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v3.20.2

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 9 Months Ended
--- | ---
Sep. 30, 2020 | Sep. 30, 2019
Cash Flows from Operating Activities: |  |
Net income | $ 645,056 | $ 579,533
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation & amortization | 376,563 | 362,736
(Gain) loss on sale of assets and businesses | 2,124 | (5,982)
Stock-based compensation expense | 49,928 | 52,167
Costs related to extinguishment of debt | 1,365 |
Provision for asset impairment |  | 97,631
Changes in assets & liabilities, net of effects from acquisitions and dispositions: |  |
Accounts receivable | 45,435 | (37,332)
Accrued interest | (10,526) | (2,962)
Accrued and deferred income taxes | (2,095) | (53,714)
Other working capital accounts | 85,944 | 90,262
Medicare accelerated payments and deferred CARES Act and other grants | 878,480 |
Other assets and deferred charges | 1,271 | 15,237
Other | 115,431 | (663)
Accrued insurance expense, net of commercial premiums paid | 113,571 | 76,245
Payments made in settlement of self-insurance claims | (84,390) | (68,046)
Net cash provided by operating activities | 2,218,157 | 1,105,112
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (546,656) | (480,247)
Proceeds received from sales of assets and businesses | 7,851 | 7,497
Acquisition of businesses and property | (52,009) |
Inflows from foreign exchange contracts that hedge our net U.K. investment | 22,453 | 34,484
Costs incurred for purchase and implementation of information technology applications | (5,345) | (18,240)
Investment in, and advances to, joint ventures and other | (997) | (11,949)
Net cash used in investing activities | (574,703) | (468,455)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (1,173,590) | (68,175)
Additional borrowings | 803,197 | 15,100
Financing costs | (8,256) |
Repurchase of common shares | (200,098) | (587,976)
Dividends paid | (17,344) | (35,556)
Issuance of common stock | 9,288 | 8,248
Profit distributions to noncontrolling interests | (15,175) | (11,887)
Purchase of ownership interests from minority members | (548) |
Net cash used in financing activities | (602,526) | (680,246)
Effect of exchange rate changes on cash, cash equivalents and restricted cash | (706) | (1,259)
Increase (decrease) in cash, cash equivalents and restricted cash | 1,040,222 | (44,848)
Cash, cash equivalents and restricted cash, beginning of period | 105,667 | 199,685
Cash, cash equivalents and restricted cash, end of period | 1,145,889 | 154,837
Supplemental Disclosures of Cash Flow Information: |  |
Interest paid | 93,579 | 122,699
Income taxes paid, net of refunds | 208,460 | 221,298
Noncash purchases of property and equipment | 76,402 | 83,552
Right-of-use assets obtained in exchange for lease obligations | $ 47,679 | $ 364,453

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