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Condensed Consolidated Statements Of Cash Flows (USD $)
In Thousands
9 Months Ended
Sep. 30, 2011
Sep. 30, 2010
Cash flows from operating activities:  
Net income$ 159,638$ 148,891
Adjustments to reconcile net income to net cash provided from operating activities:  
Depreciation and amortization18,02616,107
Accretion of contingent consideration liabilities817717
Stock-based compensation expense20,03719,099
Deferred income taxes5,5546,232
Changes in assets and liabilities:  
Accounts receivable(25,665)(10,278)
Prepaid expenses and other assets(5,026)3,632
Other assets4,021(1,087)
Accounts payable and accrued expenses(13,182)(51,757)
Income taxes payable1,73817,558
Long-term professional liabilities11,9076,347
Other liabilities3,05618
Net cash provided from operating activities180,921155,479
Cash flows from investing activities:  
Acquisition payments, net of cash acquired(79,928)(64,136)
Purchases of investments(26,039)(21,422)
Proceeds from maturities of investments28,58511,600
Purchases of property and equipment(28,622)(10,054)
Net cash used in investing activities(106,004)(84,012)
Cash flows from financing activities:  
Payments on line of credit(484,000)(409,500)
Borrowings on line of credit387,500359,500
Payments of contingent consideration liabilities(3,700)(1,600)
Payments on capital lease obligations(413)(201)
Excess tax benefit from exercises of stock options and vesting of restricted stock6,8862,253
Excess tax benefit related to resolution of income tax matters 3,394
Proceeds from issuance of common stock28,3089,571
Net cash used in financing activities(65,419)(36,583)
Net increase in cash and cash equivalents9,49834,884
Cash and cash equivalents at beginning of period26,25126,503
Cash and cash equivalents at end of period$ 35,749$ 61,387