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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
3 Months Ended
Mar. 31, 2019
Mar. 31, 2018
Cash flow used in operating activities:    
Net loss $ (6,951) $ (22,618)
Adjustments to reconcile net loss to net cash used in operating activities:    
Depreciation and amortization 8,773 9,330
Amortization of right-of-use assets 9,161  
Benefit for doubtful accounts (20) (94)
Stock-based compensation expense 3,265 2,585
Deferred income taxes (3,749) (6,355)
Amortization of debt discounts and issuance costs 375 1,701
Loss on extinguishment of debt   16,998
Gain on sale and disposal of fixed assets (481) (594)
Changes in operating assets and liabilities (Note T) (43,173) (9,426)
Net cash used in operating activities (32,800) (8,473)
Cash flows used in investing activities    
Purchase of property, plant, and equipment (6,897) (4,388)
Purchase of therapeutic program equipment leased to third parties under operating leases (1,429) (2,034)
Acquisitions, net of cash acquired (27,679)  
Purchase of company-owned life insurance investment   (598)
Proceeds from sale of property, plant and equipment 980 840
Net cash used in investing activities (35,025) (6,180)
Cash flows (used in ) provided by financing activities    
Borrowings under term loan, net of discount   501,467
Repayment of term loan (1,263) (431,875)
Borrowings under revolving credit agreement   3,000
Repayments under revolving credit agreement   (8,000)
Payment of employee taxes on stock-based compensation (3,626) (2,150)
Payment on seller notes (1,773) (1,749)
Payment of financing lease obligations (116) (364)
Payment of debt issuance costs   (6,757)
Payment of debt extinguishment costs   (8,436)
Net cash (used in) provided by financing activities (6,778) 45,136
(Decrease) increase in cash, cash equivalents and restricted cash (74,603) 30,483
Cash, cash equivalents, and restricted cash, at beginning of period 95,114 4,779
Cash, cash equivalents, and restricted cash, at end of period 20,511 35,262
Reconciliation of Cash, Cash Equivalents, and Restricted Cash:    
Cash and cash equivalents, at beginning of period 95,114 1,508
Restricted cash, at beginning of period   3,271
Cash, cash equivalents, and restricted cash, at beginning of period 95,114 4,779
Cash and cash equivalents, at end of period 20,511 32,913
Restricted cash, at end of period   2,349
Cash, cash equivalents, and restricted cash, at end of period $ 20,511 $ 35,262