Document and Entity Information (USD $)	12 Months Ended
Document and Entity Information (USD $)	Dec. 31, 2010	Feb. 18, 2011	Jun. 30, 2010
Document and Entity Information
Document Type	10-K
Amendment Flag	false
Document Fiscal Year Focus	2010
Document Fiscal Period Focus	FY
Document Period End Date	Dec. 31, 2010
Trading Symbol	md
Entity Registrant Name	MEDNAX, INC.
Entity Central Index Key	0000893949
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		47,983,543
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Public Float			$ 2,608,769,146

CONSOLIDATED BALANCE SHEETS (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2010	Dec. 31, 2009
ASSETS
Cash and cash equivalents	$ 26,251	$ 26,503
Short-term investments	17,381	5,380
Accounts receivable, net	181,395	164,444
Prepaid expenses	5,162	5,102
Income taxes receivable		5,704
Deferred income taxes	60,579	72,434
Other assets	5,241	13,098
Total current assets	296,009	292,665
Investments	27,393	28,491
Property and equipment, net	42,774	43,272
Goodwill	1,601,319	1,270,137
Other assets, net	70,151	54,785
Total assets	2,037,646	1,689,350
LIABILITIES & SHAREHOLDERS' EQUITY
Accounts payable and accrued expenses	307,723	346,470
Current portion of capital lease obligations	125	234
Income taxes payable	12,999
Total current liabilities	320,847	346,704
Line of credit	146,500	50,000
Capital lease obligations	56	209
Deferred income taxes	74,066	59,454
Other liabilities	48,723	42,885
Total liabilities	590,192	499,252
Commitments and contingencies
Shareholders' equity:
Preferred stock; $.01 par value; 1,000 shares authorized; none issued
Common stock; $.01 par value; 100,000 shares authorized; 47,937 and 46,963 shares issued and outstanding, respectively	479	470
Additional paid-in capital	659,091	604,435
Retained earnings	787,884	585,193
Total shareholders' equity	1,447,454	1,190,098
Total liabilities and shareholders' equity	$ 2,037,646	$ 1,689,350

CONSOLIDATED BALANCE SHEETS (Parenthetical) (USD $) In Thousands, except Per Share data, unless otherwise specified	Dec. 31, 2010	Dec. 31, 2009
CONSOLIDATED BALANCE SHEETS
Preferred stock, par value	$ 0.01	$ 0.01
Preferred stock, shares authorized	1,000	1,000
Preferred stock, shares issued	0	0
Common stock, par value	$ 0.01	$ 0.01
Common stock, shares authorized	100,000	100,000
Common stock, shares issued	47,937	46,963
Common stock, shares outstanding	47,937	46,963

CONSOLIDATED STATEMENTS OF INCOME (USD $) In Thousands, except Per Share data, unless otherwise specified	12 Months Ended
	Dec. 31, 2010	Dec. 31, 2009	Dec. 31, 2008
CONSOLIDATED STATEMENTS OF INCOME
Net patient service revenue	$ 1,401,559	$ 1,288,264	$ 1,068,277
Operating expenses:
Practice salaries and benefits	854,920	783,493	643,445
Practice supplies and other operating expenses	57,511	52,232	44,767
General and administrative expenses	154,267	147,162	124,965
Depreciation and amortization	21,950	16,448	13,071
Total operating expenses	1,088,648	999,335	826,248
Income from operations	312,911	288,929	242,029
Investment income	1,434	1,682	2,982
Interest expense	(3,193)	(2,911)	(3,593)
Income from continuing operations before income taxes	311,152	287,700	241,418
Income tax provision	108,461	111,896	94,736
Income from continuing operations	202,691	175,804	146,682
Income from discontinued operations, net of income taxes			22,519
Net income	$ 202,691	$ 175,804	$ 169,201
Income from continuing operations:
Basic	$ 4.35	$ 3.86	$ 3.18
Diluted	$ 4.26	$ 3.78	$ 3.11
Income from discontinued operations:
Basic			$ 0.49
Diluted			$ 0.48
Net income:
Basic	$ 4.35	$ 3.86	$ 3.67
Diluted	$ 4.26	$ 3.78	$ 3.59
Weighted average shares:
Basic	46,630	45,573	46,121
Diluted	47,570	46,471	47,161

CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY (USD $) In Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]
Balance at Dec. 31, 2007	$ 959,052	$ 484	$ 556,836	$ 401,732
Balance in shares at Dec. 31, 2007		48,421
Net income	169,201			169,201
Common stock issued under employee stock option and stock purchase plans	11,682	4	11,678
Common stock issued under employee stock option and stock purchase plans, share		359
Issuance of restricted stock		2	(2)
Issuance of restricted stock, shares		226
Stock-based compensation expense	20,863		20,863
Forfeitures of restricted stock
Forfeitures of restricted stock, shares		(7)
Repurchases of common stock	(199,997)	(34)	(38,419)	(161,544)
Repurchases of common stock, shares		(3,357)
Excess tax benefit related to employee stock incentive plans	4,337		4,337
Balance at Dec. 31, 2008	965,138	456	555,293	409,389
Balance in shares at Dec. 31, 2008		45,642
Net income	175,804			175,804
Common stock issued under employee stock option and stock purchase plans	17,959	8	17,951
Common stock issued under employee stock option and stock purchase plans, share		794
Issuance of restricted stock		6	(6)
Issuance of restricted stock, shares		553
Stock-based compensation expense	24,320		24,320
Forfeitures of restricted stock
Forfeitures of restricted stock, shares		(26)
Excess tax benefit related to employee stock incentive plans	6,877		6,877
Balance at Dec. 31, 2009	1,190,098	470	604,435	585,193
Balance in shares at Dec. 31, 2009		46,963
Net income	202,691			202,691
Common stock issued under employee stock option and stock purchase plans	22,532	5	22,527
Common stock issued under employee stock option and stock purchase plans, share		545
Issuance of restricted stock		4	(4)
Issuance of restricted stock, shares		437
Stock-based compensation expense	25,693		25,693
Forfeitures of restricted stock
Forfeitures of restricted stock, shares		(8)
Excess tax benefit related to employee stock incentive plans	3,046		3,046
Excess tax benefit related to resolution of income tax matters	3,394		3,394
Balance at Dec. 31, 2010	$ 1,447,454	$ 479	$ 659,091	$ 787,884
Balance in shares at Dec. 31, 2010		47,937

CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2010	Dec. 31, 2009	Dec. 31, 2008
Cash flows from operating activities:
Net income	$ 202,691	$ 175,804	$ 169,201
Adjustments to reconcile net income to net cash provided from operating activities:
Depreciation and amortization	21,950	16,448	13,210
Accretion of contingent consideration liabilities	967	268
Stock-based compensation expense	25,693	24,320	20,776
Deferred income taxes	24,375	7,447	(13,649)
Gain on sale of discontinued operating unit			(38,537)
Changes in assets and liabilities:
Accounts receivable	(16,951)	(2,049)	(16,929)
Prepaid expenses and other assets	3,882	(1,188)	(3,052)
Other assets	(3,601)	(1,669)	1,358
Accounts payable and accrued expenses	(37,003)	39,481	58,940
Income taxes payable	18,706	(18,884)	(4,702)
Other liabilities	(151)	1,396	(5,225)
Net cash provided from operating activities	240,558	241,374	181,391
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(338,596)	(151,321)	(274,024)
Purchases of investments	(26,478)	(19,601)	(26,227)
Proceeds from sales or maturities of investments	15,575	22,735	24,733
Purchases of property and equipment	(12,113)	(14,947)	(15,680)
Proceeds from sale of discontinued operating unit			68,300
Net cash used in investing activities	(361,612)	(163,134)	(222,898)
Cash flows from financing activities:
Borrowings on line of credit	684,000	473,500	449,800
Payments on line of credit	(587,500)	(563,000)	(310,300)
Payments of contingent consideration liabilities	(4,405)
Payments for syndication of line of credit			(1,763)
Payments on long-term debt and capital lease obligations	(262)	(316)	(521)
Excess tax benefit from exercises of stock options and vesting of restricted stock	3,043	5,774	4,131
Excess tax benefit related to resolution of income tax matters	3,394
Proceeds from issuance of common stock	22,532	17,959	11,682
Repurchases of common stock			(199,997)
Net cash provided from (used in) financing activities	120,802	(66,083)	(46,968)
Net (decrease) increase in cash and cash equivalents	(252)	12,157	(88,475)
Cash and cash equivalents at beginning of year	26,503	14,346	102,843
Cash held by discontinued operating unit			(22)
Cash and cash equivalents at end of year	26,251	26,503	14,346
Supplemental disclosure of cash flow information:
Interest	2,559	3,666	3,474
Income taxes	88,601	113,202	104,172
Non-cash investing and financing activities:
Equipment financed through capital leases		$ 145	$ 220

