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v3.22.2.2

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 9 Months Ended
--- | ---
Sep. 30, 2022 | Sep. 30, 2021
Cash Flows from Operating Activities: |  |
Net income | $ 486,613 | $ 753,721
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation & amortization | 433,508 | 399,850
(Gain) loss on sale of assets and businesses | 584 | (4,803)
Costs related to extinguishment of debt |  | 16,831
Stock-based compensation expense | 62,741 | 55,548
Provision for asset impairment |  | 7,195
Changes in assets & liabilities, net of effects from acquisitions and dispositions: |  |
Accounts receivable | (155,142) | (29,079)
Accrued interest | 529 | 3,714
Accrued and deferred income taxes | (4,900) | (52,727)
Other working capital accounts | (173,903) | 52,616
Medicare accelerated payments and deferred CARES Act and other grants | 2,921 | (697,393)
Other assets and deferred charges | 22,219 | (34,038)
Other | (23,358) | 9,607
Accrued insurance expense, net of commercial premiums paid | 134,908 | 140,702
Payments made in settlement of self-insurance claims | (88,001) | (60,069)
Net cash provided by operating activities | 698,719 | 561,675
Cash Flows from Investing Activities: |  |
Property and equipment additions | (569,555) | (666,025)
Proceeds received from sales of assets and businesses | 12,001 | 21,143
Acquisition of businesses and property | (18,666) | (39,391)
Inflows from foreign exchange contracts that hedge our net U.K. investment | 177,214 | 4,261
Decrease in capital reserves of commercial insurance subsidiary | 100 | 100
Costs incurred for purchase of information technology applications, net of refunds |  | 20,202
Net cash used in investing activities | (398,906) | (659,710)
Cash Flows from Financing Activities: |  |
Repayments of long-term debt | (194,115) | (3,026,888)
Additional borrowings, net | 705,321 | 2,912,374
Financing costs | (2,541) | (17,967)
Repurchase of common shares | (723,384) | (770,665)
Dividends paid | (44,192) | (50,284)
Issuance of common stock | 10,399 | 10,108
Profit distributions to noncontrolling interests | (5,426) | (5,744)
Purchase (sale) of ownership interests by (from) minority members | (49,089) | 13,046
Net cash used in financing activities | (303,027) | (936,020)
Effect of exchange rate changes on cash, cash equivalents and restricted cash | (10,339) | (682)
Decrease in cash, cash equivalents and restricted cash | (13,553) | (1,034,737)
Cash, cash equivalents and restricted cash, beginning of period | 178,934 | 1,279,154
Cash, cash equivalents and restricted cash, end of period | 165,381 | 244,417
Supplemental Disclosures of Cash Flow Information: |  |
Interest paid | 78,992 | 58,719
Income taxes paid, net of refunds | 182,091 | 286,376
Noncash purchases of property and equipment | $ 97,264 | $ 73,428

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