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v3.3.1.900

Supplemental Condensed Consolidating Statements of Cash flows (Detail) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2015 | Dec. 31, 2014 | Dec. 31, 2013
Condensed Financial Statements Captions [Line Items] |  |  |
Net cash (used in) provided by operating activities | $ 1,020,898 | $ 1,035,876 | $ 884,241
Cash Flows from Investing Activities: |  |  |
Property and equipment additions, net of disposals | (379,321) | (391,150) | (358,493)
Acquisition of property and businesses | (533,655) | (431,386) | (12,636)
Proceeds received from sale of assets and businesses | 3,391 | 15,178 | 37,482
Costs incurred for purchase and implementation of electronic health records application | 0 | (13,488) | (49,811)
Increase in insurance subsidiary investments | (3,300) | (12,000) | 0
Net cash used in investing activities | (912,885) | (832,846) | (383,458)
Cash Flows from Financing Activities: |  |  |
Reduction of long-term debt | (68,166) | (879,129) | (440,224)
Additional borrowings | 234,400 | 830,000 | 15,761
Financing costs | (515) | (14,976) | (231)
Repurchase of common shares | (209,782) | (100,749) | (27,201)
Dividends paid | (39,532) | (29,665) | (19,621)
Issuance of common stock | 8,441 | 6,863 | 5,708
Excess income tax benefits related to stock based compensation | 47,364 | 33,912 | 20,121
Profit distributions to noncontrolling interests | (62,220) | (33,680) | (61,329)
Proceeds received from sale/leaseback of real property | 12,765 | 0 | 0
Changes in intercompany balances with affiliates, net | 0 | 0 | 0
Net cash used in financing activities | (77,245) | (187,424) | (507,016)
Effect of exchange rate changes on cash and cash equivalents | (1,609) | (775) | 0
Increase (decrease) in cash and cash equivalents | 29,159 | 14,831 | (6,233)
Cash and cash equivalents, beginning of period | 32,069 | 17,238 | 23,471
Cash and cash equivalents, end of period | 61,228 | 32,069 | 17,238
Parent |  |  |
Condensed Financial Statements Captions [Line Items] |  |  |
Net cash (used in) provided by operating activities | (21,287) | 18,579 | 17,946
Cash Flows from Investing Activities: |  |  |
Property and equipment additions, net of disposals | 0 | 0 | 0
Acquisition of property and businesses |  | 0 | 0
Proceeds received from sale of assets and businesses | 0 | 0 | 0
Costs incurred for purchase and implementation of electronic health records application |  | 0 | 0
Increase in insurance subsidiary investments | 0 | 0 |
Net cash used in investing activities | 0 | 0 | 0
Cash Flows from Financing Activities: |  |  |
Reduction of long-term debt | (42,133) | (866,748) | (429,996)
Additional borrowings | 234,400 | 830,000 | 15,761
Financing costs | (515) | (14,976) | (231)
Repurchase of common shares | (209,782) | (100,749) | (27,201)
Dividends paid | (39,532) | (29,665) | (19,621)
Issuance of common stock | 8,441 | 6,863 | 5,708
Excess income tax benefits related to stock based compensation | 47,364 | 33,912 | 20,121
Profit distributions to noncontrolling interests | 0 | 0 | 0
Proceeds received from sale/leaseback of real property | 0 |  |
Changes in intercompany balances with affiliates, net | 23,044 | 122,784 | 417,513
Net cash used in financing activities | 21,287 | (18,579) | (17,946)
Effect of exchange rate changes on cash and cash equivalents | 0 | 0 |
Increase (decrease) in cash and cash equivalents | 0 | 0 | 0
Cash and cash equivalents, beginning of period | 0 | 0 | 0
Cash and cash equivalents, end of period | 0 | 0 | 0
Guarantors |  |  |
Condensed Financial Statements Captions [Line Items] |  |  |
Net cash (used in) provided by operating activities | 655,439 | 687,101 | 587,083
Cash Flows from Investing Activities: |  |  |
Property and equipment additions, net of disposals | (209,355) | (230,102) | (269,419)
Acquisition of property and businesses | (513,382) | (422,081) | (8,094)
Proceeds received from sale of assets and businesses | 647 | 11,450 | 7,916
Costs incurred for purchase and implementation of electronic health records application |  | (13,488) | (49,811)
Increase in insurance subsidiary investments | (3,300) | (12,000) |
Net cash used in investing activities | (725,390) | (666,221) | (319,408)
Cash Flows from Financing Activities: |  |  |
Reduction of long-term debt | (3,459) | (867) | (109)
Additional borrowings | 0 | 0 | 0
Financing costs | 0 | 0 | 0
Repurchase of common shares | 0 | 0 | 0
Dividends paid | 0 | 0 | 0
Issuance of common stock | 0 | 0 | 0
Excess income tax benefits related to stock based compensation | 0 | 0 | 0
Profit distributions to noncontrolling interests | 0 | 0 | 0
Proceeds received from sale/leaseback of real property | 0 |  |
Changes in intercompany balances with affiliates, net | 100,427 | (5,444) | (271,525)
Net cash used in financing activities | 96,968 | (6,311) | (271,634)
Effect of exchange rate changes on cash and cash equivalents | (1,609) | (775) |
Increase (decrease) in cash and cash equivalents | 25,408 | 13,794 | (3,959)
Cash and cash equivalents, beginning of period | 21,784 | 7,990 | 11,949
Cash and cash equivalents, end of period | 47,192 | 21,784 | 7,990
Non Guarantors |  |  |
Condensed Financial Statements Captions [Line Items] |  |  |
Net cash (used in) provided by operating activities | 386,746 | 330,196 | 279,212
Cash Flows from Investing Activities: |  |  |
Property and equipment additions, net of disposals | (169,966) | (161,048) | (89,074)
Acquisition of property and businesses | (20,273) | (9,305) | (4,542)
Proceeds received from sale of assets and businesses | 2,744 | 3,728 | 29,566
Costs incurred for purchase and implementation of electronic health records application |  | 0 | 0
Increase in insurance subsidiary investments | 0 | 0 |
Net cash used in investing activities | (187,495) | (166,625) | (64,050)
Cash Flows from Financing Activities: |  |  |
Reduction of long-term debt | (22,574) | (11,514) | (10,119)
Additional borrowings | 0 | 0 | 0
