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v3.22.2

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 6 Months Ended
--- | ---
Jun. 30, 2022 | Jun. 30, 2021
Cash Flows from Operating Activities: |  |
Net income | $ 309,802 | $ 534,346
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation & amortization | 287,634 | 265,388
(Gain) loss on sale of assets and businesses | 1,084 | (4,803)
Stock-based compensation expense | 41,640 | 37,031
Provision for asset impairment |  | 7,195
Changes in assets & liabilities, net of effects from acquisitions and dispositions: |  |
Accounts receivable | (89,729) | (35,903)
Accrued interest | 1,329 | (1,459)
Accrued and deferred income taxes | (34,260) | (26,769)
Other working capital accounts | (98,811) | 3,560
Medicare accelerated payments and deferred CARES Act and other grants | 5,339 | (697,011)
Other assets and deferred charges | 30,278 | (28,763)
Other | (15,763) | 5,052
Accrued insurance expense, net of commercial premiums paid | 97,570 | 104,079
Payments made in settlement of self-insurance claims | (58,066) | (42,495)
Net cash provided by operating activities | 478,047 | 119,448
Cash Flows from Investing Activities: |  |
Property and equipment additions | (407,962) | (482,211)
Proceeds received from sales of assets and businesses | 10,232 | 21,143
Acquisition of businesses and property | (12,485) |
Inflows (outflows) from foreign exchange contracts that hedge our net U.K. investment | 84,535 | (21,487)
Decrease in capital reserves of commercial insurance subsidiary | 100 | 100
Costs incurred for purchase of information technology applications, net of refunds |  | (1,246)
Net cash used in investing activities | (325,580) | (483,701)
Cash Flows from Financing Activities: |  |
Repayments of long-term debt | (226,854) | (278,785)
Additional borrowings, net | 700,000 | 6,578
Financing costs | (2,387) |
Repurchase of common shares | (565,182) | (368,080)
Dividends paid | (29,641) | (33,844)
Issuance of common stock | 6,661 | 6,442
Profit distributions to noncontrolling interests | (5,323) | (5,617)
Purchase (sale) of ownership interests by (from) minority members | (1,307) | 11,433
Net cash used in financing activities | (124,033) | (661,873)
Effect of exchange rate changes on cash, cash equivalents and restricted cash | (5,457) | 660
Increase (decrease) in cash, cash equivalents and restricted cash | 22,977 | (1,025,466)
Cash, cash equivalents and restricted cash, beginning of period | 178,934 | 1,279,154
Cash, cash equivalents and restricted cash, end of period | 201,911 | 253,688
Supplemental Disclosures of Cash Flow Information: |  |
Interest paid | 43,796 | 43,641
Income taxes paid, net of refunds | 145,448 | 189,979
Noncash purchases of property and equipment | $ 112,420 | $ 95,979

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