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Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified | 12 Months Ended
--- | ---
Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011
Cash flows from operating activities: |  |  |
Net income | $ 280,517 | $ 240,907 | $ 217,997
Adjustments to reconcile net income to net cash provided from operating activities: |  |  |
Depreciation and amortization | 39,966 | 30,816 | 25,292
Net change in fair value of contingent consideration liabilities | 3,656 | 995 | 1,083
Stock-based compensation expense | 31,288 | 28,437 | 27,092
Deferred income taxes | 15,920 | 21,344 | 8,063
Changes in assets and liabilities: |  |  |
Accounts receivable | (37,331) | (17,678) | (48,993)
Prepaid expenses and other assets | 212 | (244) | (3,433)
Other assets | (3,541) | 1,153 | 3,932
Accounts payable and accrued expenses | 49,239 | 16,953 | 21,480
Income taxes payable | 5,772 | (7,343) | 6,704
Payments of contingent consideration liabilities | (1,308) | (786) | (350)
Long-term professional liabilities | 19,797 | 9,941 | 9,843
Other liabilities | 1,211 | 411 | 1,959
Net cash provided from operating activities | 405,398 | 324,906 | 270,669
Cash flows from investing activities: |  |  |
Acquisition payments, net of cash acquired | (238,045) | (441,006) | (154,885)
Purchases of investments | (20,802) | (33,120) | (42,526)
Proceeds from sales or maturities of investments | 11,011 | 28,073 | 38,170
Purchases of property and equipment | (15,654) | (14,495) | (31,332)
Net cash used in investing activities | (263,490) | (460,548) | (190,573)
Cash flows from financing activities: |  |  |
Borrowings on line of credit | 911,500 | 517,500 | 512,500
Payments on line of credit | (1,028,500) | (402,500) | (630,000)
Payments for amendment of line of credit |  | (2,397) | (1,970)
Payments of contingent consideration liabilities | (10,365) | (9,445) | (6,211)
Payments on capital lease obligations | (99) | (136) | (463)
Excess tax benefit from exercises of stock options and vesting of restricted and deferred stock | 18,579 | 6,494 | 7,031
Proceeds from issuance of common stock | 28,697 | 28,810 | 31,362
Repurchases of common stock | (51,863) |  |
Net cash (used in) provided from financing activities | (132,051) | 138,326 | (87,751)
Net increase (decrease) in cash and cash equivalents | 9,857 | 2,684 | (7,655)
Cash and cash equivalents at beginning of year | 21,280 | 18,596 | 26,251
Cash and cash equivalents at end of year | 31,137 | 21,280 | 18,596
Supplemental disclosure of cash flow information: |  |  |
Interest | 3,312 | 2,044 | 2,569
Income taxes | 126,411 | 129,636 | 119,261
Non-cash financing activities: |  |  |
Equipment financed through capital leases |  |  | $ 751

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- Definition The cash inflow from the additional capital contribution to the entity. + 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 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3255-108585 + Details
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- Definition Amount of cash inflow from contractual arrangement with the lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.4-08.(f)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher SEC -Name Regulation S-X (SX) -Number 210 -Section 08 -Paragraph f -Article 4 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 Reference 4: 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=31042434&loc=d3e3255-108585 + Details
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- Definition The cash inflow associated with the sale, maturity and collection of all investments such as debt, security and so forth during the period. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3179-108585 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 Amount of cash outflow for payment of an obligation from a lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.4-08.(f)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher SEC -Name Regulation S-X (SX) -Number 210 -Section 08 -Paragraph f -Article 4 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585 Reference 4: 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 outflow for the obligation for a lease meeting the criteria for capitalization (with maturities exceeding one year or beyond the operating cycle of the entity, 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 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585 + 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=31042434&loc=d3e3602-108585 + Details
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