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Condensed Consolidated Statements of Cash Flows (Unaudited) (USD $)
In Thousands, unless otherwise specified
9 Months Ended
Sep. 30, 2013
Sep. 30, 2012
Cash flows from operating activities    
Net income $ 165,006 $ 260,177
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 582,604 536,362
Government settlement and related costs reserve 98,000  
Stock-based compensation expense 28,943 30,708
Loss from early extinguishment of debt 1,295 115,453
Excess tax benefit relating to stock-based compensation (6,573) (1,545)
Other non-cash expenses, net 48,387 22,482
Changes in operating assets and liabilities, net of effects of acquisitions and divestitures:    
Patient accounts receivable (231,134) (227,814)
Supplies, prepaid expenses and other current assets (60,062) (68,247)
Accounts payable, accrued liabilities and income taxes (205,913) 103,156
Other 20,547 7,133
Net cash provided by operating activities 441,100 777,865
Cash flows from investing activities    
Acquisitions of facilities and other related equipment (33,935) (312,927)
Purchases of property and equipment (420,917) (557,469)
Proceeds from sale of property and equipment 4,185 4,808
Increase in other investments (234,099) (222,164)
Net cash used in investing activities (684,766) (1,087,752)
Cash flows from financing activities    
Proceeds from exercise of stock options 108,546 5,750
Repurchase of restricted stock shares for payroll tax withholding requirements (14,696) (9,165)
Stock buy-back (27,133)  
Deferred financing costs (12,960) (135,647)
Excess tax benefit relating to stock-based compensation 6,573 1,545
Proceeds from noncontrolling investors in joint ventures 64 535
Redemption of noncontrolling investments in joint ventures (5,720) (39,709)
Distributions to noncontrolling investors in joint ventures (60,282) (60,676)
Borrowings under credit agreements 813,732 3,974,399
Issuance of long-term debt   3,825,000
Proceeds from receivables facility 320,000 300,000
Repayments of long-term indebtedness (1,128,666) (7,441,360)
Net cash (used in) provided by financing activities (542) 420,672
Net change in cash and cash equivalents (244,208) 110,785
Cash and cash equivalents at beginning of period 387,813 129,865
Cash and cash equivalents at end of period 143,605 240,650
Supplemental disclosure of cash flow information:    
Interest payments 446,124 461,604
Income tax paid (refunds received), net $ 72,482 $ 55,404