General

12 Months Ended

Dec. 31, 2010

General

General

1.	General:

The principal business activity of MEDNAX, Inc. ("MEDNAX" or the "Company") and its subsidiaries is to provide neonatal, maternal-fetal, other pediatric subspecialty and anesthesia physician services. The Company has contracts with affiliated professional associations, corporations and partnerships ("affiliated professional contractors"), which are separate legal entities that provide physician services in certain states and Puerto Rico. The Company and its affiliated professional contractors also have contracts with hospitals to provide physician services (generally for neonatal or anesthesia care), which include (i) fee-for-service contracts, whereby hospitals agree, in exchange for the Company's services, to authorize the Company and its healthcare professionals to bill and collect the charges for medical services rendered by the Company's affiliated healthcare professionals, and (ii) administrative fee contracts, whereby the Company is assured a minimum revenue level.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2010

Summary of Significant Accounting Policies

Summary of Significant Accounting Policies

2.	Summary of Significant Accounting Policies:

Principles of Presentation

The financial statements include all the accounts of the Company and its subsidiaries combined with the accounts of the affiliated professional contractors with which the Company currently has specific management arrangements. The Company's agreements with affiliated professional contractors provide that the term of the arrangements are permanent, subject only to termination by the Company, except in the case of gross negligence, fraud or bankruptcy of the Company. The Company has the right to receive income, both as ongoing fees and as proceeds from the sale of its interest in the Company's affiliated professional contractors, in an amount that fluctuates based on the performance of the affiliated professional contractors and the change in the fair value of the Company's interest in the affiliated professional contractors. The Company has exclusive responsibility for the provision of all non-medical services required for the day-to-day operation and management of the Company's affiliated professional contractors and establishes the guidelines for the employment and compensation of the physicians. In addition, the agreements provide that the Company has the right, but not the obligation, to purchase, or to designate a person(s) to purchase, the stock of the Company's affiliated professional contractors for a nominal amount. Separately, in its sole discretion, the Company has the right to assign its interest in the agreements. Based upon the provisions of these agreements, the Company has determined that the affiliated professional contractors are variable interest entities and that the Company is the primary beneficiary as defined in the accounting guidance for consolidation. All significant intercompany and interaffiliate accounts and transactions have been eliminated.

Reclassifications have been made to certain prior period financial statements to conform with the current year presentation.

New Accounting Pronouncements

Effective January 1, 2010, the Company adopted the provisions of new accounting guidance related to variable interest entities. The new guidance amended the consolidation accounting model and included new disclosure requirements for certain types of variable interest entities. The adoption of the new provisions did not have an impact on the Company's Consolidated Financial Statements.

In January 2010, the accounting guidance related to fair value measurements was amended. The amendment requires disclosure of transfers of assets and liabilities into and out of Level 1 and Level 2 of the fair value hierarchy, including the reasons and the timing of the transfers and disclosure of valuation techniques and inputs for assets and liabilities within Level 2 and Level 3 of the fair value hierarchy. Additionally, the guidance requires expanded disclosure about assets and liabilities within Level 3. The new guidance became effective for the Company on January 1, 2010, except for the new guidance related to the expanded Level 3 disclosure, which is effective for periods beginning after December 15, 2010. The Company did not have any transfers in or out of Level 1 and Level 2 fair value measurements during the year ended December 31, 2010; therefore, the adoption of the new guidance did not have any impact on the Company's Consolidated Financial Statements.

Accounting Estimates and Assumptions

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America ("GAAP") requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. Significant estimates and assumptions are involved in the calculation of the Company's allowance for contractual adjustments and uncollectibles on accounts receivable, liabilities for self-insured amounts and claims incurred but not reported related to the Company's professional liability risks, the fair value of goodwill, and liabilities for uncertain tax positions. Actual results could differ from those estimates.

Segment Reporting

The results of the Company's operations are aggregated into a single reportable segment for purposes of presenting financial information in accordance with the accounting guidance for segment reporting.

Revenue Recognition

Patient service revenue is recognized at the time services are provided by the Company's affiliated physicians. Almost all of the Company's patient service revenue is reimbursed by government-sponsored healthcare programs and third-party insurance payors. Payments for services rendered to the Company's patients are generally less than billed charges. The Company monitors its revenue and receivables from these sources and records an estimated contractual allowance to properly account for the anticipated differences between billed and reimbursed amounts.

Accordingly, patient service revenue is presented net of an estimated provision for contractual adjustments and uncollectibles. The Company estimates allowances for contractual adjustments and uncollectibles on accounts receivable based upon historical experience and other factors, including days sales outstanding ("DSO") for accounts receivable, evaluation of expected adjustments and delinquency rates, past adjustments and collection experience in relation to amounts billed, an aging of accounts receivable, current contract and reimbursement terms, changes in payor mix and other relevant information. Contractual adjustments result from the difference between the physician rates for services performed and the reimbursements by government-sponsored healthcare programs and insurance companies for such services.

Accounts receivable are primarily amounts due under fee-for-service contracts from third-party payors, such as insurance companies, self-insured employers and patients and government-sponsored healthcare programs geographically dispersed throughout the United States and its territories. Concentration of credit risk relating to accounts receivable is limited by the number, diversity and geographic dispersion of the business units managed by the Company, as well as by the large number of patients and payors, including the various governmental agencies in the states in which the Company provides services. Receivables from government agencies made up approximately 24% and 26% of net accounts receivable at December 31, 2010 and 2009, respectively.

Cash Equivalents

Cash equivalents are defined as all highly liquid financial instruments with maturities of 90 days or less from the date of purchase. The Company's cash equivalents typically consist of demand deposits, amounts on deposit in money market accounts, and funds invested in overnight repurchase agreements. Cash equivalent balances may, at certain times, exceed federally insured limits.

Certain cash equivalents carried by the Company are subject to the fair value provisions of the accounting guidance for fair value measurements. See "Fair Value of Financial Instruments" below.

Investments

Investments consist of municipal debt securities, federal home loan securities and certificates of deposit. Investments with remaining maturities of less than one year are classified as short-term investments. Investments classified as long-term have maturities of two to five years.

The Company has the ability and intent to hold its held-to-maturity securities to maturity, and therefore carries such investments at amortized cost in accordance with the provisions of the accounting guidance for investments in debt and equity securities. Held-to-maturity investments are not subject to the fair value requirements of the accounting guidance for fair value measurements.

Property and Equipment

Property and equipment are recorded at original purchase cost. Depreciation of property and equipment is computed using the straight-line method over the estimated useful lives of the underlying assets. Estimated useful lives are generally 20 years for buildings; three to 10 years for medical equipment, computer equipment, software and furniture; and the lesser of the useful life or the remaining lease term for leasehold improvements and capital leases. Upon sale or retirement of property and equipment, the related cost and accumulated depreciation are eliminated from the respective accounts and any resulting gain or loss is included in earnings.

Business Acquisitions

The Company accounts for business acquisitions as required by the provisions of the accounting guidance for business combinations, which includes provisions that the Company adopted effective January 1, 2009. The guidance retains the underlying concepts of the previous standard such that all business combinations are required to be accounted for at fair value, but changes certain aspects of applying the acquisition method of accounting. The changes require the Company to measure contingent consideration at fair value at the acquisition date and also require the Company to expense certain acquisition costs as they are incurred for acquisitions completed after January 1, 2009. See Note 6 for more information on the Company's business acquisitions.

