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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2016
Dec. 31, 2015
Dec. 31, 2014
Cash flows from operating activities:      
Net income $ 75,789 $ 28,707 $ 74,231
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 106,046 102,844 91,070
Non-cash impairment of intangible assets 4,800    
Non-cash interest expense 565 399 3,987
Non-cash stock compensation expense 37,422 50,384 40,584
Non-cash income tax (benefit) provision 4,710 (26,999) (4,291)
Non-cash amortization on investments 5,238 7,118 5,050
Cash flows from changes in assets and liabilities, net of effects from acquisitions of businesses:      
Accounts receivable, net (134,089) (52,394) (74,604)
Pharmaceutical inventory (8,246) (11,374) 10,234
Other assets (13,900) 4,149 (7,557)
Accounts payable and accrued liabilities 52,470 (36,043) 5,887
Medical claims payable and other medical liabilities (8,042) 36,187 55,670
Contingent consideration (51,205) 55,035  
Tax contingencies 673 (1,021) (14,955)
Deferred credits and other long-term liabilities (5,584) 294 4,045
Other 52 171 322
Net cash provided by operating activities 66,699 157,457 189,673
Cash flows from investing activities:      
Capital expenditures (60,881) (71,584) (62,337)
Acquisitions and investments in businesses, net of cash acquired (199,237) (55,818) (128,277)
Purchase of investments (478,477) (470,093) (340,961)
Maturity of investments 494,256 404,308 276,446
Net cash used in investing activities (244,339) (193,187) (255,129)
Cash flows from financing activities:      
Proceeds from issuance of debt 375,000   250,000
Payments to acquire treasury stock (106,806) (206,044) (197,533)
Proceeds from exercise of stock options and warrants 25,145 53,493 52,994
Payments on long-term debt and capital lease obligations (20,891) (17,038) (8,045)
Payments on contingent consideration (40,559) (20,762)  
Tax benefit from exercise of stock options and vesting of stock awards   4,073 3,218
Other 1,230 409 (4,433)
Net cash provided by (used in) financing activities 233,119 (185,869) 96,201
Net increase (decrease) in cash and cash equivalents 55,479 (221,599) 30,745
Cash and cash equivalents at beginning of period 249,029 470,628 439,883
Cash and cash equivalents at end of period $ 304,508 $ 249,029 $ 470,628