Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
Mar. 31, 2019	Mar. 31, 2018
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income	$ 49,340	$ 37,777
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	35,523	38,089
Amortization of debt issuance costs and other non-cash interest	857	891
Deferred income taxes	1,140	837
Non-cash revenue and other income	(2,937)	(4,318)
Non-cash equity compensation	3,812	3,486
Other expenses and non-cash items	3,423	1,939
Changes in assets and liabilities, net:
Accounts receivable, prepaid expenses and other assets	(2,564)	41,249
Accounts payable, accrued expenses and other liabilities	(11,921)	(12,394)
Income taxes payable	1,150	923
Net cash provided by operating activities	77,823	108,479
CASH FLOWS FROM INVESTING ACTIVITIES:
Expenditures for facility development and expansions	(36,037)	(3,447)
Expenditures for other capital improvements	(9,972)	(17,285)
Acquisitions, net of cash acquired	(30,931)	(48,461)
Proceeds from sale of assets	331	48
Increase in other assets	(1,391)	(705)
Net cash used in investing activities	(78,000)	(69,850)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of debt and borrowings from credit facility	197,141	89,500
Scheduled principal repayments	(2,876)	(2,691)
Other principal repayments of debt	(153,000)	(66,000)
Payment of debt issuance and other refinancing and related costs	(85)	(844)
Payment of lease obligations for financing leases	(134)	(746)
Contingent consideration for acquisition of businesses	(6,378)
Dividends paid	(52,365)	(51,106)
Purchase and retirement of common stock	(3,070)	(2,525)
Proceeds from exercise of stock options	207
Net cash used in financing activities	(20,560)	(34,412)
NET INCREASE (DECREASE) IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH	(20,737)	4,217
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, beginning of period	74,137	52,183
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, end of period	53,400	56,400
NON-CASH INVESTING AND FINANCING ACTIVITIES
Establishment of right of use assets and lease liabilities	82,917
Cash paid during the period for:
Interest (net of amounts capitalized of $924 and $0 in 2019 and 2018, respectively)	$ 18,522	3,278
Income taxes paid		$ 105

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