CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income (loss)	$ (25,221)	$ 9,656
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization	70,458	68,507
Gain on sale of business	(508)
Loss on sales and/or abandonment of property and equipment	1,303	637
Write-off of certain intangible assets and other long-term assets	28,409	3,492
Acquired in-process research and development		525
Amortization of right-of-use operating lease assets	9,522	9,226
Fair value adjustments to contingent consideration	884	3,573
Amortization of deferred credits	(103)	(104)
Amortization of long-term debt issuance costs	453	570
Stock-based compensation expense	10,268	6,915
Changes in operating assets and liabilities, net of acquisitions and divestitures:
Trade receivables	13,049	(6,786)
Other receivables	1,170	(29)
Inventories	15,668	(19,302)
Prepaid expenses and other current assets	(3,929)	(3,859)
Prepaid income taxes	(35)
Income tax refund receivables	(8,666)	(8,680)
Other assets	(1,088)	(3,832)
Trade payables	(2,682)	(3,775)
Accrued expenses	22,591	1,678
Income taxes payable	1,079	(928)
Deferred compensation payable	541	2,276
Operating lease liabilities	(9,398)	(8,956)
Other long-term obligations	4,590	100
Total adjustments	153,576	41,248
Net cash provided by operating activities	128,355	50,904
Capital expenditures for:
Property and equipment	(35,590)	(58,104)
Intangible assets	(2,499)	(2,560)
Proceeds from the sale of property and equipment	33	262
Proceeds from sale of business	1,285
Cash received for settlement of current note receivable	250
Cash paid in acquisitions, net of cash acquired	(260)	(53,512)
Net cash used in investing activities	(36,781)	(113,914)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of common stock	4,954	5,863
Proceeds from issuance of long-term debt	46,051	194,477
Payments on long-term debt	(128,306)	(149,477)
Long-term debt issuance costs		(1,479)
Contingent payments related to acquisitions	(12,991)	(15,684)
Payment of taxes related to an exchange of common stock	(866)
Net cash provided by (used in) financing activities	(91,158)	33,700
EFFECT OF EXCHANGE RATES ON CASH	(185)	(734)
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS	231	(30,044)
CASH AND CASH EQUIVALENTS:
Beginning of period	44,320	67,359
End of period	44,551	37,315
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Interest (net of capitalized interest of $679 and $896, respectively)	8,138	9,319
Income taxes	6,449	10,071
SUPPLEMENTAL DISCLOSURES OF NON-CASH INVESTING AND FINANCING ACTIVITIES
Property and equipment purchases in accounts payable	2,726	7,481
Current note receivable converted to equity investment	899
Proceeds from sale of business in other receivables	321
Acquisition purchases in accrued expenses and other long-term obligations		9,583
Merit common stock surrendered (39 and 3 shares, respectively) in exchange for exercise of stock options	1,467	93
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 7,285	$ 7,431