CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
Sep. 30, 2018	Sep. 30, 2017
Cash flows from operating activities:
Net loss	$ (5,321)	$ (20,258)
Adjustments to reconcile net loss to net cash from operating activities:
Depreciation and amortization	27,552	29,594
(Benefit) provision for doubtful accounts	(578)	6,850
Stock-based compensation expense	9,573	8,693
Deferred income taxes	(4,114)	(7,179)
Amortization of discounts discounts and debt issuance costs	2,453	6,348
Loss on extinguishment of debt	16,998
Gain on sale and disposal of fixed assets	(2,537)	(1,664)
Changes in operating assets and liabilities (Note Q)	(6,867)	(23,392)
Net cash provided by (used in) operating activities	37,159	(1,008)
Cash flows from investing activities:
Purchase of property, plant and equipment	(16,435)	(11,237)
Purchase of therapeutic program equipment leased to third parties under operating leases	(6,390)	(3,714)
Purchase of company-owned life insurance investment	(598)	(555)
Proceeds from sale of property, plant and equipment	3,583	4,185
Net cash used in investing activities	(19,840)	(11,321)
Cash flows from financing activities:
Borrowings under term loan, net of discount	501,467
Repayment of term loan	(434,400)	(19,688)
Borrowings under revolving credit agreement	3,000	140,965
Repayments under revolving credit agreement	(8,000)	(105,965)
Payment of employee taxes on stock-based compensation	(2,568)	(1,367)
Payment on seller notes	(2,116)	(4,633)
Payment of capital lease obligations	(942)	(873)
Payment of debt issuance costs	(6,757)	(2,863)
Payment of debt extinguishment costs	(8,436)
Net cash provided by financing activities	41,248	5,576
Increase (decrease) in cash, cash equivalents and restricted cash	58,567	(6,753)
Cash, cash equivalents and restricted cash, at beginning of period	4,779	9,412
Cash, cash equivalents and restricted cash, at end of period	63,346	2,659
Reconciliation of Cash, Cash Equivalents and Restricted Cash
Cash and cash equivalents, at beginning of period	1,508	7,157
Restricted cash, at beginning of period	3,271	2,255
Cash, cash equivalents and restricted cash, at beginning of period	4,779	9,412
Cash and cash equivalents, at end of period	61,035	460
Restricted cash, at end of period	2,311	2,199
Cash, cash equivalents and restricted cash, at end of period	$ 63,346	$ 2,659

The cash outflow associated with the purchase of equipment leased to third parties under operating leases.

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- Definition

The cash outflow for debt initially having maturity due after one year or beyond the normal operating cycle, if longer.

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- Definition

The cash outflow for the settlement of obligation drawn from a contractual arrangement with the lender, including letter of credit, standby letter of credit and revolving credit arrangements, under which borrowings can be made up to a specific amount at any point in time with maturities due beyond one year or the operating cycle, if longer.

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Amount of cash and cash equivalents restricted as to withdrawal or usage. Cash includes, but is not limited to, currency on hand, demand deposits with banks or financial institutions, and other accounts with general characteristics of demand deposits. Cash equivalents include, but are not limited to, short-term, highly liquid investments that are both readily convertible to known amounts of cash and so near their maturity that they present insignificant risk of changes in value because of changes in interest rates.

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-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 210
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-03(a)(2))
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-Topic 210
-SubTopic 10
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-Paragraph 1
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-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 210
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-Subparagraph (SX 210.9-03(1)(a))
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-Topic 230
-SubTopic 10
-Section 45
-Paragraph 4
-URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3044-108585

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The aggregate amount of noncash, equity-based employee remuneration. This may include the value of stock or unit options, amortization of restricted stock or units, and adjustment for officers' compensation. As noncash, this element is an add back when calculating net cash generated by operating activities using the indirect method.

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-SubTopic 10
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-Paragraph 28
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