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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 9 Months Ended
--- | ---
Sep. 30, 2024 | Sep. 30, 2023
CASH FLOWS FROM OPERATING ACTIVITIES |  |
Net Income | $ 24,611 | $ 24,341
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation and amortization | 101,822 | 95,705
Noncash operating lease expense | 45,516 | 47,542
Equity in earnings of joint ventures, net of dividends | (10,308) | 5,012
Amortization of deferred financing costs and loan discount | 2,336 | 2,240
Loss on sale and disposal of equipment | 735 | 1,183
Loss on extinguishment of debt | 2,080 | 0
Gain on contribution of imaging centers into joint venture | 0 | (16,808)
Amortization of cash flow hedge, net of taxes | 8,242 | 2,765
Non-cash change in fair value of interest rate hedge | 7,429 | 949
Stock-based compensation | 21,368 | 21,380
Loss on impairment | 1,200 | 3,949
Change in fair value of contingent consideration | 1,974 | (4,112)
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions: |  |
Accounts receivable | (35,369) | (1,379)
Other current assets | 4,738 | 5,754
Other assets | (7,388) | (16,641)
Deferred taxes | 4,834 | 7,389
Operating leases | (40,497) | (43,390)
Deferred revenue | (255) | 1,155
Accounts payable, accrued expenses and other | 57,426 | (5,091)
Net cash provided by operating activities | 190,494 | 131,943
CASH FLOWS FROM INVESTING ACTIVITIES |  |
Purchase of imaging facilities and other acquisitions | (37,748) | (10,915)
Purchase of property and equipment and other | (145,164) | (136,537)
Proceeds from sale of equipment | 151 | 82
Equity contributions in existing and purchase of interest in joint ventures | (1,496) | (5,453)
Net cash used in investing activities | (184,257) | (152,823)
CASH FLOWS FROM FINANCING ACTIVITIES |  |
Principal payments on notes and leases payable | (4,296) | (1,929)
Payments on Term Loan Debt | (688,375) | (11,062)
Proceeds from debt refinancing, net of issuing costs | 863,815 | 0
Contribution from noncontrolling partners | 7,569 | 0
Payments on contingent consideration | (3,614) | (3,390)
Distributions paid to noncontrolling interests | (2,423) | (3,523)
Proceeds from sale of economic interests in majority owned subsidiary, net of taxes | 8,641 | 5,102
Proceeds from issuance of common stock | 218,385 | 245,831
Proceeds from issuance of common stock upon exercise of options | 367 | 72
Net cash provided by financing activities | 400,069 | 231,101
EFFECT OF EXCHANGE RATE CHANGES ON CASH | 40 | (171)
NET INCREASE IN CASH AND CASH EQUIVALENTS | 406,346 | 210,050
CASH AND CASH EQUIVALENTS, beginning of period | 342,570 | 127,834
CASH AND CASH EQUIVALENTS, end of period | 748,916 | 337,884
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION |  |
Cash paid during the period for interest | 51,520 | 59,421
Cash paid during the period for income taxes | $ 2,202 | $ 225

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