Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cash Flows from Operating Activities:
Net income	$ 162,375	$ 151,021
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	141,621	143,784
(Gain) loss on sale of assets and businesses	(295)	1,084
Stock-based compensation expense	20,964	19,055
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(15,723)	(15,073)
Accrued interest	(662)	180
Accrued and deferred income taxes	46,576	47,548
Other working capital accounts	(119,605)	63,308
Medicare accelerated payments and deferred CARES Act and other grants	136	250
Other assets and deferred charges	24,727	26,042
Other	7,030	(4,020)
Accrued insurance expense, net of commercial premiums paid	42,545	41,685
Payments made in settlement of self-insurance claims	(18,936)	(29,431)
Net cash provided by operating activities	290,753	445,433
Cash Flows from Investing Activities:
Property and equipment additions	(168,752)	(200,002)
Proceeds received from sales of assets and businesses	9,259	10,232
Inflows from foreign exchange contracts that hedge our net U.K. investment	(18,818)	20,710
Decrease in capital reserves of commercial insurance subsidiary	0	100
Net cash used in investing activities	(178,311)	(168,960)
Cash Flows from Financing Activities:
Repayments of long-term debt	(16,489)	(11,966)
Additional borrowings, net	11,300	117,400
Financing costs	(292)
Repurchase of common shares	(85,039)	(365,505)
Dividends paid	(14,214)	(14,875)
Issuance of common stock	2,988	3,503
Profit distributions to noncontrolling interests	(4,145)	(5,289)
Sale of ownership interests from minority members	0	(1,307)
Net cash used in financing activities	(105,891)	(278,039)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	1,650	(2,232)
Decrease in cash, cash equivalents and restricted cash	8,201	(3,798)
Cash, cash equivalents and restricted cash, beginning of period	200,837	178,934
Cash, cash equivalents and restricted cash, end of period	209,038	175,136
Supplemental Disclosures of Cash Flow Information:
Interest paid	50,279	20,388
Income taxes paid, net of refunds	2,360	4,423
Noncash purchases of property and equipment	$ 61,341	$ 90,730