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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2024 | Dec. 31, 2023 | Dec. 31, 2022
CASH FLOWS FROM OPERATING ACTIVITIES |  |  |
NET INCOME | $ 38,836 | $ 30,337 | $ 33,608
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 137,838 | 128,391 | 115,877
Non-cash lease expense | 60,552 | 61,102 | 68,847
Equity in earnings of joint ventures, net of dividend | (9,926) | 9,176 | (5,952)
Amortization of deferred financing costs and loan discount | 3,093 | 2,987 | 2,693
Loss on sale and disposal of equipment | 2,276 | 2,187 | 2,529
Loss on extinguishment of debt | 3,903 | 0 | 0
Gain on contribution of imaging centers into joint venture | 0 | (16,808) | 0
Lease abandonment charges | 2,478 | 5,146 | 0
Amortization of cash flow hedge | 9,352 | 3,576 | 3,687
Non-cash change in fair value of interest rate swaps | 8,006 | 8,185 | (39,621)
Stock-based compensation | 29,833 | 26,785 | 23,770
Loss on impairment | 1,275 | 3,949 | 0
Change in fair value of contingent consideration | 1,995 | (3,880) | (325)
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions: |  |  |
Accounts receivable | (21,767) | 2,650 | (30,078)
Other current assets | (32,790) | (8,441) | (3,327)
Other assets | 10,723 | (1,484) | (12,166)
Deferred taxes | 6,454 | 6,056 | 13,356
Operating lease liability | (54,866) | (54,763) | (68,943)
Deferred revenue | (1,359) | 626 | (7,316)
Accounts payable, accrued expenses and other | 37,117 | 15,086 | 49,778
Net cash provided by operating activities | 233,023 | 220,863 | 146,417
CASH FLOWS FROM INVESTING ACTIVITIES |  |  |
Purchase of imaging facilities and other acquisitions | (43,661) | (10,918) | (129,961)
Purchase of property and equipment | (188,070) | (176,600) | (119,451)
Proceeds from sale of equipment | 157 | 83 | 3,904
Equity contributions in existing and purchase of interest in joint ventures | (1,496) | (14,035) | (1,441)
Net cash used in investing activities | (233,070) | (201,470) | (246,949)
CASH FLOWS FROM FINANCING ACTIVITIES |  |  |
Principal payments on notes and leases payable | (5,989) | (2,930) | 0
Payments on term loan debt | (692,437) | (41,063) | (53,750)
Proceeds from issuance of debt, net of issuance costs | 863,757 | 0 | 147,996
Sale of noncontrolling interests | 22,357 | 5,121 | 0
Payments of contingent consideration and holdbacks | (4,268) | (5,495) | 0
Distributions paid to noncontrolling interests | (4,522) | (5,972) | (893)
Proceeds from issuance of common stock | 218,385 | 245,832 | 0
Proceeds from issuance of common stock upon exercise of options | 667 | 142 | 294
Net cash provided by financing activities | 397,950 | 195,635 | 93,647
EFFECT OF EXCHANGE RATE CHANGES ON CASH | (453) | (292) | 113
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS | 397,450 | 214,736 | (6,772)
CASH AND CASH EQUIVALENTS, beginning of period | 342,570 | 127,834 | 134,606
CASH AND CASH EQUIVALENTS, end of period | 740,020 | 342,570 | 127,834
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION |  |  |
Cash paid during the period for interest | 84,601 | 64,695 | 39,151
Cash paid during the period for income taxes | $ 4,170 | $ 1,587 | $ 587

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