| Dec'19 | Dec'18 | Dec'17 | Dec'16 | Dec'15 | Dec'14 | Dec'13 | Dec'12 | Dec'11 | Dec'10 | Dec'09 |
|---|---|---|---|---|---|---|---|---|---|---|
Operating activities: | ||||||||||
Net income | ||||||||||
737,000 | 707,000 | -512,000 | 52,000 | 143,000 | 62,000 | 53,000 | 9,790 | 20,818 | 54,970 | 30,868 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||||
Depreciation and amortization | ||||||||||
89,000 | 127,000 | 178,000 | 182,000 | 126,000 | 134,000 | 94,000 | 78,764 | 74,383 | 60,765 | 38,110 |
Deferred income taxes | ||||||||||
-10,000 | 6,000 | 94,000 | -22,000 | 7,000 | 2,000 | 32,000 | 9,887 | -13,836 | 4,092 | 1 |
Share-based compensation | ||||||||||
39,000 | 27,000 | 46,000 | 26,000 | 23,000 | 22,000 | 29,000 | 20,018 | 17,052 | 9,531 | 7,485 |
Gain on debt repayment | ||||||||||
15,000 | -22,000 | -14,000 | 0 | 0 | - | - | - | - | - | - |
Decrease in carrying value of assets | ||||||||||
- | - | - | - | - | - | - | 30,942 | 0 | - | - |
Decrease in carrying value of liabilities | ||||||||||
- | - | - | - | - | - | - | 23,527 | 0 | - | - |
Non-cash restructuring charges | ||||||||||
0 | 17,000 | 60,000 | 0 | 0 | - | - | - | - | - | - |
Gain on purchase of convertible senior notes | ||||||||||
- | - | - | - | - | - | - | - | - | - | 1,532 |
Amortization of premium/discount on investments | ||||||||||
- | - | - | - | - | - | - | - | -7,242 | -2,029 | - |
Amortization of deferred financing costs | ||||||||||
- | - | - | - | - | - | - | - | 2,818 | 1,780 | 1,872 |
Change in fair value of derivatives | ||||||||||
- | - | - | - | - | - | - | - | 0 | 0 | - |
Change in fair value of contingent consideration liabilities | ||||||||||
- | - | - | - | - | - | - | - | 0 | - | - |
Gain on disposal of property and equipment, net | ||||||||||
- | - | - | - | - | - | - | - | 0 | 0 | - |
Unrealized gain on trading securities | ||||||||||
- | - | - | - | - | - | - | - | - | 4,170 | 3,394 |
Loss on rights agreement | ||||||||||
- | - | - | - | - | - | - | - | - | -3,807 | -3,100 |
Tax deficiency from employee stock compensation | ||||||||||
- | - | - | - | - | - | - | - | 714 | 968 | 749 |
Impairment losses | ||||||||||
0 | 0 | 470,000 | 0 | 0 | - | - | - | 64,575 | 0 | - |
Amortization of convertible senior notes and lease financing obligations | ||||||||||
5,000 | 22,000 | 32,000 | 31,000 | 30,000 | 27,000 | 23,000 | 5,942 | 5,512 | 5,114 | 4,782 |
Gain on sale of subsidiary | ||||||||||
- | - | - | - | - | - | - | 1,747 | 0 | 0 | - |
Other, net | ||||||||||
-5,000 | 4,000 | 21,000 | 16,000 | 19,000 | 7,000 | 18,000 | 11,224 | - | - | - |
Gain on acquisition | ||||||||||
- | - | - | - | - | - | - | - | 1,676 | 0 | - |
Changes in operating assets and liabilities: | ||||||||||
Receivables | ||||||||||
76,000 | 530,000 | -103,000 | 348,000 | -56,000 | 298,000 | 149,000 | -18,216 | -352 | 7,539 | 8,092 |
Prepaid expenses and other current assets | ||||||||||
-28,000 | -6,000 | 56,000 | 69,000 | 35,000 | 20,000 | 23,000 | 8,958 | -3,308 | 12,034 | -383 |
