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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2015 | Dec. 31, 2014 | Dec. 31, 2013
Cash flows from operating activities: |  |  |
Net income | $ 427,410 | $ 863,330 | $ 757,201
Adjustments to reconcile net income to cash provided by operating activities: |  |  |
Settlement charge and loss contingency accrual | 495,000 | 17,000 | 397,000
Depreciation and amortization | 638,024 | 590,935 | 528,119
Goodwill and other intangible asset impairment charges | 210,234 |  |
Debt redemption and refinancing charges | 48,072 | 97,548 |
Stock-based compensation expense | 56,664 | 56,743 | 59,998
Tax benefits from stock award exercises | 45,749 | 59,119 | 46,898
Excess tax benefits from stock award exercises | (28,157) | (45,271) | (36,197)
Deferred income taxes | 61,744 | 210,955 | (25,380)
Equity investment income, net | 9,293 | 10,125 | 2,872
Other non-cash charges | 44,691 | 39,274 | (31,351)
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures: |  |  |
Accounts receivable | (202,867) | (40,676) | (59,640)
Inventories | (48,313) | (46,398) | (8,971)
Other receivables and other current assets | 32,761 | (61,674) | (108,434)
Other long-term assets | 3,723 | 2,916 | 17,731
Accounts payable | 30,998 | (2,956) | 16,666
Accrued compensation and benefits | 54,950 | 97,261 | 38,368
Other current liabilities | 113,470 | 83,590 | 78,817
Settlement payments | (493,775) | (410,356) |
Income taxes | 24,175 | (60,475) | 33,499
Other long-term liabilities | 33,354 | (1,583) | 66,145
Net cash provided by operating activities | 1,557,200 | 1,459,407 | 1,773,341
Cash flows from investing activities: |  |  |
Additions of property and equipment | (707,998) | (641,330) | (617,597)
Acquisitions | (96,469) | (272,094) | (310,394)
Proceeds from asset and business sales | 19,715 | 8,791 | 62,258
Purchase of investments available-for-sale | (8,783) | (8,440) | (12,445)
Purchase of investments held-to-maturity | (1,709,883) | (472,628) | (1,039)
Proceeds from sale of investments available-for-sale | 2,058 | 2,475 | 4,158
Proceeds from investments held-to-maturity | 1,637,358 | 141,072 | 1,376
Purchase of intangible assets |  | (1,018) | (2,391)
Purchase of equity investments | (17,911) | (35,382) | (1,305)
Distributions received on equity investments | 129 | 825 | 497
Net cash used in investing activities | (881,784) | (1,277,729) | (876,882)
Cash flows from financing activities: |  |  |
Borrowings | 54,541,988 | 60,038,508 | 66,286,097
Payments on long-term debt and other financing costs | (53,922,290) | (60,046,487) | (66,723,385)
Deferred financing and debt redemption and refinancing costs | (76,672) | (122,988) | (719)
Purchase of treasury stock | (549,935) |  |
Distributions to noncontrolling interests | (174,635) | (149,339) | (139,326)
Stock award exercises and other share issuances, net | 26,155 | 19,500 | 16,423
Excess tax benefits from stock award exercises | 28,157 | 45,271 | 36,197
Contributions from noncontrolling interests | 54,644 | 64,655 | 36,996
Proceeds from sales of additional noncontrolling interests |  | 3,777 | 8,295
Purchases of noncontrolling interests | (66,382) | (17,876) | (3,569)
Net cash used in financing activities | (138,970) | (164,979) | (482,991)
Effect of exchange rate changes on cash and cash equivalents | (2,571) | 2,293 | (967)
Net increase in cash and cash equivalents | 533,875 | 18,992 | 412,501
Cash and cash equivalents at beginning of the year | 965,241 | 946,249 | 533,748
Cash and cash equivalents at end of the year | $ 1,499,116 | $ 965,241 | $ 946,249

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- Definition The cash outflow associated with the acquisition of business during the period. The cash portion only of the acquisition price. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3213-108585 + Details
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- Definition The cash outflow associated with the purchase of or advances to an equity method investments, which are investments in joint ventures and entities in which the entity has an equity ownership interest normally of 20 to 50 percent and exercises significant influence. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3213-108585 + Details
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- Definition Amount of cash outflow through purchase of long-term held-to-maturity securities. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 320 -SubTopic 10 -Section 45 -Paragraph 11 -URI http://asc.fasb.org/extlink&oid=49167202&loc=d3e26853-111562 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3213-108585 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 + Details
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- Definition The cash outflow to acquire asset without physical form usually arising from contractual or other legal rights, excluding goodwill. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3213-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 + Details
