| Dec'17 | Dec'16 | Dec'15 | Dec'14 | Dec'13 | Dec'12 | Dec'11 | Dec'10 | Dec'09 | Dec'08 |
|---|---|---|---|---|---|---|---|---|---|
Cash flows from operating activities: | |||||||||
Net income | |||||||||
112,900 | 131,800 | 193,000 | 134,900 | 132,600 | 155,600 | 165,700 | 158,600 | 136,600 | 105,200 |
Adjustments to reconcile net income to net cash provided by operating activities: | |||||||||
Income from discontinued operations | |||||||||
- | - | - | - | 400 | - | -200 | 100 | 5,100 | -23,700 |
Stock-based compensation | |||||||||
25,400 | 29,400 | 30,000 | 27,300 | 25,400 | 27,400 | 24,000 | 22,400 | 22,300 | 23,400 |
ESOP expense (non-cash portion) | |||||||||
- | - | - | - | - | - | - | - | - | 7,600 |
Depreciation and amortization | |||||||||
350,600 | 344,600 | 279,000 | 250,500 | 228,200 | 193,100 | 165,800 | 148,500 | 143,000 | 132,100 |
Other non-cash amortization | |||||||||
11,900 | 15,300 | 17,100 | - | - | - | - | - | - | - |
Amortization of physician minimum revenue guarantees | |||||||||
- | - | - | 14,700 | 17,200 | 19,600 | 19,800 | 17,100 | 13,600 | 9,300 |
Amortization of debt issuance costs, discounts and premium | |||||||||
- | - | - | 14,000 | 26,900 | 31,400 | 30,200 | - | - | - |
Other non-operating losses (gains), net | |||||||||
-9,100 | -23,200 | -9,800 | - | - | - | - | - | - | - |
Amortization of debt discounts | |||||||||
- | - | - | - | - | - | - | 22,600 | 21,100 | 19,700 |
Amortization of deferred loan costs | |||||||||
- | - | - | - | - | - | - | 7,100 | 8,300 | 7,300 |
Debt transaction costs | |||||||||
- | - | - | - | - | 4,400 | - | - | - | - |
Debt extinguishment costs | |||||||||
- | - | - | - | - | - | - | -2,400 | - | - |
Impairment charges | |||||||||
- | - | - | 57,700 | - | 4,000 | - | - | - | - |
Other non-operating gain | |||||||||
- | - | - | - | -300 | - | - | - | - | - |
Deferred income taxes | |||||||||
-17,300 | -44,700 | -14,400 | 22,800 | -20,400 | -24,200 | 23,100 | -29,000 | -7,200 | -4,500 |
Reserve for self-insurance claims, net of payments | |||||||||
-34,500 | 25,400 | 17,900 | 11,700 | 3,300 | 1,600 | 18,000 | 10,300 | 16,800 | 17,600 |
Increase (decrease) in cash from operating assets and liabilities, net of effects from acquisitions and divestitures: | |||||||||
Accounts receivable | |||||||||
-75,500 | 123,700 | -38,700 | 54,300 | 27,000 | 43,300 | 29,500 | 39,100 | 3,500 | 11,200 |
Inventories, prepaid expenses and other current assets | |||||||||
31,900 | 24,800 | -19,900 | 18,600 | 17,100 | 9,700 | 20,100 | 5,400 | 6,900 | 2,000 |
Accounts payable, accrued salaries and other current liabilities | |||||||||
33,700 | 45,700 | -24,700 | -14,400 | -16,300 | 19,500 | 2,900 | 13,200 | -10,700 | -11,100 |
Income taxes payable/receivable | |||||||||
-55,500 | 18,900 | 61,900 | -35,500 | 1,800 | 2,300 | 3,900 | 48,800 | 9,900 | 26,200 |
Other | |||||||||
8,300 | 5,900 | 1,100 | -1,500 | 400 | -1,200 | 2,400 | 1,900 | -1,900 | 3,300 |
Net cash provided by operating activities | |||||||||
- | - | - | 412,300 | 354,100 | 382,900 | 401,200 | 375,700 | 350,300 | 346,600 |
Net cash used in operating activities-discontinued operations | |||||||||
- | - | - | - | -100 | -700 | 300 | -1,600 | -400 | -12,500 |