Medical claims and benefits payable | ||||||||||
-107,000 | -226,000 | 263,000 | 226,000 | 482,000 | 531,000 | 175,000 | 92,054 | 48,120 | 34,363 | 22,874 |
Amounts due government agencies | ||||||||||
-303,000 | -574,000 | 341,000 | 473,000 | 202,000 | 470,000 | 28,000 | 15,267 | - | - | - |
Accounts payable, accrued liabilities and other | ||||||||||
2,000 | 45,000 | -12,000 | -4,000 | 84,000 | 11,000 | 33,000 | 8,078 | 2,778 | 40,482 | -26,467 |
Deferred revenue | ||||||||||
38,000 | -21,000 | -34,000 | 92,000 | 24,000 | 74,000 | -20,000 | 90,851 | -8,154 | -41,899 | 88,181 |
Income taxes | ||||||||||
-15,000 | 51,000 | -16,000 | -26,000 | -22,000 | 42,000 | -39,000 | 18,172 | -24,855 | 19,258 | -2,049 |
Net cash provided by operating activities | ||||||||||
427,000 | -314,000 | 804,000 | 673,000 | 1,125,000 | 1,060,000 | 190,000 | 347,784 | 225,395 | 161,397 | 155,371 |
Investing activities: | ||||||||||
Purchases of investments | ||||||||||
2,536,000 | 1,444,000 | 2,697,000 | 1,929,000 | 1,923,000 | 953,000 | 770,000 | 306,437 | 345,968 | 302,842 | 186,764 |
Proceeds from sales and maturities of investments | ||||||||||
2,302,000 | 2,445,000 | 1,759,000 | 1,966,000 | 1,126,000 | 633,000 | 400,000 | 298,006 | 302,667 | 223,077 | 204,365 |
Purchases of property, equipment and capitalized software | ||||||||||
57,000 | 30,000 | 86,000 | 176,000 | 132,000 | 115,000 | 98,000 | 78,145 | 60,581 | 48,538 | 35,870 |
Net cash received from sale of subsidiaries | ||||||||||
0 | 190,000 | 0 | 0 | - | - | - | - | - | - | - |
Increase in restricted investments held-to-maturity | ||||||||||
- | - | - | - | 6,000 | 34,000 | 19,000 | 2,647 | 4,064 | 5,566 | -1,928 |
Net cash paid in business combinations | ||||||||||
- | - | - | 48,000 | 450,000 | 44,000 | 62,000 | 0 | 84,253 | 130,743 | 11,294 |
Other, net | ||||||||||
2,000 | 18,000 | 38,000 | 19,000 | 35,000 | 23,000 | -6,000 | 13,523 | 1,898 | -5,108 | 10,078 |
Proceeds from sale of subsidiary, net of cash surrendered | ||||||||||
- | - | - | - | - | - | - | 9,162 | 0 | 0 | - |
Change in deferred contract costs | ||||||||||
- | - | - | - | - | - | - | - | 42,830 | 29,319 | - |
Net cash (used in) provided by investing activities | ||||||||||
-293,000 | 1,143,000 | -1,062,000 | -206,000 | -1,420,000 | -536,000 | -543,000 | -93,584 | -236,927 | -288,823 | -37,713 |
Financing activities: | ||||||||||
Proceeds from borrowings under term loan facility | ||||||||||
220,000 | 0 | 0 | 0 | 0 | - | - | 60,000 | 0 | 105,000 | - |
Proceeds from common stock offering, net of issuance costs | ||||||||||
- | - | - | - | 373,000 | 0 | 0 | - | - | 111,131 | - |
Proceeds from sale-leaseback transactions | ||||||||||
- | - | - | - | - | - | 159,000 | 0 | 0 | - | - |
Purchase of call option | ||||||||||
- | - | - | - | - | - | 149,000 | 0 | 0 | - | - |
Proceeds from issuance of warrants | ||||||||||
- | - | - | - | - | - | 75,000 | 0 | 0 | - | - |
Contingent consideration liabilities settled | ||||||||||
