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Condensed Consolidated Statements of Cash Flows (Unaudited) (USD $) In Thousands, unless otherwise specified | 9 Months Ended
--- | ---
Sep. 30, 2012 | Sep. 30, 2011
Cash Flows from Operating Activities: |  |
Net income | $ 341,387 | $ 340,863
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation & amortization | 227,641 | 220,208
(Gain) loss on sale of assets | (945) | 164
Stock-based compensation expense | 16,189 | 13,434
Costs related to extinguishment of debt | 29,170 | 0
Changes in assets & liabilities, net of effects from acquisitions and dispositions: |  |
Accounts receivable | (86,821) | (103,700)
Accrued interest | 11,901 | 13,143
Accrued and deferred income taxes | (260) | 102,949
Other working capital accounts | (42,916) | (74,342)
Other assets and deferred charges | 25,959 | 20,215
Other | 5,833 | 4,146
Accrued insurance expense, net of commercial premiums paid | 66,752 | 71,186
Payments made in settlement of self-insurance claims | (58,884) | (45,764)
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)
Net cash used in financing activities | (264,140) | (344,634)
(Decrease) increase 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
Supplemental Disclosures of Cash Flow Information: |  |
Interest paid | 104,560 | 120,712
Income taxes paid, net of refunds | $ 187,899 | $ 89,268

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- Definition Cash outflow in the form of capital distributions and dividends to common shareholders, preferred shareholders and noncontrolling interests. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Statement of Financial Accounting Standard (FAS) -Number 95 -Paragraph 20 -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 15 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=6943989&loc=d3e3291-108585 + Details
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