Goodwill and Other Intangible Assets

The Company records acquired assets and liabilities at their respective fair values under the acquisition method of accounting. Goodwill represents the excess of cost over the fair value of the net assets acquired. Intangible assets with finite lives, principally physician and hospital agreements, are recognized apart from goodwill at the time of acquisition based on the contractual-legal and separability criteria established in the accounting guidance for business combinations. Intangible assets with finite lives are amortized on either an accelerated basis based on the annual undiscounted economic cash flows associated with the particular intangible asset or on a straight-line basis over their estimated useful lives. Intangible assets with finite lives are amortized over periods of one to 20 years.

Goodwill is tested for impairment at a reporting unit level on at least an annual basis in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. The Company defines a reporting unit based upon its management structure for services provided in specific regions of the United States. The testing for impairment is completed using a two-step test. The first step compares the fair value of a reporting unit with its carrying amount, including goodwill. If the carrying amount of a reporting unit exceeds its fair value, a second step is performed to determine the amount of any impairment loss. The Company uses income and market-based valuation approaches to determine the fair value of its reporting units. These approaches focus on discounted cash flows and market multiples based on the Company's market capitalization to derive the fair value of a reporting unit. The Company also considers the economic outlook for the healthcare services industry and various other factors during the testing process, including hospital and physician contract changes, local market developments, changes in third-party payor payments, and other publicly available information. The Company completed annual impairment tests in the third quarter of each of 2010, 2009 and 2008 and determined that goodwill was not impaired in any of the three years.

Long-Lived Assets

The Company is required to evaluate long-lived assets, including intangible assets subject to amortization, whenever events or changes in circumstances indicate that the carrying value of the assets may not be fully recoverable. The recoverability of such assets is measured by a comparison of the carrying value of the assets to the future undiscounted cash flows before interest charges to be generated by the assets. If long-lived assets are impaired, the impairment to be recognized is measured as the excess of the carrying value over the fair value. Long-lived assets held for disposal are reported at the lower of the carrying value or fair value less disposal costs. The Company does not believe there are any indicators that would require an adjustment to such assets or their estimated periods of recovery at December 31, 2010 pursuant to current accounting standards.

Professional Liability Coverage

The Company maintains professional liability insurance policies with third-party insurers on a claims-made basis, subject to self-insured retention, exclusions and other restrictions. The Company's self-insured retention under its professional liability insurance program is maintained primarily through a wholly owned captive insurance subsidiary. The Company records an estimate of liabilities for self-insured amounts and claims incurred but not reported based on an actuarial valuation using historical loss information, claim emergence patterns and various actuarial assumptions. Liabilities for claims incurred but not reported are not discounted.

Income Taxes

The Company records deferred income taxes using the liability method, whereby deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse.

The accounting guidance for uncertain tax positions prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The guidance also requires policy disclosures regarding penalties and interest and extensive disclosures regarding increases and decreases in uncertain tax positions as a result of tax positions taken in a current or prior period, settlements with taxing authorities and any lapse of an applicable statute of limitations. Additional qualitative discussion is required for any tax position that may result in a significant increase or decrease in uncertain tax positions within a 12-month period from the Company's reporting date.

Stock Incentive Plans

The Company grants stock-based awards consisting of restricted and deferred stock and stock options to key employees under its 2008 Incentive Compensation Plan and certain prior incentive compensation plans (collectively, "Stock Incentive Plans").

In accordance with the accounting guidance for stock-based compensation, the Company measures the cost of employee services received in exchange for stock-based awards based on grant-date fair value. As prescribed under the accounting guidance, the Company estimates the grant-date fair value of stock option grants using a valuation model known as the Black-Scholes-Merton formula or the "Black-Scholes Model" and allocates the resulting compensation expense over the corresponding requisite service period using the graded vesting attribution method. The Black-Scholes Model requires the use of several variables to estimate the grant-date fair value of stock options including expected volatility, expected life, expected risk-free interest rate and expected dividends. The Company performs significant analyses to calculate and select the appropriate variable assumptions used in the Black-Scholes Model. The Company also performs significant analyses to estimate forfeitures of stock-based awards as required by the accounting guidance for stock-based compensation. The Company is required to adjust its forfeiture estimates on at least an annual basis based on the number of awards that ultimately vest.

Net Income Per Share

Basic net income per share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the period. Potential common shares consist of outstanding options and restricted and deferred stock calculated using the treasury stock method. Under the treasury stock method, the Company includes the assumed excess tax benefits related to the potential exercise or vesting of its stock-based awards using the difference between the average market price for the applicable period less the option price, if any, and the fair value of the stock-based award on the date of grant multiplied by the applicable tax rate.

Fair Value of Financial Instruments

In accordance with the accounting guidance for fair value measurements and disclosures, the Company carries its money market funds and the cash surrender value of life insurance related to its deferred compensation arrangements at fair value. Under this guidance, the fair value of these instruments is determined using a three-tier fair value hierarchy. Based on this hierarchy, the Company determined the fair value of its money market funds and the cash surrender value of life insurance using quoted market prices, a Level 1 or an observable input as defined under the accounting guidance for fair value measurements. The investments underlying the cash surrender value of life insurance consist primarily of exchange-traded equity securities and mutual funds with quoted prices in active markets. At December 31, 2010, the Company's money market funds and the cash surrender value of life insurance had carrying amounts of $11.7 million and $12.5 million, respectively. At December 31, 2009, the Company's money market funds and the cash surrender value of life insurance had carrying amounts of $20.2 million and $10.7 million, respectively.

The carrying amounts of cash equivalents, short-term investments, accounts receivable and accounts payable and accrued expenses approximate fair value due to the short maturities of the respective instruments. The carrying value of long-term investments and capital lease obligations approximates fair value.

Investments

12 Months Ended

Dec. 31, 2010

Investments

Investments

3.	Investments:

Investments held are summarized as follows (in thousands):


	December 31, 2010				December 31, 2009
	Short-Term		Long-Term		Short-Term		Long-Term
Municipal debt securities	$	16,901	$	11,327	$	4,880	$	24,271
Federal home loan securities		—		16,066		500		3,500
Certificates of deposit		480		—		—		720

	$	17,381	$	27,393	$	5,380	$	28,491

- Definition

This item represents the entire disclosure related to Investments in Certain Debt and Equity Securities (and certain other trading assets) which include all debt and equity securities (other than those equity securities accounted for under the equity or cost methods of accounting) with readily determinable fair values. Other trading assets include assets that are carried on the balance sheet at fair value and held for trading purposes. A debt security represents a creditor relationship with an enterprise that is in the form of a security. Debt securities include, among other items, US Treasury securities, US government securities, municipal securities, corporate bonds, convertible debt, commercial paper, and all securitized debt instruments. An equity security represents an ownership interest in an enterprise or the right to acquire or dispose of an ownership interest in an enterprise at fixed or determinable prices. Equity securities include, among other things, common stock, certain preferred stock, warrant rights, call options, and put options, but do not include convertible debt. An entity may opt to provide the reader with additional narrative text to better understand the nature of investments in debt and equity securities (and other trading assets).

+ References+ Details

Accounts Receivable and Net Patient Service Revenue

12 Months Ended

Dec. 31, 2010

Accounts Receivable and Net Patient Service Revenue

Accounts Receivable and Net Patient Service Revenue

4.	Accounts Receivable and Net Patient Service Revenue:

Accounts receivable, net consists of the following (in thousands):


	December 31,
	2010			2009
Gross accounts receivable	$	603,372		$	541,950
Allowance for contractual adjustments and uncollectibles		(421,977	)		(377,506)

	$	181,395		$	164,444

Net patient service revenue consists of the following (in thousands):


	Years Ended December 31,
	2010			2009			2008
Gross patient service revenue	$	4,140,312		$	3,658,459		$	3,014,035
Contractual adjustments and uncollectibles		(2,825,827	)		(2,444,222	)		(2,006,415	)
Hospital contract administrative fees		87,074			74,027			60,657

	$	1,401,559		$	1,288,264		$	1,068,277

Accounts receivable of $181.4 million and $164.4 million at December 31, 2010 and 2009, respectively, consist primarily of amounts due from government-sponsored healthcare programs and third-party insurance payors for services provided by the Company's affiliated physicians.

Net patient service revenue of $1.4 billion, $1.3 billion and $1.1 billion for the years ended December 31, 2010, 2009 and 2008, respectively, consists primarily of gross billed charges for services provided by the Company's affiliated physicians less an estimated allowance for contractual adjustments and uncollectibles to properly account for the anticipated differences between gross billed charge amounts and expected reimbursement amounts.

