Condensed Consolidated Statements of Cash Flows (unaudited) - USD ($) $ in Thousands	9 Months Ended
Sep. 30, 2019	Sep. 30, 2018
Operating activities
Net income	$ 157,360	$ 147,220
Adjustments to reconcile net income to net cash provided by operating activities:
Distributions from unconsolidated subsidiaries	13,609	10,734
Depreciation and amortization	160,072	149,022
Provision for bad debts	2,344	(373)
Equity in earnings of unconsolidated subsidiaries	(18,710)	(14,914)
Loss on extinguishment of debt	10,160	484
Gain on sale of assets and businesses	(6,349)	(9,129)
Stock compensation expense	19,431	17,175
Amortization of debt discount, premium and issuance costs	9,469	9,845
Deferred income taxes	(7,247)	(2,092)
Changes in operating assets and liabilities, net of effects of business combinations:
Accounts receivable	(93,425)	23,495
Other current assets	(6,016)	(10,274)
Other assets	1,259	4,828
Accounts payable	1,369	(3,507)
Accrued expenses	22,396	49,391
Income taxes	918	9,072
Net cash provided by operating activities	266,640	380,977
Investing activities
Business combinations, net of cash acquired	(86,269)	(519,258)
Purchases of property and equipment	(123,956)	(121,039)
Investment in businesses	(60,668)	(12,936)
Proceeds from sale of assets and businesses	183	6,691
Net cash used in investing activities	(270,710)	(646,542)
Financing activities
Borrowings on revolving facilities	700,000	420,000
Payments on revolving facilities	(720,000)	(585,000)
Proceeds from term loans	593,683	779,904
Payments on term loans	(375,084)	(8,625)
Proceeds from 6.250% senior notes	539,176	0
Payment on 6.375% senior notes	710,000	0
Revolving facility debt issuance costs	(310)	(1,333)
Borrowings of other debt	19,282	30,134
Principal payments on other debt	(22,628)	(17,971)
Repurchase of common stock	(37,309)	(5,640)
Proceeds from exercise of stock options	872	1,633
Decrease in overdrafts	(25,083)	(6,172)
Proceeds from issuance of non-controlling interests	18,288	2,926
Distributions to and purchases of non-controlling interests	(16,032)	(306,427)
Net cash provided by (used in) financing activities	(35,145)	303,429
Net increase (decrease) in cash and cash equivalents	(39,215)	37,864
Cash and cash equivalents at beginning of period	175,178	122,549
Cash and cash equivalents at end of period	135,963	160,413
Supplemental Information
Cash paid for interest	149,090	134,378
Cash paid for taxes	58,472	40,460
Non-cash equity exchange for acquisition of U.S. HealthWorks	$ 0	$ 238,000

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Amount of cash inflow from a noncontrolling interest. Includes, but is not limited to, purchase of additional shares or other increase in noncontrolling interest ownership.

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Amount of cash inflow from debt classified as other.

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Aggregate cash proceeds received from a combination of transactions in which noncurrent assets are sold, which may include the sale of a business, an investment in an affiliate (including an equity method investee), property, plant and equipment and intangible assets. Excludes sales of trading, available-for-sale, and held-to-maturity securities.

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Amount of cash inflow from exercise of stock options granted under share-based compensation arrangement.

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The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

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Amount of expense related to write-down of receivables to the amount expected to be collected. Includes, but is not limited to, accounts receivable and notes receivable.

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Write-off of amounts previously capitalized as debt issuance cost in an extinguishment of debt.

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