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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020
CASH FLOWS FROM OPERATING ACTIVITIES |  |  |
Net income (loss) | $ 33,608 | $ 44,319 | $ (1,749)
Adjustments to reconcile net income (loss) to net cash provided by operating activities: |  |  |
Depreciation and amortization | 115,877 | 96,694 | 86,795
Amortization of operating lease right-of-use assets | 68,847 | 73,967 | 67,915
Lease abandonment charges | 0 | 19,675 | 0
Equity in earnings of joint ventures, net of dividends | (5,952) | (6,260) | 1,577
Amortization and write off of deferred financing costs and loan discount | 2,693 | 3,254 | 4,413
Loss on sale and disposal of equipment and other | 2,529 | 1,246 | 1,200
Loss (gain) on extinguishment of debt | 0 | 1,496 | (4,047)
Loss on impairment | 0 | 0 | 4,170
Amortization of cash flow hedge | 3,687 | 3,695 | 3,448
Non-cash change in fair value of interest rate swap | (39,621) | (21,670) | 2,528
Stock-based compensation | 23,770 | 25,203 | 12,405
Non cash item in other expenses | 0 | 0 | 242
Change in value of contingent consideration | (325) | 0 | 0
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions: |  |  |
Accounts receivable | (30,078) | (5,890) | 25,206
Other current assets | (3,327) | (15,777) | 6,588
Other assets | (12,166) | 662 | (5,425)
Deferred taxes | 13,356 | 19,834 | (611)
Operating lease liability | (68,943) | (72,553) | (53,906)
Deferred revenue | (7,316) | (28,319) | 37,941
Accounts payable, accrued expenses and other liabilities | 49,778 | 9,915 | 45,069
Net cash provided by operating activities | 146,417 | 149,491 | 233,759
CASH FLOWS FROM INVESTING ACTIVITIES |  |  |
Purchase of imaging centers and other operations | (129,961) | (77,691) | (31,265)
Purchase of property and equipment | (119,451) | (137,874) | (94,172)
Purchase of intangible assets | 0 | (5,130) | 0
Proceeds from sale of equipment | 3,904 | 625 | 828
Equity contributions in existing and purchase of interest in joint ventures | (1,441) | (1,441) | (1,635)
Net cash used in investing activities | (246,949) | (221,511) | (126,244)
CASH FLOWS FROM FINANCING ACTIVITIES |  |  |
Payments on term loan debt | (53,750) | (619,529) | (43,296)
Principal payments on notes and leases payable other than term loan debt | 0 | (3,302) | (3,562)
Additional deferred finance costs on revolving loan amendment | 0 | (938) | (741)
Proceeds from debt issuance, net of issuance costs | 147,996 | 717,307 | 0
Proceeds from paycheck protection program loans | 0 | 0 | 4,023
Distributions paid to noncontrolling interests | (893) | (2,426) | (1,985)
Proceeds from sale of economic interest in majority owned subsidiary | 0 | 13,073 | 0
Proceeds from revolving credit facility | 0 | 128,300 | 250,900
Payments on revolving credit facility | 0 | (128,300) | (250,900)
Proceeds from issuance of common stock upon exercise of options | 294 | 488 | 0
Net cash provided by (used in) financing activities | 93,647 | 104,673 | (45,561)
EFFECT OF EXCHANGE RATE CHANGES ON CASH | 113 | (65) | (101)
NET (DECREASE) INCREASE IN CASH AND CASH EQUIVALENTS | (6,772) | 32,588 | 61,853
CASH AND CASH EQUIVALENTS, beginning of period | 134,606 | 102,018 | 40,165
CASH AND CASH EQUIVALENTS, end of period | 127,834 | 134,606 | 102,018
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION |  |  |
Cash paid during the period for interest | 39,151 | 29,042 | 39,521
Cash paid during the period for income taxes | $ 587 | $ 1,950 | $ 5,069

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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 https://asc.fasb.org/extlink&oid=126954810&loc=d3e3213-108585 + Details
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