XML 15 R5.htm IDEA: XBRL DOCUMENT v3.5.0.2
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2016
Jun. 30, 2015
Cash flows from operating activities:    
Net income $ 150,096 $ 152,637
Adjustments to reconcile net income to net cash provided from operating activities:    
Depreciation and amortization 39,825 29,161
Amortization of premiums, discounts and issuance costs 2,693 762
Net change in fair value of contingent consideration liabilities 494 (261)
Stock-based compensation expense 17,240 15,764
Equity in earnings of unconsolidated affiliate (1,583) (1,566)
Distribution of earnings from unconsolidated affiliate   2,062
Deferred income taxes 18,081 17,535
Changes in assets and liabilities:    
Accounts receivable (16,228) (2,125)
Prepaid expenses and other assets (2,225) (2,680)
Other long-term assets 795 3,097
Accounts payable and accrued expenses (91,836) (119,527)
Income taxes payable (6,136) (12,135)
Payments of contingent consideration liabilities (501) (792)
Long-term professional liabilities 3,522 5,289
Other liabilities 2,467 5,228
Net cash provided from operating activities 116,704 92,449
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (195,715) (569,465)
Purchases of investments (38,679) (10,948)
Proceeds from maturities of investments 25,020 14,028
Purchases of property and equipment (19,171) (12,669)
Net cash used in investing activities (228,545) (579,054)
Cash flows from financing activities:    
Borrowings on credit agreement 902,000 1,414,500
Payments on credit agreement (737,500) (690,500)
Payments for credit facility amendment   (1,227)
Payments of contingent consideration liabilities (4,393) (4,647)
Payments on capital lease obligations (927) (455)
Excess tax benefit from vesting of restricted stock and exercises from stock options 3,354 8,973
Proceeds from issuance of common stock 11,455 10,956
Repurchases of common stock (61,828) (233,601)
Net cash provided from financing activities 112,161 503,999
Net increase in cash and cash equivalents 320 17,394
Cash and cash equivalents at beginning of period 51,572 47,928
Cash and cash equivalents at end of period $ 51,892 $ 65,322