XML 15 R5.htm IDEA: XBRL DOCUMENT v3.5.0.2
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2016
Sep. 30, 2015
Cash flows from operating activities:    
Net income $ 246,517 $ 243,277
Adjustments to reconcile net income to net cash provided from operating activities:    
Depreciation and amortization 64,010 46,079
Amortization of premiums, discounts and issuance costs 4,077 1,236
Net change in fair value of contingent consideration liabilities 592 (16)
Stock-based compensation expense 25,889 23,960
Equity in earnings of unconsolidated affiliate (2,379) (2,350)
Distribution of earnings from unconsolidated affiliate 2,625 2,062
Deferred income taxes 16,276 2,870
Changes in assets and liabilities:    
Accounts receivable (24,812) (17,623)
Prepaid expenses and other current assets (1,121) (4,480)
Other long-term assets 10,279 5,744
Accounts payable and accrued expenses (32,628) (52,734)
Income taxes payable 8,930 15,954
Payments of contingent consideration liabilities (735) (1,045)
Long-term professional liabilities 3,453 2,814
Other liabilities (8,143) (1,183)
Net cash provided from operating activities 312,830 264,565
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (724,861) (806,304)
Purchases of investments (50,868) (20,382)
Proceeds from maturities of investments 32,240 23,208
Purchases of property and equipment (28,420) (19,908)
Net cash used in investing activities (771,909) (823,386)
Cash flows from financing activities:    
Borrowings on credit agreement 1,661,000 1,846,500
Payments on credit agreement (1,148,000) (1,056,500)
Payments for credit facility amendment   (1,227)
Payments of contingent consideration liabilities (8,282) (9,040)
Payments on capital lease obligations (1,601) (1,063)
Excess tax benefit from vesting of restricted stock and exercises from stock options 3,424 11,467
Proceeds from issuance of common stock 15,599 16,722
Repurchases of common stock (61,828) (235,051)
Net cash provided from financing activities 460,312 571,808
Net increase in cash and cash equivalents 1,233 12,987
Cash and cash equivalents at beginning of period 51,572 47,928
Cash and cash equivalents at end of period $ 52,805 $ 60,915