Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Cash Flows from Operating Activities:
Net income	$ 486,613	$ 753,721
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	433,508	399,850
(Gain) loss on sale of assets and businesses	584	(4,803)
Costs related to extinguishment of debt		16,831
Stock-based compensation expense	62,741	55,548
Provision for asset impairment		7,195
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(155,142)	(29,079)
Accrued interest	529	3,714
Accrued and deferred income taxes	(4,900)	(52,727)
Other working capital accounts	(173,903)	52,616
Medicare accelerated payments and deferred CARES Act and other grants	2,921	(697,393)
Other assets and deferred charges	22,219	(34,038)
Other	(23,358)	9,607
Accrued insurance expense, net of commercial premiums paid	134,908	140,702
Payments made in settlement of self-insurance claims	(88,001)	(60,069)
Net cash provided by operating activities	698,719	561,675
Cash Flows from Investing Activities:
Property and equipment additions	(569,555)	(666,025)
Proceeds received from sales of assets and businesses	12,001	21,143
Acquisition of businesses and property	(18,666)	(39,391)
Inflows from foreign exchange contracts that hedge our net U.K. investment	177,214	4,261
Decrease in capital reserves of commercial insurance subsidiary	100	100
Costs incurred for purchase of information technology applications, net of refunds		20,202
Net cash used in investing activities	(398,906)	(659,710)
Cash Flows from Financing Activities:
Repayments of long-term debt	(194,115)	(3,026,888)
Additional borrowings, net	705,321	2,912,374
Financing costs	(2,541)	(17,967)
Repurchase of common shares	(723,384)	(770,665)
Dividends paid	(44,192)	(50,284)
Issuance of common stock	10,399	10,108
Profit distributions to noncontrolling interests	(5,426)	(5,744)
Purchase (sale) of ownership interests by (from) minority members	(49,089)	13,046
Net cash used in financing activities	(303,027)	(936,020)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(10,339)	(682)
Decrease in cash, cash equivalents and restricted cash	(13,553)	(1,034,737)
Cash, cash equivalents and restricted cash, beginning of period	178,934	1,279,154
Cash, cash equivalents and restricted cash, end of period	165,381	244,417
Supplemental Disclosures of Cash Flow Information:
Interest paid	78,992	58,719
Income taxes paid, net of refunds	182,091	286,376
Noncash purchases of property and equipment	$ 97,264	$ 73,428