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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
3 Months Ended 6 Months Ended
Jun. 30, 2018
Jun. 30, 2019
Jun. 30, 2018
Cash flows (used in) provided by operating activities:      
Net income (loss) $ 12,928 $ 3,084 $ (9,690)
Adjustments to reconcile net income (loss) to net cash (used in) provided by operating activities:      
Depreciation and amortization 9,272 17,533 18,602
Amortization of right-of-use assets   18,289  
Provision (benefit) for doubtful accounts   304 (602)
Stock-based compensation expense   6,715 5,906
Deferred income taxes   779 (6,511)
Amortization of debt discounts and issuance costs   797 2,186
Loss on extinguishment of debt     16,998
Gain on sale and disposal of fixed assets   (792) (1,349)
Changes in operating assets and liabilities (Note T)   (50,248) (8,632)
Net cash provided by operating activities   (3,539) 16,908
Cash flows used in investing activities      
Purchase of property, plant, and equipment   (14,806) (11,322)
Purchase of therapeutic program equipment leased to third parties under operating leases   (3,530) (3,822)
Acquisitions, net of cash acquired   (27,916)  
Purchase of company-owned life insurance investment     (598)
Proceeds from sale of property, plant and equipment   1,476 1,682
Net cash used in investing activities   (44,776) (14,060)
Cash flows (used in ) provided by financing activities      
Borrowings under term loan, net of discount     500,204
Repayment of term loan   (2,525) (431,875)
Borrowings under revolving credit agreement     3,000
Repayments under revolving credit agreement     (8,000)
Payment of employee taxes on stock-based compensation   (3,654) (2,463)
Payment on seller notes   (2,162) (1,765)
Payment of financing lease obligations   (229) (682)
Payment of debt issuance costs     (6,487)
Payment of debt extinguishment costs     (8,436)
Net cash (used in) provided by financing activities   (8,570) 43,496
(Decrease) increase in cash, cash equivalents, and restricted cash   (56,885) 46,344
Cash, cash equivalents, and restricted cash, at beginning of period   95,114 4,779
Cash, cash equivalents, and restricted cash, at end of period 51,123 38,229 51,123
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 48,792 38,229 48,792
Restricted cash, at end of period 2,331   2,331
Cash, cash equivalents, and restricted cash, at end of period $ 51,123 $ 38,229 $ 51,123