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v3.23.1

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 3 Months Ended
--- | ---
Mar. 31, 2023 | Mar. 31, 2022
Cash Flows from Operating Activities: |  |
Net income | $ 162,375 | $ 151,021
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation & amortization | 141,621 | 143,784
(Gain) loss on sale of assets and businesses | (295) | 1,084
Stock-based compensation expense | 20,964 | 19,055
Changes in assets & liabilities, net of effects from acquisitions and dispositions: |  |
Accounts receivable | (15,723) | (15,073)
Accrued interest | (662) | 180
Accrued and deferred income taxes | 46,576 | 47,548
Other working capital accounts | (119,605) | 63,308
Medicare accelerated payments and deferred CARES Act and other grants | 136 | 250
Other assets and deferred charges | 24,727 | 26,042
Other | 7,030 | (4,020)
Accrued insurance expense, net of commercial premiums paid | 42,545 | 41,685
Payments made in settlement of self-insurance claims | (18,936) | (29,431)
Net cash provided by operating activities | 290,753 | 445,433
Cash Flows from Investing Activities: |  |
Property and equipment additions | (168,752) | (200,002)
Proceeds received from sales of assets and businesses | 9,259 | 10,232
Inflows from foreign exchange contracts that hedge our net U.K. investment | (18,818) | 20,710
Decrease in capital reserves of commercial insurance subsidiary | 0 | 100
Net cash used in investing activities | (178,311) | (168,960)
Cash Flows from Financing Activities: |  |
Repayments of long-term debt | (16,489) | (11,966)
Additional borrowings, net | 11,300 | 117,400
Financing costs | (292) |
Repurchase of common shares | (85,039) | (365,505)
Dividends paid | (14,214) | (14,875)
Issuance of common stock | 2,988 | 3,503
Profit distributions to noncontrolling interests | (4,145) | (5,289)
Sale of ownership interests from minority members | 0 | (1,307)
Net cash used in financing activities | (105,891) | (278,039)
Effect of exchange rate changes on cash, cash equivalents and restricted cash | 1,650 | (2,232)
Decrease in cash, cash equivalents and restricted cash | 8,201 | (3,798)
Cash, cash equivalents and restricted cash, beginning of period | 200,837 | 178,934
Cash, cash equivalents and restricted cash, end of period | 209,038 | 175,136
Supplemental Disclosures of Cash Flow Information: |  |
Interest paid | 50,279 | 20,388
Income taxes paid, net of refunds | 2,360 | 4,423
Noncash purchases of property and equipment | $ 61,341 | $ 90,730

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