| Dec'19 | Dec'18 | 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 (loss) | |||||||||||
-1,497,702 | 268,629 | 320,372 | 324,596 | 335,691 | 317,203 | 280,517 | 240,907 | 217,997 | 202,691 | 175,804 | 169,201 |
Loss from discontinued operations | |||||||||||
-347,608 | 10,018 | 14,930 | - | - | - | - | - | - | - | - | - |
Adjustments to reconcile net income to net cash from operating activities: | |||||||||||
Depreciation and amortization | |||||||||||
78,860 | 83,832 | 78,856 | 89,264 | 64,228 | 45,990 | 39,966 | 30,816 | 25,292 | 21,950 | 16,448 | 13,210 |
Goodwill impairment | |||||||||||
1,449,215 | 0 | 0 | - | - | - | - | - | - | - | - | - |
Amortization of premiums, discounts and issuance costs | |||||||||||
5,672 | 4,572 | 5,514 | 4,816 | 1,541 | 1,230 | - | - | - | - | - | - |
Net change in fair value of contingent consideration liabilities | |||||||||||
- | - | - | - | - | -417 | 3,656 | 995 | 1,083 | 967 | 268 | - |
Stock-based compensation expense | |||||||||||
35,351 | 37,910 | 28,778 | 34,000 | 32,129 | 31,719 | 31,288 | 28,437 | 27,092 | 25,693 | 24,320 | 20,776 |
Equity in earnings of unconsolidated affiliate | |||||||||||
- | - | - | - | - | 1,780 | - | - | - | - | - | - |
Deferred income taxes | |||||||||||
-177,000 | -25,647 | -61,233 | 18,149 | 14,494 | 2,559 | 15,920 | 21,344 | 8,063 | 24,375 | 7,447 | -13,649 |
Other | |||||||||||
-389 | 10,903 | 3,782 | -212 | 1,052 | - | - | - | - | - | - | - |
Gain on sale of discontinued operating unit | |||||||||||
- | - | - | - | - | - | - | - | - | - | - | 38,537 |
Changes in assets and liabilities: | |||||||||||
Accounts receivable | |||||||||||
-7,854 | 43,408 | -10,784 | 34,000 | 55,391 | 57,018 | 37,331 | 17,678 | 48,993 | 16,951 | 2,049 | 16,929 |
Prepaid expenses and other current assets | |||||||||||
9,998 | 6,074 | 3,015 | 783 | 4,905 | -1,506 | -212 | 244 | 3,433 | -3,882 | 1,188 | 3,052 |
Other long-term assets | |||||||||||
-37,989 | -68 | 2,950 | -10,035 | -98 | -907 | 3,541 | -1,153 | -3,932 | 3,601 | 1,669 | -1,358 |
Accounts payable and accrued expenses | |||||||||||
104,161 | 45,943 | 34,882 | 11,617 | -7,874 | 66,039 | 49,239 | 16,953 | 21,480 | -38,918 | 25,421 | 58,940 |
Income taxes payable | |||||||||||
-24,119 | -61,256 | 73,050 | -2,234 | -4,101 | 6,998 | 5,772 | -7,343 | 6,704 | 18,706 | -18,884 | -4,702 |
Payments of contingent consideration liabilities | |||||||||||
1,170 | 1,093 | 750 | 1,037 | 1,439 | 4,071 | 1,308 | 786 | 350 | - | - | - |
Long-term professional liabilities | |||||||||||
9,844 | -4,490 | 18,478 | -3,452 | -2,064 | 9,284 | 19,797 | 9,941 | 9,843 | 1,915 | 14,060 | - |
Other liabilities | |||||||||||
-28,487 | -3,957 | -687 | -7,405 | -2,654 | 2,492 | 1,211 | 411 | 1,959 | -151 | 1,396 | -5,225 |
Net cash provided by operating activities - discontinued operations | |||||||||||
8,170 | 15,817 | 28,011 | - | - | - | - | - | - | - | - | - |
Net cash used in operating activities | |||||||||||
338,467 | 274,108 | 483,367 | 443,778 | 368,701 | 422,641 | 405,398 | 324,906 | 270,669 | 240,558 | 241,374 | 181,391 |
Cash flows from investing activities: | |||||||||||
Acquisition payments, net of cash acquired | |||||||||||
111,975 | 114,491 | 531,232 | 762,302 | 818,903 | 479,394 | 238,045 | 441,006 | 154,885 | 338,596 | 151,321 | 274,024 |
Purchases of investments | |||||||||||
35,101 | 15,884 | 27,723 | 60,976 | 33,980 | 26,884 | 20,802 | 33,120 | 42,526 | 26,478 | 19,601 | 26,227 |
Proceeds from maturities or sales of investments | |||||||||||
51,105 | 13,710 | 25,410 | 41,325 | 31,956 | 20,735 | 11,011 | 28,073 | 38,170 | 15,575 | 22,735 | 24,733 |
Purchases of property and equipment | |||||||||||
31,881 | 30,479 | 26,150 | 39,264 | 27,073 | 18,061 | 15,654 | 14,495 | 31,332 | 12,113 | 14,947 | 15,680 |
Proceeds from sales of businesses | |||||||||||
249,730 | 22,764 | 0 | - | - | - | - | - | - | - | - | - |
