on terminated purchase agreement | 6,500 | 0
Net cash used in investing activities | (286,443) | (208,195)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (1,127,829) | (267,539)
Additional borrowings | 906,000 | 36,000
Financing costs | (8,257) | (23,559)
Repurchase of common shares | (9,676) | (44,532)
Dividends paid | (14,519) | (14,638)
Issuance of common stock | 3,828 | 3,596
Profit distributions to noncontrolling interests | (13,687) | (33,962)
Changes in intercompany balances with affiliates, net | 0 | 0
Net cash used in financing activities | (264,140) | (344,634)
Increase (decrease) in cash and cash equivalents | (15,577) | 9,673
Cash and cash equivalents, beginning of period | 41,229 | 29,474
Cash and cash equivalents, end of period | 25,652 | 39,147
Parent [Member] |  |
Cash Flows from Operating Activities: |  |
Net cash provided by operating activities | (7,607) | 60,800
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | 0 | 0
Proceeds received from sale of assets and businesses | 0 | 0
Acquisition of property and businesses | 0 | 0
Costs incurred for purchase and implementation of electronic health records application | 0 | 0
Return of deposit on terminated purchase agreement | 6,500 |
Net cash used in investing activities | 6,500 | 0
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (1,123,140) | (252,289)
Additional borrowings | 906,000 | 36,000
Financing costs | (8,257) | 23,559
Repurchase of common shares | (9,676) | 44,532
Dividends paid | (14,519) | 14,638
Issuance of common stock | 3,828 | 3,596
Profit distributions to noncontrolling interests | 0 | 0
Changes in intercompany balances with affiliates, net | 246,871 | 234,622
Net cash used in financing activities | 1,107 | (60,800)
Increase (decrease) in cash and cash equivalents | 0 | 0
Cash and cash equivalents, beginning of period | 0 | 0
Cash and cash equivalents, end of period | 0 | 0
Guarantors [Member] |  |
Cash Flows from Operating Activities: |  |
Net cash provided by operating activities | 379,574 | 388,838
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (236,978) | 143,953
Proceeds received from sale of assets and businesses | 49,984 | 0
Acquisition of property and businesses | (11,476) | 0
Costs incurred for purchase and implementation of electronic health records application | (41,854) | (27,874)
Return of deposit on terminated purchase agreement | 0 |
Net cash used in investing activities | (240,324) | (171,827)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (2,567) | (1,156)
Additional borrowings | 0 | 0
Financing costs | 0 | 0
Repurchase of common shares | 0 | 0
Dividends paid | 0 | 0
Issuance of common stock | 0 | 0
Profit distributions to noncontrolling interests | 0 | 0
Changes in intercompany balances with affiliates, net | (151,417) | (205,164)
Net cash used in financing activities | (153,984) | (206,320)
Increase (decrease) in cash and cash equivalents | (14,734) | 10,691
Cash and cash equivalents, beginning of period | 33,221 | 21,385
Cash and cash equivalents, end of period | 18,487 | 32,076
Non Guarantors [Member] |  |
Cash Flows from Operating Activities: |  |
Net cash provided by operating activities | 163,039 | 112,864
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (45,213) | 51,451
Proceeds received from sale of assets and businesses | 6,210 | 23,682
Acquisition of property and businesses | (13,616) | (8,599)
Costs incurred for purchase and implementation of electronic health records application | 0 | 0
Return of deposit on terminated purchase agreement | 0 |
Net cash used in investing activities | (52,619) | (36,368)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (2,122) | (14,094)
Additional borrowings | 0 | 0
Financing costs | 0 | 0
Repurchase of common shares | 0 | 0
Dividends paid | 0 | 0
Issuance of common stock | 0 | 0
Profit distributions to noncontrolling interests | (13,687) | 33,962
Changes in intercompany balances with affiliates, net | (95,454) | (29,458)
Net cash used in financing activities | (111,263) | (77,514)
Increase (decrease) in cash and cash equivalents | (843) | (1,018)
Cash and cash equivalents, beginning of period | 8,008 | 8,089
Cash and cash equivalents, end of period | 7,165 | 7,071
Consolidating Adjustments [Member] |  |
Cash Flows from Operating Activities: |  |
Net cash provided by operating activities | 0 | 0
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | 0 | 0
Proceeds received from sale of assets and businesses | 0 | 0
Acquisition of property and businesses |  | 0
Costs incurred for purchase and implementation of electronic health records application | 0 | 0
Return of deposit on terminated purchase agreement | 0 |
Net cash used in investing activities | 0 | 0
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | 0 | 0
Additional borrowings | 0 | 0
Financing costs | 0 | 0
Repurchase of common shares | 0 | 0
Dividends paid | 0 | 0
Issuance of common stock | 0 | 0
Profit distributions to noncontrolling interests | 0 | 0
Changes in intercompany balances with affiliates, net | 0 |
Net cash used in financing activities | 0 | 0
Increase (decrease) in cash and cash equivalents | 0 | 0
Cash and cash equivalents, beginning of period | 0 | 0
Cash and cash equivalents, end of period | $ 0 | $ 0

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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 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 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 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 4: 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 + Details
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- Definition The cash inflow from a contractual arrangement with the lender, including letter of credit, standby letter of credit and revolving credit arrangements, under which borrowings can be made up to a specific amount at any point in time with either short term or long term maturity that is collateralized (backed by pledge, mortgage or other lien in the entity's assets). + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 19 -Subparagraph b -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 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 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3255-108585 + Details
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- Definition The net cash inflow or outflow from other financing activities. This element is used when there is not a more specific and appropriate element in the taxonomy. + 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 8 -URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3095-108585 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 9 -URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3098-108585 + 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 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 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 3: 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 4: 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 + Details
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- Definition The cash outflow for debt initially having maturity due after one year or beyond the normal operating cycle, if longer. + References Reference 1: 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 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 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3291-108585 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 20 -Subparagraph b -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. + Details
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