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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS $ in Thousands | 6 Months Ended
--- | ---
Jun. 30, 2021 USD ($) | Jun. 30, 2020 USD ($)
CASH FLOWS FROM OPERATING ACTIVITIES |  |
Net (loss) income | $ 21,862 | $ (22,958)
Adjustments to reconcile net income (loss) to net cash provided by operating activities: |  |
Depreciation and amortization | 46,667 | 43,289
Amortization of operating lease right-of-use assets | 36,834 | 34,094
Equity in earnings of joint ventures, net of dividends | (5,406) | (2,900)
Amortization of deferred financing costs and loan discount | 1,959 | 2,163
(Gain) loss on sale and disposal of equipment and other | (2,874) | 202
Loss on extinguishment of debt | 1,496 | 0
Amortization of cash flow hedge, net of taxes | 1,845 | 892
Non-cash change in fair value of interest rate hedge | (11,280) | 3,843
Stock-based compensation | 17,145 | 8,078
Change in fair value of contingent consideration | 1,292 | (97)
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions: |  |
Accounts receivable | (28,156) | 29,018
Other current assets | 2,963 | 9,884
Other assets | (4,997) | (4,257)
Deferred taxes | 5,297 | (11,678)
Operating lease liability | (36,564) | (30,182)
Deferred revenue | (7,147) | 44,384
Accounts payable, accrued expenses and other | 17,765 | 27,690
Net cash provided by operating activities | 58,701 | 131,465
CASH FLOWS FROM INVESTING ACTIVITIES |  |
Purchase of imaging facilities and other acquisitions | (64,918) | (4,188)
Purchase of property and equipment | (53,799) | (64,193)
Proceeds from sale of equipment | 500 | 779
Equity contributions in existing and purchase of interest in joint ventures | (1,441) | 0
Net cash used in investing activities | (119,658) | (67,602)
CASH FLOWS FROM FINANCING ACTIVITIES |  |
Principal payments on notes and leases payable | (3,304) | (1,814)
Payments on term loan debt | (613,279) | (21,648)
Proceeds from debt refinancing, net of issuing costs | 716,369 | 0
Proceeds from paycheck protection program loans | 0 | 4,023
Proceeds from revolving credit facility | 128,300 | 250,900
Payments on revolving credit facility | (128,300) | (250,900)
Proceeds from issuance of common stock upon exercise of options | 26 | 0
Net cash provided by (used in) financing activities | 99,812 | (19,439)
EFFECT OF EXCHANGE RATE CHANGES ON CASH | (21) | (6)
NET INCREASE IN CASH AND CASH EQUIVALENTS | 38,834 | 44,418
CASH AND CASH EQUIVALENTS, beginning of period | 102,018 | 40,165
CASH AND CASH EQUIVALENTS, end of period | 140,852 | 84,583
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION |  |
Cash paid during the period for interest | 13,774 | 22,826
Equipment acquired and leasehold improvements | 42,100 | $ 31,800
Investment in joint ventures | $ 41,375 |

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