The Company's contractual adjustments and uncollectibles as a percentage of gross patient service revenue vary slightly each year depending on several factors, including improved managed care contracting, changes in reimbursement from state Medicaid programs and other government-sponsored programs and annual price increases.

The Company's annual price increases typically increase contractual adjustments as a percentage of gross patient service revenue. This increase is primarily due to Medicaid and other government-sponsored health care programs that generally provide for reimbursements on a fee-schedule basis rather than on a gross charge basis. When the Company bills these programs, like other payors, on a gross-charge basis, it also increases its provision for contractual adjustments and uncollectibles by the amount of any price increase, resulting in a higher contractual adjustment percentage.

Property and Equipment

12 Months Ended

Dec. 31, 2010

Property and Equipment

Property and Equipment

5.	Property and Equipment:

Property and equipment consists of the following (in thousands):


	December 31,
	2010			2009
Building	$	8,056		$	8,056
Land		2,032			2,032
Equipment and furniture		88,868			93,794

		98,956			103,882
Accumulated depreciation		(56,182	)		(60,610)

	$	42,774		$	43,272

At December 31, 2010 and 2009, property and equipment includes medical and other equipment held under capital leases of approximately $1.0 million and $1.3 million, and related accumulated depreciation of approximately $0.8 million and $0.9 million, respectively. The Company recorded depreciation expense of approximately $13.5 million, $11.2 million and $9.4 million for the years ended December 31, 2010, 2009 and 2008, respectively.

Business Acquisitions

12 Months Ended

Dec. 31, 2010

Business Acquisitions

Business Acquisitions

6.	Business Acquisitions:

During 2010, the Company completed the acquisition of 15 physician group practices for total consideration of $339.3 million, consisting of $328.7 million in cash and $10.6 million of contingent consideration. In connection with these acquisitions, the Company recorded goodwill of approximately $317.5 million, other intangible assets consisting primarily of physician and hospital agreements of approximately $21.4 million, fixed assets of approximately $0.9 million, and other liabilities of approximately $0.5 million. These acquisitions expand the Company's national network of physician practices. The Company expects to improve the results of these physician practices through improved managed care contracting, improved collections, identification of growth initiatives, as well as, operating and cost savings based upon the significant infrastructure it has developed.

The contingent consideration of $10.6 million recorded during 2010 is related to agreements to pay additional amounts based on the achievement of certain performance measures for up to five years ending after the acquisition dates. The accrued contingent consideration for each acquisition was recorded at acquisition-date fair value using the income approach with assumed discount rates ranging from 3.0% to 6.0% over the applicable terms and an assumed payment probability of 100% for each of the applicable years. The range of the undiscounted amount the Company could pay under the contingent consideration agreements is between $0 and $12.1 million.

During 2010, the Company paid approximately $14.3 million for contingent consideration related to certain prior-period acquisitions, of which $4.4 million was accrued as of December 31, 2009.

During 2009, the Company completed the acquisition of 11 physician group practices for total consideration of $145.5 million, consisting of $128.1 million in cash and $17.4 million of contingent consideration. In connection with these acquisitions, the Company recorded goodwill of approximately $124.8 million, other intangible assets consisting primarily of physician and hospital agreements of approximately $20.2 million, and fixed assets of approximately $0.5 million.

Certain purchase agreements contain contingent purchase price provisions based on volume and other performance measures. Potential payments under these provisions are not contingent upon the future employment of the sellers. The amount of the payments due under these provisions cannot be determined until the specific targets or measures are attained. In some cases, the sellers are eligible for annual contingent purchase price payments over a three- to five-year period based on the growth in profitability of the physician practice with no stated limit on the annual payment amount. Under all contingent purchase price provisions, payments of up to $43.3 million may be due through 2015, of which $26.1 million is accrued as of December 31, 2010.

The results of operations of the practices acquired in 2010 and 2009 have been included in the Company's Consolidated Financial Statements from the dates of acquisition. The following pro forma information combines the consolidated results of operations of the Company on a GAAP basis and the acquisitions completed during 2010 and 2009 as if the transactions had occurred on January 1, 2009 (in thousands, except per share data):


	Years Ended December 31,
	2010		2009
Net patient service revenue	$	1,504,048	$	1,493,588
Net income		221,091		212,293
Net income per share:
Basic	$	4.74	$	4.66
Diluted	$	4.65	$	4.57

The pro forma results do not necessarily represent results which would have occurred if the acquisitions had taken place at the beginning of the period, nor are they indicative of the results of future combined operations.

Goodwill and Other Assets

12 Months Ended

Dec. 31, 2010

Goodwill and Other Assets

Goodwill and Other Assets

7.	Goodwill and Other Assets:

Goodwill was $1.6 billion and $1.3 billion at December 31, 2010 and 2009, respectively. The change in the carrying amount of goodwill of approximately $331.2 million during the year ended December 31, 2010 is primarily related to the Company's 2010 acquisitions and the 2010 contingent consideration payments related to acquisitions completed prior to January 1, 2009 as discussed in Note 6. The Company expects that approximately $284.2 million of the $331.2 million of goodwill recorded during the year ended December 31, 2010 will be deductible for tax purposes. Goodwill of approximately $142.2 million related to the 2009 acquisitions and the 2009 contingent consideration payments related to acquisitions completed prior to January 1, 2009 as discussed in Note 6 represent the only changes in the carrying amount of goodwill for the year ended December 31, 2009.

Other assets consist of the following (in thousands):


	December 31,
	2010		2009
Other intangible assets, net	$	51,776	$	38,844
Other assets		18,375		15,941

	$	70,151	$	54,785

At December 31, 2010, other intangible assets consisted of amortizable hospital, state and other contracts; physician and hospital agreements; and other agreements with gross carrying amounts of approximately $73.0 million, less accumulated amortization of approximately $21.2 million. At December 31, 2009, other intangible assets consisted of amortizable hospital, state and other contracts; physician and hospital agreements; and other agreements with gross carrying amounts of approximately $53.1 million, less accumulated amortization of approximately $14.3 million. Other intangible assets with finite lives are amortized on either an accelerated basis based on the annual undiscounted economic cash flows associated with the particular intangible asset or on a straight-line basis over their estimated useful lives.

Amortization expense related to other intangible assets for the years ended December 31, 2010, 2009 and 2008 was approximately $8.5 million, $5.2 million and $3.6 million, respectively. Amortization expense on other intangible assets for the years 2011 through 2015 is expected to be approximately $8.9 million, $8.0 million, $7.4 million, $6.3 million and $5.4 million, respectively. The remaining weighted average amortization period of other intangible assets is 4.1 years. The calculation of the weighted average amortization period includes amortization expense related to years beyond 2015 of approximately $15.8 million.

Other assets of $18.4 million and $15.9 million at December 31, 2010 and 2009, respectively, consist primarily of the cash surrender value of life insurance related to the Company's deferred compensation arrangements and other long-term assets.

- Definition

Discloses the aggregate amount of goodwill and a description of intangible assets, which may include (a) for amortizable intangible assets (also referred to as finite-lived intangible assets), the carrying amount, the amount of any significant residual value, and the weighted-average amortization period, (b) for intangible assets not subject to amortization (also referred to as indefinite-lived intangible assets), the carrying amount, and (c) the amount of research and development assets acquired and written off in the period, including the line item in the income statement in which the amounts written off are aggregated, if not readily apparent from the income statement. Also discloses (a) for amortizable intangibles assets in total and by major class, the gross carrying amount and accumulated amortization, the total amortization expense for the period, and the estimated aggregate amortization expense for each of the five succeeding fiscal years, (b) for intangible assets not subject to amortization the carrying amount in total and by major class, and (c) for goodwill, in total and for each reportable segment, the changes in the carrying amount of goodwill during the period (including the aggregate amount of goodwill acquired, the aggregate amount of impairment losses recognized, and the amount of goodwill included in the gain or loss on disposal of a reporting unit). If any part of goodwill has not been allocated to a reportable segment, discloses the unallocated amount and the reasons for not allocating. For each impairment loss recognized related to an intangible asset (excluding goodwill), discloses: (a) a description of the impaired intangible asset and the facts and circumstances leading to the impairment, (b) the amount of the impairment loss and the method for determining fair value, (c) the caption in the income statement or the statement of activities in which the impairment loss is aggregated, and (d) the segment in which the impaired intangible asset is reported. For each goodwill impairment loss recognized, discloses: (a) a description of the facts and circumstances leading to the impairment, (b) the amount of the impairment loss and the method of determining the fair value of the associated reporting unit, and (c) if a recognized impairment loss is an estimate not finalized and the reasons why the estimate is not final. May also disclose the nature and amount of any significant adjustments made to a previous estimate of an impairment loss. This element may be used as a single block of text to include the entire intangible asset disclosure including data and tables.