Net cash provided by operating activities | |||||||||
471,600 | 435,200 | 627,100 | - | 354,000 | 382,200 | 401,500 | 374,100 | 349,900 | 334,100 |
Cash flows from investing activities: | |||||||||
Purchases of property and equipment | |||||||||
474,200 | 399,500 | 274,700 | 207,100 | 185,200 | 221,400 | 219,900 | 168,700 | 166,600 | 157,600 |
Acquisitions, net of cash acquired | |||||||||
5,800 | 121,100 | 619,400 | 265,600 | 188,100 | 199,700 | 121,000 | 184,900 | 81,400 | 21,800 |
Proceeds from sale of businesses | |||||||||
110,000 | - | 18,800 | - | - | - | - | - | - | - |
Other | |||||||||
-500 | 100 | 1,000 | 500 | -1,000 | 1,000 | 1,200 | - | -3,900 | 5,900 |
Net cash used in investing activities | |||||||||
- | - | - | -473,200 | -372,300 | - | - | - | -244,100 | -185,300 |
Net cash provided by investing activities-discontinued operations | |||||||||
- | - | - | - | - | - | - | - | 19,600 | -5,800 |
Net cash used in investing activities | |||||||||
-369,500 | -520,700 | -876,300 | - | - | -422,100 | -342,100 | -353,600 | -224,500 | -191,100 |
Cash flows from financing activities: | |||||||||
Proceeds from borrowings | |||||||||
205,000 | 1,350,000 | 500,000 | 412,000 | 1,053,000 | 555,000 | - | 400,000 | - | 10,400 |
Payments of borrowings | |||||||||
222,500 | 1,186,300 | 16,900 | 585,400 | 453,700 | 469,300 | 100 | 255,200 | 13,500 | 10,100 |
Repurchases of common stock | |||||||||
76,100 | 233,100 | 134,500 | 222,300 | 39,100 | 95,500 | 174,600 | 152,100 | 3,100 | 118,300 |
Proceeds from (refunds of) employee stock purchase plans | |||||||||
- | - | - | - | - | - | - | 1,000 | 1,000 | 800 |
Distributions to noncontrolling interests and redeemable noncontrolling interests | |||||||||
- | - | - | - | - | - | - | 2,400 | 4,200 | 3,300 |
Payment of debt financing costs | |||||||||
500 | 30,000 | 7,200 | 7,200 | 20,000 | 10,000 | 400 | 13,700 | - | 0 |
Proceeds from exercise of stock options | |||||||||
16,100 | 12,100 | 11,500 | 23,900 | 39,200 | 21,800 | 39,000 | 20,400 | 10,800 | 3,600 |
Sales of redeemable noncontrolling interests | |||||||||
- | - | - | - | - | - | - | 3,100 | -800 | 2,200 |
Other | |||||||||
-8,200 | -15,100 | -11,200 | -6,500 | -8,200 | -3,300 | -4,500 | -1,400 | -4,100 | -4,600 |
Net cash (used in) provided by financing activities | |||||||||
- | - | - | -385,500 | 571,200 | - | - | - | - | -119,300 |
Net cash used in financing activities - discontinued operations | |||||||||
- | - | - | - | - | - | - | - | - | -1,100 |
Net cash used in financing activities | |||||||||
-86,200 | -102,400 | 341,700 | - | - | -1,300 | -140,600 | -300 | -13,900 | -120,400 |
Change in cash and cash equivalents | |||||||||
15,900 | -187,900 | 92,500 | -446,400 | 552,900 | -41,200 | -81,200 | 20,200 | 111,500 | 22,600 |
Supplemental disclosure of cash flow information: | |||||||||
Interest payments | |||||||||
139,100 | 138,800 | 103,200 | 112,800 | 68,600 | 70,000 | 79,200 | 71,000 | 76,100 | 82,600 |
Capitalized interest | |||||||||
8,200 | 5,100 | 2,200 | 1,000 | 1,400 | 2,300 | 2,000 | 800 | 1,100 | 900 |
Income tax payments, net of refunds | |||||||||
119,700 | 98,600 | 62,000 | 80,900 | 98,200 | 110,500 | 71,000 | 62,500 | 75,400 | 59,200 |