Other | |||||||||||
0 | 0 | -6,705 | - | - | - | - | - | - | - | - | - |
Net cash used in investing activities - discontinued operations | |||||||||||
-19,423 | -18,389 | -23,623 | - | - | - | - | - | - | - | - | - |
Proceeds from sale of discontinued operating unit | |||||||||||
- | - | - | - | - | - | - | - | - | - | - | 68,300 |
Net cash used in investing activities | |||||||||||
121,878 | -124,380 | -552,990 | -821,217 | -848,000 | -503,604 | -263,490 | -460,548 | -190,573 | -361,612 | -163,134 | -222,898 |
Cash flows from financing activities: | |||||||||||
Borrowings on credit agreement | |||||||||||
1,247,300 | 1,723,500 | 2,846,000 | 1,940,000 | 2,121,500 | 1,754,500 | 911,500 | 517,500 | 512,500 | 684,000 | 473,500 | 449,800 |
Payments on credit agreement | |||||||||||
1,986,800 | 2,094,500 | 2,699,000 | 1,510,000 | 2,156,000 | 1,213,500 | 1,028,500 | 402,500 | 630,000 | 587,500 | 563,000 | 310,300 |
Proceeds from issuance of senior notes | |||||||||||
500,000 | 500,000 | 0 | - | 750,000 | - | - | - | - | - | - | - |
Payments for credit facility amendment and financing costs | |||||||||||
9,194 | 7,090 | 3,525 | - | 14,190 | 4,281 | - | 2,397 | - | - | - | - |
Payments of contingent consideration liabilities | |||||||||||
10,120 | 5,263 | 5,449 | 10,740 | 12,856 | 11,740 | 10,365 | 9,445 | 6,211 | 4,405 | - | - |
Payments for amendment of line of credit | |||||||||||
- | - | - | - | - | - | - | - | 1,970 | - | - | - |
Payments on finance lease obligations | |||||||||||
234 | 1,339 | 1,659 | 2,130 | 2,171 | 159 | 99 | 136 | 463 | 262 | 316 | - |
Payments for syndication of line of credit | |||||||||||
- | - | - | - | - | - | - | - | - | - | - | 1,763 |
Payments on long-term debt and capital lease obligations | |||||||||||
- | - | - | - | - | - | - | - | - | - | - | 521 |
Excess tax benefit from exercises of stock options and vesting of restricted stock | |||||||||||
- | - | - | 4,241 | 11,583 | 17,462 | 18,579 | 6,494 | 7,031 | 3,043 | 5,774 | 4,131 |
Excess tax benefit related to resolution of income tax matters | |||||||||||
- | - | - | - | - | - | - | - | - | 3,394 | - | - |
Proceeds from issuance of common stock | |||||||||||
11,258 | 16,258 | 23,276 | 22,022 | 20,128 | 42,876 | 28,697 | 28,810 | 31,362 | 22,532 | 17,959 | 11,682 |
Contribution from noncontrolling interests | |||||||||||
0 | 0 | 894 | - | - | 1,025 | - | - | - | - | - | - |
Repurchases of common stock | |||||||||||
145,280 | 302,160 | 70,192 | 61,828 | 235,051 | 488,429 | 51,863 | - | 0 | - | - | 199,997 |
Net cash used in financing activities - discontinued operations | |||||||||||
0 | -17 | -608 | - | - | - | - | - | - | - | - | - |
Net cash (used in) provided by financing activities | |||||||||||
-393,070 | -170,594 | 90,345 | 381,565 | 482,943 | 97,754 | -132,051 | 138,326 | -87,751 | 120,802 | -66,083 | -46,968 |
Net increase in cash and cash equivalents | |||||||||||
56,022 | -23,455 | 24,502 | 4,126 | 3,644 | 16,791 | 9,857 | 2,684 | -7,655 | -252 | 12,157 | -88,475 |
Cash held by discontinued operating unit | |||||||||||
- | - | - | - | - | - | - | - | - | - | - | -22 |
Supplemental disclosure of cash flow information: | |||||||||||
Interest | |||||||||||
95,444 | 82,540 | 73,837 | 60,453 | 20,367 | 7,323 | 3,312 | 2,044 | 2,569 | 2,559 | 3,666 | 3,474 |
Income taxes | |||||||||||
86,268 | 185,416 | 75,427 | 175,962 | 181,005 | 161,841 | 126,411 | 129,636 | 119,261 | 88,601 | 113,202 | 104,172 |
Non-cash investing and financing activities: | |||||||||||
Value of common stock issued for acquisitions | |||||||||||
0 | 0 | 2,657 | - | 7,800 | - | - | - | - | - | - | - |
Equipment financed through finance leases | |||||||||||
0 | 0 | 684 | 1,619 | 3,135 | 1,244 | - | - | 751 | - | 145 | 220 |
Property and equipment included in accounts payable | |||||||||||
2,400 | 2,415 | 1,918 | 2,673 | 1,800 | - | - | - | - | - | - | - |