+ References+ Details

Accounts Payable and Accrued Expenses

12 Months Ended

Dec. 31, 2010

Accounts Payable and Accrued Expenses

Accounts Payable and Accrued Expenses

8.	Accounts Payable and Accrued Expenses:

Accounts payable and accrued expenses consist of the following (in thousands):


	December 31,
	2010		2009
Accounts payable	$	9,581	$	11,199
Accrued salaries and bonuses		132,221		144,827
Accrued professional liability risks		111,662		109,628
Accrued payroll taxes and benefits		26,122		22,600
Accrual for uncertain tax positions		10,948		40,859
Other accrued expenses		17,189		17,357

	$	307,723	$	346,470

At December 31, 2010 and 2009, accrued salaries and bonuses of $132.2 million and $144.8 million, respectively, consist primarily of amounts due under the Company's performance-based incentive compensation program.

At December 31, 2010 and 2009, accrued professional liability risks of $111.7 million and $109.6 million, respectively, consist of the Company's liabilities for self-insured retention under its professional liability insurance program and an estimate of liabilities for claims incurred but not reported based on an actuarial valuation. See Note 9 for more information regarding the Company's accrued professional liability.

The accrual for uncertain tax positions, which represents the current portion of reserves for uncertain tax positions including interest and penalties, decreased by $30.0 million, from $40.9 million at December 31, 2009 to $10.9 million at December 31, 2010, of which $19.0 million related to reclassifications of certain temporary differences to deferred taxes payable and $10.5 million related to the resolution of certain income tax matters that were under review with taxing authorities. See Note 11 for more information regarding the Company's uncertain tax positions.

Accrued Professional Liability

12 Months Ended

Dec. 31, 2010

Accrued Professional Liability

Accrued Professional Liability

9.	Accrued Professional Liability:

At December 31, 2010 and 2009, the Company's total accrued professional liability of $111.7 million and $109.6 million, respectively, includes incurred but not reported loss reserves of $71.0 million and $68.2 million, respectively, and loss reserves for reported claims associated with self-insured retention amounts through the Company's wholly owned captive insurance subsidiary of $40.7 million and $41.4 million, respectively.

The activity related to the Company's loss reserves for reported claims for the years ended December 31, 2010, 2009 and 2008 is as follows (in thousands):


	Years Ended December 31,
	2010			2009			2008
Balance at beginning of year	$	41,355		$	36,366		$	31,786

Provision (adjustment) for losses related to:
Current year		17,256			16,497			15,174
Prior years		(4,029	)		(3,519	)		(5,010	)

Total provision for losses		13,227			12,978			10,164

Claim payments related to:
Current year		(553	)		(568	)		(15	)
Prior years		(13,357	)		(7,421	)		(5,569	)

Total payments		(13,910	)		(7,989	)		(5,584	)

Balance at end of year	$	40,672		$	41,355		$	36,366

The net changes in reserves for reported claims for the years ended December 31, 2010 and 2009, are primarily attributable to the increase in the number of physicians insured through the Company's wholly owned captive insurance subsidiary due to acquisitions and same-unit growth, offset by higher claim payments and adjustments to the provision for losses related to prior years resulting from favorable trends in the Company's claims experience.

Line of Credit and Capital Lease Obligations

12 Months Ended

Dec. 31, 2010

Line of Credit and Capital Lease Obligations

Line of Credit and Capital Lease Obligations

10.

Line of Credit and Capital Lease Obligations:

The Company has an unsecured $350 million revolving line of credit ("Line of Credit") that is guaranteed by substantially all of the Company's subsidiaries and includes a $50 million sub-facility for the issuance of letters of credit and a $25 million sub-facility for swingline loans. In addition, the Line of Credit may be increased to $400 million subject to the satisfaction of specified conditions. At the Company's option, the Line of Credit (other than swingline loans) bears interest at (1) the alternate base rate, which is defined as the higher of (i) the Federal Funds Rate plus one half of 1% and (ii) the Wells Fargo Bank, N.A prime rate or (2) the LIBOR rate, plus, in either case, an applicable margin rate of up to 1.5% based on the Company's consolidated leverage ratio. The Line of Credit is also subject to facility fees based on applicable rates defined in the agreement and the aggregate commitments, regardless of usage. Swingline loans bear interest at the alternate base rate plus the applicable margin. The Line of Credit matures in September 2013. The Company is subject to certain covenants and restrictions specified in the Line of Credit, including covenants that require it to maintain a minimum fixed charge coverage ratio and to not exceed a specified consolidated leverage ratio, to comply with laws, and restrict it from paying dividends and making certain other distributions, as specified therein. Failure to comply with these covenants would constitute an event of default under the Line of Credit, notwithstanding the Company's ability to meet its debt service obligations. The Line of Credit includes various customary remedies for the lenders following an event of default. At December 31, 2010, the Company believes it was in compliance, in all material respects, with the financial covenants and other restrictions applicable under the Line of Credit.

The Company had $146.5 million in outstanding principal balance under the Line of Credit at December 31, 2010. The Company has outstanding letters of credit associated with its professional liability insurance program which reduced the amount available under the Line of Credit by $6.0 million at December 31, 2010. The weighted average interest rate on the letters of credit was 1.0% at December 31, 2010. At December 31, 2010, the Company had an available balance on the Line of Credit of $197.5 million.

The Company's capital lease obligations consist of the following (in thousands):


	December 31,
	2010			2009
Capital lease obligations	$	181		$	443
Less: Current portion		(125	)		(234	)

Long-term portion	$	56		$	209

The amounts due under the terms of the Company's capital lease obligations at December 31, 2010 are as follows (in thousands):


2011	$	125
2012		56

	$	181

Income Taxes

12 Months Ended

Dec. 31, 2010

Income Taxes

Income Taxes

11.

Income Taxes:

The components of the income tax provision (benefit) are as follows (in thousands):


	December 31,
	2010		2009		2008
Federal:
Current	$	73,756	$	93,590	$	92,960
Deferred		22,814		6,391		(10,066	)

		96,570		99,981		82,894

State:
Current		10,330		11,315		12,822
Deferred		1,561		600		(980	)

		11,891		11,915		11,842

Total	$	108,461	$	111,896	$	94,736

The Company files its tax return on a consolidated basis with its subsidiaries. The remaining affiliated professional contractors file tax returns on an individual basis.

The effective tax rate was 34.86%, 38.89% and 39.24% for the years ended December 31, 2010, 2009 and 2008, respectively. The net decrease in the Company's effective income tax rate for the year ended December 31, 2010 was primarily related to the $10.9 million reduction in its income tax provision resulting from a resolution of certain matters that were under review with taxing authorities.

