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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $) In Thousands, unless otherwise specified | 3 Months Ended
--- | ---
Mar. 31, 2013 | Mar. 31, 2012
Cash Flows from Operating Activities: |  |
Net income | $ 129,935 | $ 142,570
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation & amortization | 79,923 | 73,820
Gain on sales of assets and businesses, net of losses | (2,092) | 0
Stock-based compensation expense | 7,111 | 5,486
Changes in assets & liabilities, net of effects from acquisitions and dispositions: |  |
Accounts receivable | (81,859) | (146,670)
Accrued interest | 11,497 | 13,280
Accrued and deferred income taxes | 68,890 | 75,471
Other working capital accounts | (39,785) | (48,074)
Other assets and deferred charges | 6,662 | 7,120
Other | 1,604 | (2,082)
Accrued insurance expense, net of commercial premiums paid | 22,962 | 24,581
Payments made in settlement of self-insurance claims | (17,085) | (18,279)
Net cash provided by operating activities | 187,763 | 127,223
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (95,919) | (92,563)
Proceeds received from sale of assets and businesses | 6,657 | 53,461
Costs incurred for purchase and implementation of electronic health records application | (16,412) | (14,501)
Return of deposit on terminated purchase agreement | 0 | 6,500
Net cash used in investing activities | (105,674) | (47,103)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (69,926) | (70,942)
Additional borrowings | 9,500 | 0
Repurchase of common shares | (14,027) | (2,017)
Dividends paid | (4,870) | (4,832)
Issuance of common stock | 1,232 | 1,016
Profit distributions to noncontrolling interests | (10,074) | (2,575)
Net cash (used in) provided by financing activities | (88,165) | (79,350)
(Decrease) increase in cash and cash equivalents | (6,076) | 770
Cash and cash equivalents, beginning of period | 23,471 | 41,229
Cash and cash equivalents, end of period | 17,395 | 41,999
Supplemental Disclosures of Cash Flow Information: |  |
Interest paid | 22,982 | 25,945
Income taxes paid, net of refunds | $ 4,908 | $ 3,419

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