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CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $)
In Thousands, unless otherwise specified
9 Months Ended
Sep. 30, 2013
Sep. 30, 2012
Cash flows from operating activities:    
Net income $ 732,107 $ 526,526
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 210,983 215,300
Provision for doubtful accounts 204,101 208,360
Deferred income tax (benefit) provision (3,098) 139
Stock-based compensation expense 24,107 43,087
Excess tax benefits from stock-based compensation arrangements (3,566) (3,810)
Gain on sale of royalty rights (474,138) 0
Loss on sale of businesses, net 17,400 0
Other, net (668) (5,350)
Changes in operating assets and liabilities:    
Accounts receivable (252,441) (231,375)
Accounts payable and accrued expenses (76,798) (56,134)
Income taxes payable 76,967 32,311
Termination of interest rate swap agreements 0 71,820
Other assets and liabilities, net (13,308) 5,881
Net cash provided by operating activities 441,648 806,755
Cash flows from investing activities:    
Business acquisitions, net of cash acquired (179,895) (50,574)
Proceeds from sale of businesses 296,333 0
Proceeds from sale of royalty rights 474,279 0
Capital expenditures (155,467) (122,318)
Increase in investments and other assets (1,610) (2,098)
Net cash provided by (used in) investing activities 433,640 (174,990)
Cash flows from financing activities:    
Proceeds from borrowings 789,623 715,000
Repayments of debt (757,234) (1,222,036)
Purchases of treasury stock (994,102) (149,996)
Exercise of stock options 98,057 143,945
Excess tax benefits from stock-based compensation arrangements 3,566 3,810
Dividends paid (141,001) (81,034)
Distributions to noncontrolling interests (21,381) (24,112)
Other financing activities, net (7,356) 9,542
Net cash used in financing activities (1,029,828) (604,881)
Net change in cash and cash equivalents (154,540) 26,884
Add: Decrease in cash and cash equivalents included in assets held for sale 17,234 0
Cash and cash equivalents, beginning of period 295,586 164,886
Cash and cash equivalents, end of period $ 158,280 $ 191,770