The differences between the effective rate and the United States federal income tax statutory rate are as follows:


	December 31,
	2010			2009			2008
Tax at statutory rate		35.00	%		35.00	%		35.00	%
State income tax, net of federal benefit		2.42			2.69			3.19
Non-deductible expenses		0.35			0.40			0.56
Change in accrual estimates relating to uncertain tax positions		(2.81	)		0.82			0.63
Other, net		(0.10	)		(0.02	)		(0.14	)

Income tax provision		34.86	%		38.89	%		39.24	%

The significant components of deferred income tax assets and liabilities are as follows (in thousands):


	December 31, 2010									December 31, 2009
	Total			Current			Non- Current			Total			Current			Non- Current
Allowance for uncollectible accounts	$	34,254		$	34,254		$	—		$	43,068		$	43,068		$	—
Net operating loss carryforward		7,799			7,799			—			2,789			2,789			—
Reserves and accruals		37,045			33,378			3,667			35,466			31,810			3,656
Other		488			488			—			271			271			—
Stock-based compensation		18,316			8,700			9,616			15,906			6,238			9,668

Total deferred tax assets		97,902			84,619			13,283			97,500			84,176			13,324

Accrual to cash adjustment		(24,040	)		(24,040	)		—			(11,742	)		(11,742	)		—
Property and equipment		(965	)		—			(965	)		(1,481	)		—			(1,481	)
Amortization		(86,384	)		—			(86,384	)		(71,297	)		—			(71,297	)

Total deferred tax liabilities		(111,389	)		(24,040	)		(87,349	)		(84,520	)		(11,742	)		(72,778	)

Net deferred tax (liability) asset	$	(13,487	)	$	60,579		$	(74,066	)	$	12,980		$	72,434		$	(59,454	)

The income tax benefit related to the exercise of stock options, the purchase of shares under the Company's non-qualified employee stock purchase plan and the vesting of restricted stock in excess of amounts recorded as equity compensation expense reduces taxes currently payable and is credited to additional paid-in capital. Such amounts totaled approximately $3.0 million, $6.9 million, and $4.3 million for the years ended December 31, 2010, 2009 and 2008, respectively.

The Company has net operating loss carryforwards for federal and state tax purposes totaling approximately $20.7 million, $8.0 million, and $14.9 million at December 31, 2010, 2009 and 2008, respectively, expiring at various times commencing in 2014. The increase in net operating loss carryforwards of $12.7 million in 2010 and the decrease of $6.9 million in 2009 are primarily due to timing differences related to the recognition of income for tax purposes associated with physician practice acquisitions.

As of December 31, 2010, 2009 and 2008, the Company's liability for uncertain tax positions, excluding accrued interest and penalties, was $22.3 million, $49.4 million and $47.6 million, respectively. The Company had approximately $12.3 million of uncertain tax positions that, if recognized, would favorably impact its effective tax rate at December 31, 2010.

During the third quarter of 2010, the Company reached a resolution with taxing authorities on certain income tax matters that were under review. In connection with this resolution, the Company recorded a reduction in reserves for uncertain tax positions of $9.6 million, excluding interest of $4.7 million, and also recorded a reduction in its income tax provision of $10.9 million. In addition, the resolution resulted in an increase in additional paid-in capital of $3.4 million for excess tax benefits related to stock-based awards, which increased the Company's cash flow from financing activities.

The following table summarizes the activity related to the Company's liability for uncertain tax positions for the years ended December 31, 2010, 2009 and 2008 (in thousands):


	Years Ended December 31,
	2010			2009			2008
Balance at beginning of year	$	49,416		$	47,562		$	29,769
Increases related to prior year tax positions		948			—			16,574
Decreases related to prior year tax positions		(9,569	)		(1,051	)		(4,227	)
Increases related to current year tax positions		2,334			5,867			9,815
Decreases related to current year tax positions		(19,035	)		—			—
Settlements		(500	)		(2,191	)		(3,556	)
Decreases related to lapse of statutes of limitations		(1,304	)		(771	)		(813	)

Balance at end of year	$	22,290		$	49,416		$	47,562

During the 12 months ended December 31, 2010, the Company decreased its liability for uncertain tax positions by a total of $27.1 million, of which $19.0 million related to reclassifications of certain temporary differences to deferred taxes payable and $9.6 million related to the resolution reached with taxing authorities discussed above. During the 12 months ended December 31, 2009, the Company increased its liability for uncertain tax positions by a total of $1.9 million, which is primarily related to changes in temporary differences, partially offset by settlements.

The Company includes interest and penalties related to income tax liabilities in income tax expense. The Company recognized $1.7 million, $2.5 million and $3.2 million, respectively, of interest and penalties related to income tax liabilities during the years ended December 31, 2010, 2009 and 2008. The Company also recorded a reduction in interest expense of $4.7 million during the year ended December 31, 2010 in connection with the resolution of income tax matters discussed above. At December 31, 2010 and 2009, the Company's accrued liability for interest and penalties related to income tax liabilities totaled $8.3 million and $11.3 million, respectively.

At December 31, 2010, accounts payable and accrued expenses and other liabilities as presented in the Company's Consolidated Balance Sheet include $10.9 million and $19.7 million, respectively, related to the Company's total liability for uncertain tax positions of $30.6 million. At December 31, 2009, accounts payable and accrued expenses and other liabilities as presented in the Company's Consolidated Balance Sheet include $40.9 million and $19.8 million, respectively, related to the Company's total liability for uncertain tax positions of $60.7 million.

The Company's liability for uncertain tax positions could be reduced over the next 12 months by approximately $1.5 million, excluding accrued interest, due to the expiration of statutes of limitation. Additionally, the Company anticipates that its liability for uncertain tax positions will be increased over the next 12 months by additional taxes of approximately $2.3 million. Although the Company anticipates additional changes in its liability for uncertain tax positions related to certain temporary differences, an estimate of the range of such changes cannot be made at this time.

The Company is currently subject to U.S. Federal and various state income tax examinations for the tax years 2004 through 2009.

Common and Common Equivalent Shares

12 Months Ended

Dec. 31, 2010

Common and Common Equivalent Shares

Common and Common Equivalent Shares

12.

Common and Common Equivalent Shares:

The calculation of shares used in the basic and diluted net income per share calculation for the years ended December 31, 2010, 2009 and 2008 is as follows (in thousands):


	Years Ended December 31,
	2010		2009		2008
Weighted average number of common shares outstanding		46,630		45,573		46,121
Weighted average number of dilutive common share equivalents		940		898		1,040

Weighted average number of common and common equivalent shares outstanding		47,570		46,471		47,161

Antidilutive securities not included in the diluted earnings per share calculation		464		2,348		1,625

Stock Incentive Plans and Stock Purchase Plan

12 Months Ended

Dec. 31, 2010

Stock Incentive Plans and Stock Purchase Plan

Stock Incentive Plans and Stock Purchase Plan

13.

Stock Incentive Plans and Stock Purchase Plan:

The Company's 2008 Incentive Compensation Plan (the "2008 Incentive Plan") provides for grants of stock options, stock appreciation rights, restricted stock, deferred stock, and other stock-related awards and performance awards that may be settled in cash, stock or other property. As provided in the 2008 Incentive Plan, no additional grants can be made from the Company's prior incentive plans, except that new awards will be permitted under the 2004 Incentive Compensation Plan (the "2004 Incentive Plan") to the extent that shares previously granted under the 2004 Incentive Plan are forfeited, expire or terminate. Under the 2008 Incentive Plan, a total of six million shares were available for the granting of awards, inclusive of the number of shares remaining available for grant under the 2004 Incentive Plan as of May 23, 2008. To date, the only equity awards made by the Company under the 2008 Incentive Plan are for stock options, restricted stock and deferred stock. Collectively, the Company's prior incentive plans and the 2008 Incentive Plan are referred to as the Stock Incentive Plans.

Under the 2008 Incentive Plan, options to purchase shares of common stock may be granted at a price not less than the fair market value of the shares on the date of grant. The options must be exercised within 10 years from the date of grant and generally become exercisable on a pro rata basis over a three-year period from the date of grant. The Company issues new shares of its common stock upon exercise of its stock options. Restricted stock awards generally vest over periods of three years upon the fulfillment of specified service-based conditions and in certain instances performance-based conditions. Deferred stock awards vest on a cliff basis over a term of five years upon the fulfillment of specified service-based and performance-based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. At December 31, 2010, the Company had approximately 2.2 million shares available for future grants and awards under its Stock Incentive Plans.

In September 2008, the Company's shareholders approved an amendment to the Company's 1996 Non-Qualified Employee Stock Purchase Plan (the "Non-Qualified Plan") to increase the number of shares issuable under the Non-Qualified Plan from 1.5 million to 2.5 million shares. The approved amendment also expanded participation in the Non-Qualified Plan to all employees who formerly participated in the 1996 Qualified Employee Stock Purchase Plan, which was terminated in August 2008. Under the Non-Qualified Plan, employees are permitted to purchase the Company's common stock at 85% of market value on January 1st, April 1st, July 1st and October 1st of each year. In accordance with the provisions of accounting guidance for stock-based compensation, the Company recognizes stock-based compensation expense for the 15% discount received by participating employees. During the year ended December 31, 2010, 128,158 shares were issued under the Non-Qualified Plan. At December 31, 2010, the Company had approximately 674,000 shares reserved for issuance under the Non-Qualified Plan.

