XML 96 R84.htm IDEA: XBRL DOCUMENT v3.4.0.3
Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2016
Mar. 31, 2015
Cash flows from operating activities:    
Net income (loss) $ 138,159 $ (76,148)
Changes in operating and intercompany assets and liabilities and non-cash items included in net income 290,843 486,237
Net cash provided by operating activities 429,002 410,089
Cash flows from investing activities:    
Additions of property and equipment (173,187) (121,421)
Acquisitions and divestitures, net (405,154)  
Proceeds from discontinued operations 4,657 2,565
Investments and other items 19,373 (92,781)
Net cash used in investing activities (554,311) (252,287)
Cash flows from financing activities:    
Long-term debt (24,571) (28,439)
Other items (308,526) (82,429)
Net cash used in financing activities (333,097) (110,868)
Effect of exchange rate changes on cash 717 (904)
Net (decrease) increase in cash and cash equivalents (457,689) 46,030
Cash and cash equivalents at beginning of the year 1,499,116 965,241
Cash and cash equivalents at end of the period 1,041,427 $ 1,011,271
Physician Groups    
Cash flows from operating activities:    
Net income (loss) (16,867)  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income (64,656)  
Net cash provided by operating activities (81,523)  
Cash flows from investing activities:    
Additions of property and equipment (200)  
Investments and other items (536)  
Net cash used in investing activities (736)  
Cash flows from financing activities:    
Intercompany 137,967  
Net cash used in financing activities 137,967  
Net (decrease) increase in cash and cash equivalents 55,708  
Cash and cash equivalents at beginning of the year 88,245  
Cash and cash equivalents at end of the period 143,953  
Unrestricted Subsidiaries    
Cash flows from operating activities:    
Net income (loss) 95  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income (95)  
Company and Restricted Subsidiaries    
Cash flows from operating activities:    
Net income (loss) [1] 154,931  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income [1] 355,594  
Net cash provided by operating activities [1] 510,525  
Cash flows from investing activities:    
Additions of property and equipment [1] (172,987)  
Acquisitions and divestitures, net [1] (405,154)  
Proceeds from discontinued operations [1] 4,657  
Investments and other items [1] 19,909  
Net cash used in investing activities [1] (553,575)  
Cash flows from financing activities:    
Long-term debt [1] (24,571)  
Intercompany [1] (137,967)  
Other items [1] (308,526)  
Net cash used in financing activities [1] (471,064)  
Effect of exchange rate changes on cash [1] 717  
Net (decrease) increase in cash and cash equivalents [1] (513,397)  
Cash and cash equivalents at beginning of the year [1] 1,410,871  
Cash and cash equivalents at end of the period [1] $ 897,474  
[1] After elimination of the unrestricted subsidiaries and the physician groups.