| 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 | |||||||||||
55,902 | 24,181 | 110,141 | 75,789 | 28,707 | 74,231 | 125,261 | 151,027 | 129,623 | 138,659 | 106,671 | 86,205 |
Adjustments to reconcile net income to net cash from operating activities: | |||||||||||
Depreciation and amortization | |||||||||||
131,509 | 132,660 | 115,706 | 106,046 | 102,844 | 91,070 | 71,994 | 60,488 | 58,623 | 54,682 | 47,268 | 60,810 |
Non-cash impairment of intangible assets | |||||||||||
- | - | - | 4,800 | - | - | - | - | - | - | - | - |
Non-cash interest expense | |||||||||||
1,537 | 1,221 | 4,757 | 565 | 399 | 3,987 | 736 | 728 | 1,033 | 569 | 899 | 1,423 |
Non-cash stock compensation expense | |||||||||||
25,501 | 29,472 | 39,116 | 37,422 | 50,384 | 40,584 | 21,252 | 17,783 | 17,418 | 15,102 | 19,782 | 32,763 |
Non-cash income tax (benefit) provision | |||||||||||
7,052 | -1,725 | -30,981 | 4,710 | -26,999 | -4,291 | -1,212 | 17,306 | 8,285 | 42,251 | 30,033 | 42,241 |
Non-cash amortization on investments | |||||||||||
433 | -1,344 | -3,924 | -5,238 | -7,118 | -5,050 | -9,107 | -7,193 | -12,309 | -10,155 | -4,161 | - |
Changes in assets and liabilities, net of effects from acquisitions of businesses: | |||||||||||
Restricted cash | |||||||||||
- | - | - | - | - | - | 2,242 | 40,760 | 69,060 | -42,925 | -32,736 | -60,368 |
Accounts receivable, net | |||||||||||
133,999 | 99,295 | 40,910 | 134,089 | 52,394 | 74,604 | 40,804 | 16,411 | 15,609 | -3,262 | 3,328 | 15,720 |
Pharmaceutical inventory | |||||||||||
4,144 | -127 | -17,605 | 8,246 | 11,374 | -10,234 | 3,882 | 6,160 | 11,657 | 2,347 | 7,577 | - |
Other assets | |||||||||||
-19,492 | 25,774 | 4,565 | 13,900 | -4,149 | 7,557 | 9,293 | -414 | -3,804 | 14,847 | 1,359 | 9,290 |
Accounts payable and accrued liabilities | |||||||||||
56,843 | 9,139 | -84,445 | 52,470 | -36,043 | 5,887 | 3,593 | -8,321 | -7,251 | 14,447 | -2,908 | 11,519 |
Medical claims payable and other medical liabilities | |||||||||||
-28,969 | 72,347 | 26,235 | -8,042 | 36,187 | 55,670 | 17,866 | 31,292 | -7,905 | 3,638 | -7,495 | -426 |
Contingent consideration | |||||||||||
-3,877 | 1,307 | 696 | -51,205 | 55,035 | - | - | - | - | - | - | - |
Tax contingencies | |||||||||||
-1,352 | 1,803 | 1,681 | 673 | -1,021 | -14,955 | -22,960 | -35,376 | -9,453 | - | - | - |
Deferred credits and other long-term liabilities | |||||||||||
-10,668 | 18,020 | 3,218 | -5,584 | 294 | 4,045 | 10,988 | 1,901 | 1,558 | - | - | - |
Other | |||||||||||
-1,452 | -17 | -95 | -52 | -171 | -322 | -2,757 | -189 | -285 | -445 | 310 | 1,589 |
Net cash provided by operating activities | |||||||||||
115,846 | 164,844 | 162,273 | 66,699 | 157,457 | 189,673 | 183,161 | 181,293 | 112,003 | 308,941 | 218,573 | 268,304 |
Cash flows from investing activities: | |||||||||||
Capital expenditures | |||||||||||
60,402 | 68,275 | 57,232 | 60,881 | 71,584 | 62,337 | 64,542 | 69,549 | 54,394 | 46,162 | 33,220 | 36,314 |
Acquisitions and investments in businesses, net of cash acquired | |||||||||||
727 | 958 | 232,403 | 199,237 | 55,818 | 128,277 | 107,541 | - | 376 | - | 115,438 | 25,425 |
Purchases of investments | |||||||||||
514,324 | 557,232 | 449,873 | 478,477 | 470,093 | 340,961 | 323,253 | 321,541 | 259,552 | 291,289 | 299,357 | 404,420 |
Proceeds from maturities and sales of investments | |||||||||||
555,960 | 498,032 | 423,118 | 494,256 | 404,308 | 276,446 | 339,428 | 281,748 | 330,583 | 226,957 | 298,556 | 228,392 |
Other | |||||||||||
- | - | - | - | - | - | - | 1,225 | - | - | - | - |
Net cash used in investing activities | |||||||||||
-19,493 | -128,433 | -316,390 | -244,339 | -193,187 | -255,129 | -155,908 | -110,567 | 16,261 | -110,494 | -149,459 | -237,767 |
Cash flows from financing activities: | |||||||||||
Proceeds from issuance of debt | |||||||||||
- | - | 1,041,736 | 375,000 | - | 250,000 | - | - | - | - | - | - |
Payments to acquire treasury stock | |||||||||||
4,125 | 62,640 | 21,765 | 106,806 | 206,044 | 197,533 | 60,677 | 21,868 | 407,645 | 149,805 | 89,667 | 136,153 |
Proceeds from exercise of stock options | |||||||||||
32,708 | 23,064 | 44,355 | 25,145 | 53,493 | 52,994 | 47,529 | 20,486 | 41,796 | 92,876 | 2,580 | 12,896 |
Payments on debt, finance lease and deferred financing obligations | |||||||||||
67,511 | 122,239 | 803,393 | 20,891 | 17,038 | 8,045 | 3,001 | - | 559 | 1,120 | 3 | 13,981 |
Payments on contingent consideration | |||||||||||
6,247 | - | 3,032 | 40,559 | 20,762 | - | - | - | - | - | - | - |
Tax benefit from exercise of stock options and vesting of stock awards | |||||||||||
- | - | - | - | 4,073 | 3,218 | 3,212 | 990 | 2,038 | 1,121 | 2,917 | 7,549 |
Other | |||||||||||
1,763 | -1,020 | -9,560 | 1,230 | 409 | -4,433 | -593 | -732 | -1,211 | -847 | -259 | -1,395 |
Proceeds from issuance of equity | |||||||||||
- | - | - | - | - | - | - | - | 20,000 | - | - | - |
Net cash (used in) provided by financing activities | |||||||||||
-43,412 | -162,835 | 248,341 | 233,119 | -185,869 | 96,201 | -13,530 | -1,124 | -345,581 | -57,775 | -84,432 | -131,084 |
Net (decrease) increase in cash and cash equivalents | |||||||||||
52,941 | -126,424 | 94,224 | 55,479 | -221,599 | 30,745 | 13,723 | 69,602 | -217,317 | 140,672 | -15,318 | -100,547 |
Supplemental Cash Flow Information [Abstract] | |||||||||||
Non-cash investing activities: | |||||||||||
Assets acquired under finance leases and deferred financing obligations | |||||||||||
3,302 | 20,576 | 2,418 | - | - | - | - | - | - | - | - | - |