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- Definition The cash outflow associated with the acquisition of long-lived, physical assets that are used in the normal conduct of business to produce goods and services and not intended for resale; includes cash outflows to pay for construction of self-constructed assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3213-108585 + Details
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- Definition Amount of cash outflow to a noncontrolling interest. Includes, but not limited to, reduction of noncontrolling interest ownership. Excludes dividends paid to the noncontrolling interest. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3291-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 + Details
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- Definition The cash inflow from an entity that is affiliated with the entity by means of direct or indirect ownership. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3255-108585 + Details
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- Definition Cash dividends or other distributions received from unconsolidated subsidiaries, certain corporate joint ventures, and certain noncontrolled corporations that are returns of capital. Excludes dividends or distributions from equity method investments classified as operating activities. + References No definition available. + Details
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- Definition The cash inflow from a debt initially having maturity due after one year or beyond the operating cycle, if longer. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3255-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 + Details
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- Definition Amount of cash inflow from a noncontrolling interest. Includes, but is not limited to, purchase of additional shares or other increase in noncontrolling interest ownership. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3255-108585 + Details
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- Definition Amount of cash inflow from the sale or maturity of long-term held-to-maturity securities. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 320 -SubTopic 10 -Section 45 -Paragraph 11 -URI http://asc.fasb.org/extlink&oid=49167202&loc=d3e26853-111562 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3179-108585 + Details
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- Definition The cash inflow associated with the sale of debt and equity securities classified as available-for-sale securities. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 320 -SubTopic 10 -Section 45 -Paragraph 11 -URI http://asc.fasb.org/extlink&oid=49167202&loc=d3e26853-111562 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -Subparagraph (a),(b) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3179-108585 + Details
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- Definition Aggregate cash proceeds received from a combination of transactions in which noncurrent assets are sold, which may include the sale of a business, an investment in an affiliate (including an equity method investee), property, plant and equipment and intangible assets. Excludes sales of trading, available-for-sale, and held-to-maturity securities. + References No definition available. + Details
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- Definition The cash inflow associated with the amount received from holders exercising their stock options. This item inherently excludes any excess tax benefit, which the entity may have realized and reported separately. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 718 -SubTopic 10 -Section 50 -Paragraph 2 -Subparagraph (j) -URI http://asc.fasb.org/extlink&oid=6415400&loc=d3e5070-113901 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3255-108585 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 + Details
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- Definition The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 45 -Paragraph 19 -URI http://asc.fasb.org/extlink&oid=51664549&loc=SL4569616-111683 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 55 -Paragraph 4K -URI http://asc.fasb.org/extlink&oid=35736750&loc=SL4591552-111686 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 50 -Paragraph 1A -Subparagraph (a),(c) -URI http://asc.fasb.org/extlink&oid=18733093&loc=SL4573702-111684 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 55 -Paragraph 4J -URI http://asc.fasb.org/extlink&oid=35736750&loc=SL4591551-111686 + Details
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- Definition The cash outflow during the period from the repayment of aggregate short-term and long-term debt and payment of capital lease obligations. + References No definition available. + Details
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- Definition The aggregate amount of noncash, equity-based employee remuneration. This may include the value of stock or unit options, amortization of restricted stock or units, and adjustment for officers' compensation. As noncash, this element is an add back when calculating net cash generated by operating activities using the indirect method. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3602-108585 + Details
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