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Condensed Consolidated Statements of Cash Flows (Unaudited) (USD $)
In Thousands, unless otherwise specified
6 Months Ended
Jun. 30, 2013
Jun. 30, 2012
Cash flows from operating activities    
Net income $ 143,408 $ 201,419
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 386,763 354,155
Stock-based compensation expense 19,429 20,624
Loss from early extinguishment of debt 1,295 63,429
Excess tax benefit relating to stock-based compensation (6,331) (1,037)
Other non-cash expenses, net 26,955 16,461
Changes in operating assets and liabilities, net of effects of acquisitions and divestitures:    
Patient accounts receivable (105,579) (199,383)
Supplies, prepaid expenses and other current assets 15,141 (39,920)
Accounts payable, accrued liabilities and income taxes (179,760) 51,843
Other 7,851 15,336
Net cash provided by operating activities 309,172 482,927
Cash flows from investing activities    
Acquisitions of facilities and other related equipment (10,492) (245,227)
Purchases of property and equipment (294,991) (386,461)
Proceeds from sale of property and equipment 2,056 3,437
Increase in other investments (134,389) (162,316)
Net cash used in investing activities (437,816) (790,567)
Cash flows from financing activities    
Proceeds from exercise of stock options 103,626 1,269
Repurchase of restricted stock shares for payroll tax withholding requirements (14,569) (9,074)
Stock buy-back (27,133)  
Deferred financing costs (924) (63,986)
Excess tax benefit relating to stock-based compensation 6,331 1,037
Proceeds from noncontrolling investors in joint ventures 64 637
Redemption of noncontrolling investments in joint ventures (701) (35,888)
Distributions to noncontrolling investors in joint ventures (37,937) (34,590)
Borrowings under credit agreements 296,001 3,633,589
Issuance of long-term debt   1,025,000
Proceeds from receivables facility 300,000 300,000
Repayments of long-term indebtedness (632,700) (4,525,110)
Net cash provided by (used in) financing activities (7,942) 292,884
Net change in cash and cash equivalents (136,586) (14,756)
Cash and cash equivalents at beginning of period 387,813 129,865
Cash and cash equivalents at end of period 251,227 115,109
Supplemental disclosure of cash flow information:    
Interest payments 296,193 331,161
Income tax paid (refunds received), net $ 70,379 $ 22,028