- | - | - | - | - | 50,000 | 0 | 0 | - | - | - |
Payments for Repurchase of Common Stock | ||||||||||
47,000 | 0 | 0 | - | - | - | 53,000 | 3,000 | 7,000 | 0 | 27,712 |
Repayment of credit facility | ||||||||||
0 | 300,000 | 0 | 0 | - | - | - | - | - | - | - |
Cash paid for financing transaction fees | ||||||||||
- | - | - | - | 0 | - | - | - | - | - | - |
Proceeds from senior notes offerings, net of issuance costs | ||||||||||
0 | 0 | 325,000 | 0 | 689,000 | 123,000 | 538,000 | 0 | 0 | 0 | - |
Proceeds from borrowings under term loan facility | ||||||||||
0 | 0 | 300,000 | - | - | - | - | - | - | - | - |
Payments for Repurchase of Warrants | ||||||||||
514,000 | 549,000 | 0 | 0 | - | - | - | - | - | - | - |
Cash paid for partial settlement of conversion option | ||||||||||
578,000 | 623,000 | 0 | 0 | - | - | - | - | - | - | - |
Cash received for partial settlement of call option | ||||||||||
578,000 | 623,000 | 0 | 0 | - | - | - | - | - | - | - |
Repayment of principal amount of convertible senior notes | ||||||||||
240,000 | 362,000 | 0 | - | - | 10,000 | 0 | 0 | - | - | - |
Principal payments on term loan | ||||||||||
- | - | - | - | - | - | 48,000 | 1,129 | 0 | 0 | - |
Repayment of amount borrowed under credit facility | ||||||||||
- | - | - | - | - | - | 40,000 | 20,000 | 0 | 105,000 | - |
Proceeds from employee stock plans | ||||||||||
- | - | - | - | 18,000 | 14,000 | 9,000 | 8,205 | 7,347 | 4,056 | 2,015 |
Excess tax benefits from employee stock compensation | ||||||||||
- | - | - | - | - | - | - | - | 1,651 | 295 | 31 |
Other, net | ||||||||||
29,000 | 18,000 | 11,000 | 19,000 | 5,000 | 2,000 | 2,000 | 3,667 | - | - | - |
Amount borrowed under term loan | ||||||||||
- | - | - | - | - | - | - | - | 48,600 | - | - |
Purchase of convertible senior notes | ||||||||||
- | - | - | - | - | - | - | - | - | - | -9,653 |
Credit facility fees paid | ||||||||||
- | - | - | - | - | - | - | - | 1,125 | 1,671 | - |
Net cash used in financing activities | ||||||||||
-552,000 | -1,193,000 | 636,000 | 19,000 | 1,085,000 | 79,000 | 493,000 | 47,743 | 49,473 | 113,811 | -35,319 |
Net (decrease) increase in cash, cash equivalents, and restricted cash and cash equivalents | ||||||||||
-418,000 | -364,000 | 378,000 | 486,000 | 790,000 | 603,000 | 140,000 | 301,943 | 37,941 | -13,615 | 82,339 |
Supplemental cash flow information: | ||||||||||
Cash paid during the period for: | ||||||||||
Income taxes | ||||||||||
239,000 | 240,000 | 7,000 | 153,000 | 197,000 | 30,000 | 95,000 | -4,634 | 54,663 | 18,299 | 23,480 |
Interest | ||||||||||
78,000 | 93,000 | 78,000 | 66,000 | 38,000 | 29,000 | 35,000 | 10,099 | 11,399 | 10,951 | 8,205 |
Schedule of non-cash investing and financing activities: | ||||||||||
Common stock issued in exchange for convertible senior notes | ||||||||||
0 | 131,000 | 193,000 | 0 | 0 | 177,000 | 0 | 0 | - | - | - |
Component of convertible senior notes allocated to additional paid-in capital, net of income taxes | ||||||||||
