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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 9 Months Ended
--- | ---
Sep. 30, 2023 | Sep. 30, 2022
CASH FLOWS FROM OPERATING ACTIVITIES |  |
Net income (loss) | $ 24,341 | $ 28,640
Adjustments to reconcile net income (loss) to net cash provided by operating activities: |  |
Depreciation and amortization | 95,705 | 85,209
Amortization of operating lease right-of-use assets | 47,542 | 51,573
Equity in earnings of joint ventures, net of dividends | 5,012 | (8,350)
Amortization of deferred financing costs and loan discount | 2,240 | 1,943
(Gain) on contribution of imaging centers into joint venture | (16,808) | 0
(Gain) loss on sale and disposal of equipment and other | 1,183 | 962
Amortization of cash flow hedge, net of taxes | 2,765 | 2,771
Non-cash change in fair value of interest rate hedge | 949 | (39,576)
Stock-based compensation | 21,380 | 19,112
Loss on impairment | 3,949 | 0
Change in fair value of contingent consideration | (4,112) | (329)
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions: |  |
Accounts receivable | (1,379) | (36,686)
Other current assets | 5,754 | (4,934)
Other assets | (16,641) | 3,738
Deferred taxes | 7,389 | 8,955
Operating lease liability | (43,390) | (49,597)
Deferred revenue | 1,155 | (7,809)
Accounts payable, accrued expenses and other | (5,091) | 37,148
Net cash provided by (used in) operating activities | 131,943 | 92,770
CASH FLOWS FROM INVESTING ACTIVITIES |  |
Purchase of imaging centers and other acquisitions | (10,915) | (26,009)
Purchase of property and equipment | (136,537) | (98,606)
Proceeds from sale of equipment | 82 | 3,008
Equity contributions in existing and purchase of interest in joint ventures | (5,453) | (1,441)
Net cash provided by (used in) investing activities | (152,823) | (123,048)
CASH FLOWS FROM FINANCING ACTIVITIES |  |
Principal payments on notes payable | (1,929) | 0
Payments on term loan debt | (11,062) | (9,938)
Proceeds from sale of economic interest in majority owned subsidiary, net of taxes | 5,102 | 0
Distributions paid to noncontrolling interests | (3,523) | 0
Payments on contingent consideration | (3,390) | 0
Proceeds from issuance of common stock, net of issuance costs | 245,831 | 0
Proceeds from issuance of common stock upon exercise of options | 72 | 0
Net cash provided by (used in) financing activities | 231,101 | (9,938)
EFFECT OF EXCHANGE RATE CHANGES ON CASH | (171) | 616
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS | 210,050 | (39,600)
CASH AND CASH EQUIVALENTS, beginning of period | 127,834 | 134,606
CASH AND CASH EQUIVALENTS, end of period | 337,884 | 95,006
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION |  |
Cash paid during the period for interest | 59,421 | 30,251
Cash paid during the period for income taxes | $ 225 | $ 560

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