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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $) In Thousands, unless otherwise specified | 6 Months Ended
--- | ---
Jun. 30, 2013 | Jun. 30, 2012
Cash Flows from Operating Activities: |  |
Net income | $ 297,738 | $ 260,014
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation & amortization | 161,677 | 148,703
Stock-based compensation expense | 13,579 | 10,996
Gains on sales of assets and businesses, net of losses | (2,277) | 0
Changes in assets & liabilities, net of effects from acquisitions and dispositions: |  |
Accounts receivable | (82,224) | (63,937)
Accrued interest | 13,199 | 15,873
Accrued and deferred income taxes | 18,365 | 3,955
Other working capital accounts | 32,421 | (13,085)
Other assets and deferred charges | 9,069 | 13,866
Other | 4,083 | 2,050
Accrued insurance expense, net of commercial premiums paid | (22,590) | 42,241
Payments made in settlement of self-insurance claims | (37,038) | (47,814)
Net cash provided by operating activities | 406,002 | 372,862
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (175,944) | (182,351)
Proceeds received from sale of assets and businesses | 34,008 | 53,461
Acquisition of property and businesses | (1,320) | (11,476)
Costs incurred for purchase and implementation of electronic health records application | (33,396) | (28,008)
Return of deposit on terminated purchase agreement | 0 | 6,500
Net cash used in investing activities | (176,652) | (161,874)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (196,096) | (195,686)
Additional borrowings | 11,000 | 0
Repurchase of common shares | (21,373) | (2,927)
Dividends paid | (9,795) | (9,673)
Issuance of common stock | 2,735 | 2,575
Profit distributions to noncontrolling interests | (26,734) | (13,565)
Net cash used in financing activities | (240,263) | (219,276)
Decrease in cash and cash equivalents | (10,913) | (8,288)
Cash and cash equivalents, beginning of period | 23,471 | 41,229
Cash and cash equivalents, end of period | 12,558 | 32,941
Supplemental Disclosures of Cash Flow Information: |  |
Interest paid | 54,067 | 62,158
Income taxes paid, net of refunds | $ 152,553 | $ 141,571

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Period Type: | duration

X
- Details
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Namespace Prefix: | us-gaap_
Data Type: | xbrli:stringItemType
Balance Type: | na
Period Type: | duration