The Company recognized approximately $25.7 million, $24.3 million and $20.8 million of stock-based compensation expense related to its Stock Incentive Plans and Stock Purchase Plan during the years ended December 31, 2010, 2009 and 2008, respectively. The after-tax impact of stock-based compensation expense on net income was approximately $16.7 million, $14.9 million and $12.6 million for the years ended December 31, 2010, 2009 and 2008, respectively.

The activity related to the Company's restricted and deferred stock awards and the corresponding weighted average grant-date fair values are as follows:


	Number of Shares			Weighted Average Fair Value
Non-vested shares at December 31, 2007		470,700		$	46.23
Awarded		325,748		$	54.40
Forfeited		(6,950	)	$	49.65
Vested		(296,811	)	$	42.84

Non-vested shares at December 31, 2008		492,687		$	53.63
Awarded		552,632		$	41.74
Forfeited		(25,764	)	$	45.44
Vested		(188,222	)	$	51.65

Non-vested shares at December 31, 2009		831,333		$	46.43
Awarded		436,756		$	54.90
Forfeited		(8,086	)	$	46.12
Vested		(304,554	)	$	47.13

Non-vested shares at December 31, 2010		955,449		$	50.08

The aggregate fair value of the restricted shares that vested during the years ended December 31, 2010, 2009 and 2008 was approximately $14.4 million, $9.7 million and $12.7 million, respectively.

At December 31, 2010, the total stock-based compensation cost related to non-vested restricted and deferred stock remaining to be recognized as compensation expense over a weighted-average period of approximately 1.6 years was $22.7 million.

The Company uses the Black-Scholes Model to estimate the fair value of each stock option on the date of grant. The weighted average grant-date fair values for stock options granted during the years ended December 31, 2010, 2009 and 2008 were $18.89, $12.19 and $12.97, respectively, which were calculated using the following weighted average assumptions for expected volatility, expected life, risk-free interest rate and dividend yield:


	Years Ended December 31,
	2010	2009	2008
Expected volatility	35%	32% to 37	23% to 29
Expected life—officers (in years)	4.5	4.5	4.5
Expected life—other employees (in years)	3.5	3.5	3.5
Risk-free interest rate	2.1% to 2.3	1.4% to 2.1	2.1% to 3.3
Dividend yield	0%	0%	0%

Expected volatility is estimated using sequential periods of historical price data related to the Company's common stock. The Company assigns expected lives and corresponding risk-free interest rates to two separate homogenous employee groups consisting of officers and all other employees. The Company evaluates the estimated expected lives assigned to its two employee groups, officers and other employees, using historical exercise data, taking into consideration the impact of partial life cycle data, contractual term and post-vesting cancellations. The risk-free interest rates used are based on the published U.S. Treasury yield curve in effect at the time of the grant for instruments with a similar life. The dividend yield reflects the Company's dividend yield at the date of grant.

The activity and certain other information related to the Company's stock option awards are as follows:


	Number of Shares			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (in years)		Aggregate Intrinsic Value (in millions)
Outstanding at December 31, 2007		2,906,614		$	34.31
Granted		773,972		$	54.91
Canceled		(22,160	)	$	48.74
Exercised		(231,337	)	$	23.61			$	9.3

Outstanding at December 31, 2008		3,427,089		$	39.59
Granted		162,269		$	40.76
Canceled		(38,992	)	$	56.61
Exercised		(617,612	)	$	20.17			$	21.8

Outstanding at December 31, 2009		2,932,754		$	43.52
Granted		60,747		$	58.26
Canceled		(8,667	)	$	61.27
Exercised		(416,901	)	$	39.25			$	9.1

Outstanding at December 31, 2010		2,567,933		$	44.50		5.6	$	58.5

Exercisable at December 31, 2010		2,133,802		$	43.04		5.2	$	51.7

At December 31, 2010, the total stock-based compensation cost related to non-vested stock options remaining to be recognized as compensation expense over a weighted-average period of approximately 1.1 years was $1.6 million.

The excess tax benefit related primarily to stock options and restricted stock for the years ended December 31, 2010, 2009 and 2008 was approximately $3.0 million, $6.9 million and $4.3 million, respectively. The cash proceeds received from the exercise of stock options for the years ended December 31, 2010, 2009 and 2008 were approximately $16.4 million, $12.5 million and $5.5 million, respectively.

Retirement Plans

12 Months Ended

Dec. 31, 2010

Retirement Plans

Retirement Plans

14.

Retirement Plans:

The Company maintains four qualified contributory savings plans as allowed under Section 401(k) of the Internal Revenue Code and Section 1165(e) of the Puerto Rico Income Tax Act of 1954 (the "401(k) Plans"). The 401(k) Plans permit participant contributions and allow elective and, in certain situations, non-elective Company contributions based on each participant's contribution or a specified percentage of eligible wages. Participants may defer a percentage of their annual compensation subject to the limits defined in the 401(k) Plans. The Company recorded an expense of $18.2 million, $16.1 million and $13.2 million for the years ended December 31, 2010, 2009 and 2008, respectively, related to the 401(k) Plans.

- Definition

Description containing the entire pension and other postretirement benefits disclosure as a single block of text.

+ References

Reference 1: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 158

-Paragraph 7, 21, 22

Reference 2: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 132R

-Paragraph 5, 6, 7, 8

Reference 3: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 132R

-Paragraph 8

-Subparagraph m

Reference 4: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 106

-Paragraph 518

Reference 5: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 87

-Paragraph 264

Reference 6: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 132R

-Paragraph 5

-Subparagraph b

Reference 7: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 132R

-Paragraph 5

-Subparagraph a

Reference 8: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 132R

-Paragraph 5

-Subparagraph h

Reference 9: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Statement of Financial Accounting Standard (FAS)

-Number 132R

-Paragraph 5

-Subparagraph q

Reference 10: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name FASB Staff Position (FSP)

-Number FAS106-2

-Paragraph 20, 21, 22

Reference 11: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Emerging Issues Task Force (EITF)

-Number 03-2

-Paragraph 8

Reference 12: http://www.xbrl.org/2003/role/presentationRef

-Publisher AICPA

-Name Accounting Principles Board Opinion (APB)

-Number 30

-Paragraph 26

Reference 13: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Implementation Guide (Q and A)

-Number FAS88

-Paragraph 63

+ Details

Commitments and Contingencies

12 Months Ended

Dec. 31, 2010

Commitments and Contingencies

Commitments and Contingencies

15.

Commitments and Contingencies:

In September 2006, the Company entered into a settlement agreement with the Department of Justice and a relator who initiated a "qui tam" complaint against the Company relating to its billing practices for services provided from January 1996 through December 1999 that were reimbursed by Medicaid, the Federal Employees Health Benefit program, and the United States Department of Defense's TRICARE program for military dependents and retirees ("Settlement Agreement"). As part of the Settlement Agreement, the Company is in the final year of a five-year Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services (the "OIG"). The Corporate Integrity Agreement acknowledges the existence of the Company's comprehensive Compliance Plan, which provides for policies and procedures aimed at promoting the Company's adherence with FHC Program requirements and requires the Company to maintain the Compliance Plan in full operation for the term of the Corporate Integrity Agreement. In addition, the Corporate Integrity Agreement requires, among other things, that the Company must comply with the following integrity obligations during the term of the Corporate Integrity Agreement:

•

maintaining a Chief Compliance Officer and Compliance Committee to administer compliance with FHC Program requirements, the Compliance Plan and the Corporate Integrity Agreement;

•

maintaining the Code of Conduct for the Company's officers, directors, employees, contractors, subcontractors, agents, or other persons who provide patient care items or services (the "Covered Persons");

•

maintaining the written policies and procedures regarding the operation of the Compliance Plan and the Company's compliance with FHC Program requirements;

•

providing general compliance training to the Covered Persons as well as specific training to the Covered Persons who perform coding functions relating to claims for reimbursement from any FHC Program;

•

engaging an independent review organization to perform annual reviews of samples of claims from multiple hospital units to assist the Company in assessing and evaluating its coding, billing, and claims-submission practices;

•

maintaining the Disclosure Program that includes a mechanism to enable individuals to confidentially disclose issues or questions believed by the individual to be a potential violation of criminal, civil, or administrative laws;

•

not hiring or, if employed, removing from the Company's business operations which are related to or compensated, in whole or part, by FHC Programs, persons (i) convicted of a criminal offense related to the provision of healthcare items or services or (ii) ineligible to participate in FHC Programs or Federal procurement or non-procurement programs;

•

notifying the OIG of (i) new investigations or legal proceedings by a governmental entity or its agents involving an allegation that the Company has committed a crime or has engaged in fraudulent activities, (ii) matters that a reasonable person would consider a probable violation of criminal, civil or administrative laws applicable to any FHC Program for which penalties or exclusion may be imposed, and (iii) the purchase, sale, closure, establishment, or relocation of any facility furnishing items or services that are reimbursed under FHC Programs;

•

reporting and returning overpayments received from FHC Programs;

•

submitting reports to the OIG regarding the Company's compliance with the Corporate Integrity Agreement; and

•

maintaining for inspection, for a period of six years from the effective date, all documents and records relating to reimbursement from the FHC Programs and compliance with the Corporate Integrity Agreement.

