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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Cash flows from operating activities:      
Net income $ 110,141 $ 75,789 $ 28,707
Adjustments to reconcile net income to net cash from operating activities:      
Depreciation and amortization 115,706 106,046 102,844
Non-cash impairment of intangible assets   4,800  
Non-cash interest expense 4,757 565 399
Non-cash stock compensation expense 39,116 37,422 50,384
Non-cash income tax (benefit) provision (30,981) 4,710 (26,999)
Non-cash amortization on investments 3,924 5,238 7,118
Changes in assets and liabilities, net of effects from acquisitions of businesses:      
Accounts receivable, net (40,910) (134,089) (52,394)
Pharmaceutical inventory 17,605 (8,246) (11,374)
Other assets (4,565) (13,900) 4,149
Accounts payable and accrued liabilities (84,445) 52,470 (36,043)
Medical claims payable and other medical liabilities 26,235 (8,042) 36,187
Contingent consideration 696 (51,205) 55,035
Tax contingencies 1,681 673 (1,021)
Deferred credits and other long-term liabilities 3,218 (5,584) 294
Other 95 52 171
Net cash provided by operating activities 162,273 66,699 157,457
Cash flows from investing activities:      
Capital expenditures (57,232) (60,881) (71,584)
Acquisitions and investments in businesses, net of cash acquired (232,403) (199,237) (55,818)
Purchase of investments (449,873) (478,477) (470,093)
Maturity of investments 423,118 494,256 404,308
Net cash provided by (used in) investing activities (316,390) (244,339) (193,187)
Cash flows from financing activities:      
Proceeds from issuance of debt 1,041,736 375,000  
Payments to acquire treasury stock (21,765) (106,806) (206,044)
Proceeds from exercise of stock options and warrants 44,355 25,145 53,493
Payments on debt and capital lease obligations (803,393) (20,891) (17,038)
Payments on contingent consideration (3,032) (40,559) (20,762)
Tax benefit from exercise of stock options and vesting of stock awards     4,073
Other (9,560) 1,230 409
Net cash (used in) provided by financing activities 248,341 233,119 (185,869)
Net (decrease) increase in cash and cash equivalents 94,224 55,479 (221,599)
Cash and cash equivalents at beginning of period 304,508 249,029 470,628
Cash and cash equivalents at end of period $ 398,732 $ 304,508 $ 249,029