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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2015
Dec. 31, 2014
Dec. 31, 2013
Cash flows from operating activities:      
Net income $ 28,707 $ 74,231 $ 125,261
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 102,844 91,070 71,994
Non-cash interest expense 399 3,987 736
Non-cash stock compensation expense 50,384 40,584 21,252
Non-cash income tax benefit (26,999) (4,291) (1,212)
Non-cash amortization on investments 7,118 5,050 9,107
Cash flows from changes in assets and liabilities, net of effects from acquisitions of businesses:      
Restricted cash 81,728 21,371 (2,242)
Accounts receivable, net (52,394) (74,604) (40,804)
Pharmaceutical inventory (11,374) 10,234 (3,882)
Other assets 4,149 (7,557) (9,293)
Accounts payable and accrued liabilities (36,043) 5,887 3,593
Medical claims payable and other medical liabilities 36,187 55,670 17,866
Contingent consideration 55,035    
Tax contingencies (1,021) (14,955) (22,960)
Deferred credits and other long-term liabilities 294 4,045 10,988
Other 171 322 2,757
Net cash provided by operating activities 239,185 211,044 183,161
Cash flows from investing activities:      
Capital expenditures (71,584) (62,337) (64,542)
Acquisitions and investments in businesses, net of cash acquired (55,818) (128,277) (107,541)
Purchase of investments (470,093) (340,961) (323,253)
Maturity of investments 404,308 276,446 339,428
Net cash used in investing activities (193,187) (255,129) (155,908)
Cash flows from financing activities:      
Proceeds from issuance of debt   250,000  
Payments to acquire treasury stock (206,044) (197,533) (60,677)
Proceeds from exercise of stock options and warrants 53,493 52,994 47,529
Payments on long-term debt and capital lease obligations (17,038) (8,045) (3,001)
Payments on contingent consideration (20,762)    
Tax benefit from exercise of stock options and vesting of stock awards 4,073 3,218 3,212
Other 409 (4,433) (593)
Net cash (used in) provided by financing activities (185,869) 96,201 (13,530)
Net increase (decrease) in cash and cash equivalents (139,871) 52,116 13,723
Cash and cash equivalents at beginning of period 255,303 203,187 189,464
Cash and cash equivalents at end of period $ 115,432 $ 255,303 $ 203,187