Failure to comply with the Company's duties under the Corporate Integrity Agreement could result in substantial monetary penalties and in the case of a material breach, could even result in the Company being excluded from participating in FHC Programs. Management believes that the Company was in compliance with the Corporate Integrity Agreement as of December 31, 2010.

In July 2007, the Audit Committee of the Company's Board of Directors concluded a comprehensive review of the Company's historical practices related to the granting of stock options. In connection with the review, the Company had discussions with the U.S. Attorney's office for the Southern District of Florida concerning the matters covered by the review and, in response to a subpoena received in December 2007, provided the office with various documents and information related to the Company's stock option granting practices. The Company intends to fully cooperate with the U.S. Attorney's office if there is any additional activity with respect to this matter. In March 2009, the Company settled an investigation by the Securities and Exchange Commission relating to this matter by entering into a consent decree.

The Company expects that additional audits, inquiries and investigations from government authorities and agencies will continue to occur in the ordinary course of business. Such audits, inquiries and investigations and their ultimate resolutions, individually or in the aggregate, could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its common stock.

In the ordinary course of business, the Company becomes involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services provided by the Company's affiliated physicians. The Company's contracts with hospitals generally require the Company to indemnify them and their affiliates for losses resulting from the negligence of the Company's affiliated physicians. The Company may also become subject to other lawsuits which could involve large claims and significant defense costs. The Company believes, based upon a review of pending actions and proceedings, that the outcome of such legal actions and proceedings will not have a material adverse effect on its business, financial condition or results of operations. The outcome of such actions and proceedings, however, cannot be predicted with certainty and an unfavorable resolution of one or more of them could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its common stock.

Although the Company currently maintains liability insurance coverage intended to cover professional liability and certain other claims, the Company cannot assure that its insurance coverage will be adequate to cover liabilities arising out of claims asserted against it in the future where the outcomes of such claims are unfavorable. With respect to professional liability risk, the Company generally self-insures a portion of this risk through its wholly owned captive insurance subsidiary. Liabilities in excess of the Company's insurance coverage, including coverage for professional liability and certain other claims, could have a material adverse effect on the Company's business, financial condition and results of operations. See "Professional and General Liability Coverage" in Item 1 of this Form 10-K.

The Company leases space for certain corporate offices and its regional offices and medical offices, storage space and temporary housing of medical staff. Rent expense for the years ended December 31, 2010, 2009 and 2008 was approximately $19.8 million, $18.1 million, and $14.3 million, respectively.

Future minimum lease payments under non-cancelable operating leases as of December 31, 2010 are as follows (in thousands):


2011	$	18,198
2012		13,748
2013		10,552
2014		8,267
2015		4,728
Thereafter		2,498

	$	57,991

Selected Quarterly Financial Information

12 Months Ended

Dec. 31, 2010

Selected Quarterly Financial Information

Selected Quarterly Financial Information

16.

Selected Quarterly Financial Information (Unaudited):

The following tables set forth a summary of the Company's selected quarterly financial information for each of the four quarters ended December 31, 2010 and 2009 (in thousands, except for per share data):


	2010 Quarters
	First			Second			Third			Fourth
Net patient service revenue	$	332,927		$	349,094		$	351,058		$	368,480

Operating expenses:
Practice salaries and benefits		213,402			208,762			211,884			220,872
Practice supplies and other operating expenses		13,095			14,062			13,980			16,374
General and administrative expenses		38,099			39,164			37,499			39,505
Depreciation and amortization		4,780			5,006			6,321			5,843

Total operating expenses		269,376			266,994			269,684			282,594

Income from operations		63,551			82,100			81,374			85,886

Investment income		404			265			438			327
Interest expense		(710	)		(1,118	)		(481	)		(884	)

Income before income taxes		63,245			81,247			81,331			85,329

Income tax provision		24,982			31,889			20,061			31,529

Net income	$	38,263		$	49,358		$	61,270		$	53,800

Per common and common equivalent share data (1):
Net income:
Basic	$	0.83		$	1.06		$	1.31		$	1.15

Diluted	$	0.81		$	1.04		$	1.29		$	1.12

Weighted average shares:
Basic		46,300			46,516			46,788			46,914

Diluted		47,267			47,528			47,482			47,998

(1)	Basic and diluted per share amounts are computed for each of the periods presented. Accordingly, the sum of the quarterly per share amounts may not agree with the full year amount.


	2009 Quarters
	First			Second			Third			Fourth
Net patient service revenue	$	303,885		$	319,815		$	331,276		$	333,288

Operating expenses:
Practice salaries and benefits		194,008			191,756			198,229			199,500
Practice supplies and other operating expenses		12,641			12,798			13,100			13,693
General and administrative expenses		36,650			36,295			37,648			36,569
Depreciation and amortization		3,963			4,187			3,956			4,342

Total operating expenses		247,262			245,036			252,933			254,104

Income from operations		56,623			74,779			78,343			79,184

Investment income		441			429			430			382
Interest expense		(1,011	)		(824	)		(570	)		(506	)

Income before income taxes		56,053			74,384			78,203			79,060

Income tax provision		22,001			31,167			30,069			28,659

Net income	$	34,052		$	43,217		$	48,134		$	50,401

Per common and common equivalent share data (1):
Net income:
Basic	$	0.75		$	0.95		$	1.05		$	1.10

Diluted	$	0.74		$	0.93		$	1.03		$	1.07

Weighted average shares:
Basic		45,282			45,446			45,663			45,918

Diluted		45,931			46,253			46,664			47,054

(1)	Basic and diluted per share amounts are computed for each of the periods presented. Accordingly, the sum of the quarterly per share amounts may not agree with the full year amount.

- Definition

This element can be used to disclose the entire quarterly financial data disclosure in the annual financial statements as a single block of text. The disclosure includes a tabular presentation of financial information for each fiscal quarter for the current and previous year, including revenues, gross profit, income (loss) before extraordinary items and cumulative effect of a change in accounting principle and earnings per share data. It also includes an indication if the information in the note is unaudited, comments on the aggregate effect of year-end adjustments, and an explanation of matters or transactions that affect comparability or are pertinent to an understanding of the information furnished. Alternatively, the details of this disclosure can be reported using the elements in this group, or by using other taxonomy elements and applying the appropriate quarterly date and period contexts when creating an instance document. For example, the element for "Interest and Dividend Income, Operating" may be used by financial institutions from the Statement of Income, applying the appropriate quarterly date and period context when creating an instance document.

+ References+ Details

Schedule II: Valuation and Qualifying Accounts

12 Months Ended

Dec. 31, 2010

Schedule II: Valuation and Qualifying Accounts

Schedule II: Valuation and Qualifying Accounts

Schedule II: Valuation and Qualifying Accounts


	Years Ended December 31,
	2010			2009			2008
Allowance for contractual adjustments and uncollectibles:
Balance at beginning of year	$	377,506		$	369,446		$	313,131
Amount charged against operating revenue		2,825,827			2,444,222			2,006,415
Accounts receivable contractual adjustments and write-offs (net of recoveries)		(2,781,356	)		(2,436,162	)		(1,950,100	)

Balance at end of year	$	421,977		$	377,506		$	369,446