v3.22.4
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Cash flows from operating activities:      
Net income $ 224,652 $ 197,725 $ 171,364
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 62,355 55,985 54,571
Impairment of long-lived assets 0 0 2,681
Amortization of deferred financing fees 1,036 859 840
Non-cash leasing arrangement 493 485 451
Write-off of deferred financing fees 566 0 0
Deferred income taxes (6,496) (724) (27,809)
Provision for doubtful accounts 2,390 2,609 7,058
Stock-based compensation 22,720 18,678 14,524
Cash received from insurance proceeds 1,282 2,382 0
Gain on sale of assets (3,467) (1,371) 0
Loss (gain) on insurance claims, legal finding and asset disposals 3,926 (977) 625
Change in operating assets and liabilities      
Accounts receivable (82,426) (30,771) 2,171
Prepaid income taxes 809 (4,228) (485)
Prepaid expenses and other assets (9,141) (4,898) (2,897)
Deferred employer portion of social security taxes (24,155) (24,154) 48,309
Cash surrender value of life insurance policy premiums (7,614) (10,953) (6,577)
Deferred compensation liability 7,637 11,078 6,615
Operating lease obligations 345 (5,814) (724)
Accounts payable 17,870 7,117 6,627
Accrued wages and related liabilities 38,982 47,701 68,365
Other accrued liabilities 3,010 1,297 17,536
Accrued self-insurance liabilities 17,785 13,724 10,293
Other long-term liabilities (46) (66) (187)
NET CASH PROVIDED BY OPERATING ACTIVITIES 272,513 275,684 373,351
Cash flows from investing activities:      
Purchase of property and equipment (87,545) (69,550) (50,326)
Cash payments for business acquisitions (Note 9) (16,400) (6,000) 0
Cash payments for asset acquisitions (Note 9) (84,736) (98,224) (24,997)
Escrow deposits 0 100 (100)
Escrow deposits used to fund acquisitions 0 0 14,050
Cash from insurance proceeds 1,339 6,899 800
Cash proceeds from the sale of assets 8,630 1,854 412
Deconsolidation of an ancillary business 0 (1,984) 0
Cash payments for Medicare and Medicaid licenses 0 (106) 0
Purchases of investments (21,975) (32,257) (21,708)
Maturities of investments 14,356 27,481 24,479
Other restricted assets 149 (2,120) (1,276)
NET CASH USED IN INVESTING ACTIVITIES (186,182) (173,907) (58,666)
Cash flows from financing activities:      
Proceeds from debt (Note 16) 411 45,218 417,200
Payments on debt (Note 16) (4,106) (3,056) (629,745)
Issuance of common stock upon exercise of options 12,677 9,180 12,654
Repurchase of shares of common stock to satisfy tax withholding obligations (1,702) (1,711) (917)
Repurchase of shares of common stock (Note 22) (29,882) (10,118) (25,000)
Dividends paid (12,168) (11,548) (10,830)
Proceeds from sale of subsidiary shares (Note 7) 6,693 0 0
Non-controlling interest distribution (284) (2,908) (2,683)
Purchase of non-controlling interest (704) 2,000 0
Payments of deferred financing costs (3,197) (1,172) 0
Proceeds from CARES Act Provider Relief Fund and Medicare Advance Payment Program (Note 3) 0 11,637 246,955
Repayments of CARES Act Provider Relief Fund and Medicare Advance Payment Program (Note 3) 0 (113,660) (144,932)
NET CASH USED IN FINANCING ACTIVITIES (32,262) (76,138) (137,298)
Net increase in cash and cash equivalents 54,069 25,639 177,387
Cash and cash equivalents beginning of period 262,201 236,562 59,175
Cash and cash equivalents end of period 316,270 262,201 236,562
Cash paid during the period for:      
Interest 7,604 5,690 9,920
Income taxes 70,055 65,547 74,365
Lease liabilities 151,870 138,795 129,569
Non-cash financing and investing activity      
Accrued capital expenditures 4,800 3,700 3,400
Accrued dividends declared 3,201 3,035 2,868
Note receivable from insurance settlement 0 0 5,500
Right-of-use assets obtained in exchange for new and modified operating lease obligations $ 370,753 $ 198,593 $ 24,599