Financing costs | 0 | 0 | 0
Repurchase of common shares | 0 | 0 | 0
Dividends paid | 0 | 0 | 0
Issuance of common stock | 0 | 0 | 0
Excess income tax benefits related to stock based compensation | 0 | 0 | 0
Profit distributions to noncontrolling interests | (62,220) | (33,680) | (61,329)
Proceeds received from sale/leaseback of real property | 12,765 |  |
Changes in intercompany balances with affiliates, net | (123,471) | (117,340) | (145,988)
Net cash used in financing activities | (195,500) | (162,534) | (217,436)
Effect of exchange rate changes on cash and cash equivalents | 0 | 0 |
Increase (decrease) in cash and cash equivalents | 3,751 | 1,037 | (2,274)
Cash and cash equivalents, beginning of period | 10,285 | 9,248 | 11,522
Cash and cash equivalents, end of period | 14,036 | 10,285 | 9,248
Consolidating Adjustments |  |  |
Condensed Financial Statements Captions [Line Items] |  |  |
Net cash (used in) provided by operating activities | 0 | 0 | 0
Cash Flows from Investing Activities: |  |  |
Property and equipment additions, net of disposals | 0 | 0 | 0
Acquisition of property and businesses |  | 0 | 0
Proceeds received from sale of assets and businesses | 0 | 0 | 0
Costs incurred for purchase and implementation of electronic health records application |  | 0 | 0
Increase in insurance subsidiary investments | 0 | 0 |
Net cash used in investing activities | 0 | 0 | 0
Cash Flows from Financing Activities: |  |  |
Reduction of long-term debt | 0 | 0 | 0
Additional borrowings | 0 | 0 | 0
Financing costs | 0 | 0 | 0
Repurchase of common shares | 0 | 0 | 0
Dividends paid | 0 | 0 | 0
Issuance of common stock | 0 | 0 | 0
Excess income tax benefits related to stock based compensation | 0 | 0 | 0
Profit distributions to noncontrolling interests | 0 | 0 | 0
Proceeds received from sale/leaseback of real property | 0 |  |
Changes in intercompany balances with affiliates, net | 0 | 0 | 0
Net cash used in financing activities | 0 | 0 | 0
Effect of exchange rate changes on cash and cash equivalents | 0 | 0 |
Increase (decrease) in cash and cash equivalents | 0 | 0 | 0
Cash and cash equivalents, beginning of period | 0 | 0 | 0
Cash and cash equivalents, end of period | $ 0 | $ 0 | $ 0

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- Definition Amount of currency on hand as well as demand deposits with banks or financial institutions. Includes other kinds of accounts that have the general characteristics of demand deposits. Also includes short-term, highly liquid investments that are both readily convertible to known amounts of cash and so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. Excludes cash and cash equivalents within disposal group and discontinued operation. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Cash -URI http://asc.fasb.org/extlink&oid=6506951 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section 45 -Paragraph 1 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=28358313&loc=d3e6676-107765 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 4 -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3044-108585 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Cash Equivalents -URI http://asc.fasb.org/extlink&oid=6507016 Reference 5: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.5-02.1) -URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682 + Details
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- Definition Amount of increase (decrease) in cash and cash equivalents. Cash and cash equivalents are the amount of currency on hand as well as demand deposits with banks or financial institutions. Includes other kinds of accounts that have the general characteristics of demand deposits. Also includes short-term, highly liquid investments that are both readily convertible to known amounts of cash and so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. Includes effect from exchange rate changes. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 830 -SubTopic 230 -Section 45 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=49171198&loc=d3e33268-110906 + Details
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- Definition Amount of increase (decrease) from the effect of exchange rate changes on cash and cash equivalent balances held in foreign currencies. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 830 -SubTopic 230 -Section 45 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=49171198&loc=d3e33268-110906 + Details
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- Definition Amount of cash inflow from realized tax benefit related to deductible compensation cost reported on the entity's tax return for equity instruments in excess of the compensation cost for those instruments recognized for financial reporting purposes. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 718 -SubTopic 20 -Section 55 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=32706628&loc=d3e11374-113907 + Details
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- Definition Amount of cash inflow (outflow) from financing activities, including discontinued operations. Financing activity cash flows include obtaining resources from owners and providing them with a return on, and a return of, their investment; borrowing money and repaying amounts borrowed, or settling the obligation; and obtaining and paying for other resources obtained from creditors on long-term credit. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3574-108585 + Details
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- Definition Amount of cash inflow (outflow) from investing activities, including discontinued operations. Investing activity cash flows include making and collecting loans and acquiring and disposing of debt or equity instruments and property, plant, and equipment and other productive assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3574-108585 + Details
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