0 | -23,000 | -32,000 | 0 | 0 | - | - | - | - | - | - |
Net increase to additional paid-in capital | ||||||||||
0 | 108,000 | 161,000 | 0 | 0 | - | - | - | - | - | - |
Retirement of treasury stock | ||||||||||
- | - | - | - | - | - | 56,000 | 0 | 7,000 | 0 | 48,102 |
Increase in non-cash lease financing obligation | ||||||||||
- | - | - | - | - | 14,000 | 27,000 | 0 | 0 | - | - |
Common stock used for share-based compensation | ||||||||||
7,000 | 6,000 | 22,000 | 8,000 | 15,000 | 9,000 | 8,000 | - | - | - | - |
Common stock purchases not settled at end of period | ||||||||||
7,000 | 0 | 0 | - | - | - | - | - | - | - | - |
Details of sales of subsidiaries: | ||||||||||
Decrease in carrying amount of assets | ||||||||||
0 | -327,000 | 0 | 0 | - | - | - | - | - | - | - |
Decrease in carrying amount of liabilities | ||||||||||
0 | 85,000 | 0 | 0 | - | - | - | - | - | - | - |
Transaction costs | ||||||||||
0 | 15,000 | 0 | 0 | - | - | - | - | - | - | - |
Cash received from buyers | ||||||||||
0 | 242,000 | 0 | 0 | - | - | - | - | - | - | - |
Gain (Loss) on Disposition of Business | ||||||||||
0 | -15,000 | 0 | 0 | - | - | - | - | - | - | - |
Common stock used for stock-based compensation | ||||||||||
- | - | - | - | - | - | - | 11,862 | 3,926 | -2,316 | - |
Fair value of assets acquired | ||||||||||
- | - | - | 186,000 | 389,000 | 52,000 | 122,000 | 0 | 81,256 | 159,916 | -34,594 |
Fair value of liabilities assumed | ||||||||||
- | - | - | 28,000 | 41,000 | 0 | 0 | - | -1,045 | 24,450 | - |
Payable to seller | ||||||||||
- | - | - | 8,000 | 0 | 8,000 | 0 | 0 | 1,952 | -4,723 | 5,300 |
Fair value of contingent consideration liabilities incurred | ||||||||||
- | - | - | - | - | - | 60,000 | 0 | 0 | - | - |
Release of deposit | ||||||||||
- | - | - | - | - | - | - | - | - | - | 18,000 |
Amounts advanced for acquisitions | ||||||||||
- | - | - | 102,000 | -102,000 | 0 | 0 | - | - | - | - |
Escrow deposit | ||||||||||
- | - | - | - | - | - | - | 0 | 0 | - | - |
Net cash paid in business combinations | ||||||||||
- | - | - | 48,000 | 450,000 | 44,000 | 62,000 | 0 | 84,253 | 130,743 | 11,294 |
Details of change in fair value of derivatives, net: | ||||||||||
Change in fair value of derivatives, net | ||||||||||
0 | 0 | 0 | 0 | 0 | 0 | -4,000 | -1,307 | 0 | - | - |
Proceeds from sale of subsidiary, net of cash surrendered | ||||||||||
- | - | - | - | - | - | - | 9,162 | 0 | - | - |
1.125% Notes | ||||||||||
Repayment of principal amount of Notes | ||||||||||
- | - | - | 0 | - | - | - | - | - | - | - |
1.625% Notes | ||||||||||
Repayment of principal amount of Notes | ||||||||||
- | - | - | 0 | - | - | - | - | - | - | - |
1.125% Call Option | ||||||||||
Change in fair value of derivatives, net | ||||||||||
132,000 | 577,000 | 255,000 | -107,000 | - | - | - | - | - | - | - |
Embedded Derivative Financial Instruments [Member] | ||||||||||
Change in fair value of derivatives, net | ||||||||||
-132,000 | -577,000 | -255,000 | 107,000 | - | - | - | - | - | - | - |