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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019
CASH FLOWS FROM OPERATING ACTIVITIES |  |  |
Net income (loss) | $ 44,319 | $ (1,749) | $ 23,440
Adjustments to reconcile net income (loss) to net cash provided by operating activities: |  |  |
Depreciation and amortization | 96,694 | 86,795 | 80,607
Amortization of operating lease right-of-use assets | 73,967 | 67,915 | 66,842
Lease abandonment charges | 19,675 | 0 | 0
Equity in earnings of joint ventures, net of dividends | (6,260) | 1,577 | 248
Amortization and write off of deferred financing costs and loan discount | 3,254 | 4,413 | 4,184
Loss on sale and disposal of equipment and other | 1,246 | 1,200 | 2,383
Loss (gain) on extinguishment of debt | 1,496 | (4,047) | 0
Gain on re-measurement of pre-existing interest | 0 | 0 | (768)
Loss on impairment | 0 | 4,170 | 0
Amortization of cash flow hedge | 3,695 | 3,448 | 0
Non-cash change in fair value of interest rate hedge | (21,670) | 2,528 | 0
Stock-based compensation | 25,203 | 12,405 | 8,730
Other non cash item in other expenses | 0 | 242 | (371)
Change in value of contingent consideration | 0 | 0 | (3,123)
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions: |  |  |
Accounts receivable | (5,890) | 25,206 | (17,482)
Other current assets | (15,777) | 6,588 | (3,557)
Other assets | 662 | (5,425) | (2,326)
Deferred taxes | 19,834 | (611) | (3,888)
Operating lease liability | (72,553) | (53,906) | (66,831)
Deferred revenue | (28,319) | 37,941 | (1,082)
Accounts payable, accrued expenses and other liabilities | 9,915 | 45,069 | 17,316
Net cash provided by operating activities | 149,491 | 233,759 | 104,322
CASH FLOWS FROM INVESTING ACTIVITIES |  |  |
Purchase of imaging facilities | (77,691) | (31,265) | (27,150)
Equity investments at fair value | 0 | 0 | (143)
Purchase of property and equipment | (137,874) | (94,172) | (74,153)
Purchase of intangible assets | (5,130) | 0 | 0
Proceeds from sale of equipment | 625 | 828 | 1,160
Proceeds from the sale of equity interests in a joint venture | 0 | 0 | 132
Nulogix return of capital | 0 | 0 | 792
Equity contributions in existing and purchase of interest in joint ventures | (1,441) | (1,635) | (103)
Net cash used in investing activities | (221,511) | (126,244) | (99,465)
CASH FLOWS FROM FINANCING ACTIVITIES |  |  |
Principal payments on notes and leases payable | (3,302) | (3,562) | (6,494)
Payments on term loan debt | (619,529) | (43,296) | (40,742)
Additional deferred finance costs on revolving loan amendment | (938) | (741) | 0
Proceeds from debt issuance, net of issuance costs | 717,307 | 0 | 97,144
Proceeds from paycheck protection program loans | 0 | 4,023 | 0
Distributions paid to noncontrolling interests | (2,426) | (1,985) | (3,057)
Proceeds from sale of economic interest in majority owned subsidiary | 13,073 | 0 | 5,275
Contributions from noncontrolling partners | 0 | 0 | 750
Proceeds from revolving credit facility | 128,300 | 250,900 | 261,200
Payments on revolving credit facility | (128,300) | (250,900) | (289,200)
Proceeds from issuance of common stock upon exercise of options | 488 | 0 | 75
Net cash provided by (used in) financing activities | 104,673 | (45,561) | 24,951
EFFECT OF EXCHANGE RATE CHANGES ON CASH | (65) | (101) | (32)
NET INCREASE IN CASH AND CASH EQUIVALENTS | 32,588 | 61,853 | 29,776
CASH AND CASH EQUIVALENTS, beginning of period | 102,018 | 40,165 | 10,389
CASH AND CASH EQUIVALENTS, end of period | 134,606 | 102,018 | 40,165
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION |  |  |
Cash paid during the period for interest | 29,042 | 39,521 | 46,254
Cash paid during the period for income taxes | $ 1,950 | $ 5,069 | $ 5,884

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- Definition The cash outflow paid to third parties in connection with debt origination, which will be amortized over the remaining maturity period of the associated long-term debt. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (e) -URI http://asc.fasb.org/extlink&oid=123570139&loc=d3e3291-108585 + Details
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- Definition The cash outflow to acquire asset without physical form usually arising from contractual or other legal rights, excluding goodwill. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=123570139&loc=d3e3213-108585 + Details
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