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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 | $ 103,135 | $ 86,870 | $ 101,035
Depreciation and amortization | 89,698 | 85,631 | 76,916
Operatingleaserightofuseassetamortization | 9,594 | 9,216 | 8,294
Provision for doubtful accounts | 345 | 7,137 | 14,882
Provision for warranty and returns | 831 | (1,576) | (134)
Stock compensation | 27,341 | 23,954 | 21,918
Gain (Loss) on Disposition of Property Plant Equipment | 1,652 | (1,789) | 12,872
Bond premium amortization | 655 | 231 | 135
Debt issuance cost amortization | 240 | 288 | 288
Change in fair value of contingent earn-out | 0 | 9,000 | (47,400)
Production Related Impairments or Charges | 3,380 | 2,626 | 0
Sparepartsusage | 13,046 | 11,191 | 24,301
Other | 2,582 | 6,939 | 447
Increase (Decrease) in Accounts Receivable | 13,755 | 78,049 | (23,684)
Increase (Decrease) in Inventories | 20,815 | 19,196 | (24,997)
Increase (Decrease) in Prepaid Expense and Other Assets | (7,973) | (4,311) | 8,588
Increase (Decrease) in Other Operating Assets | (21,038) | (16,069) | (29,837)
Accounts payable | 2,347 | (46,415) | (2,697)
Accrued liabilities | 6,259 | (29,379) | (43,689)
Income taxes, including excess tax benefits and deferred income taxes | 874 | (18,037) | 4,680
Net cash provided by operating activities | 267,538 | 222,752 | 101,918
CASH FLOWS FROM INVESTING ACTIVITIES: |  |  |
Purchases of property and equipment | (68,542) | (92,005) | (97,312)
Proceeds from Sale of Other Property, Plant, and Equipment | 218 | 6,176 | 33
Intangible asset additions | (12,627) | (8,385) | (8,728)
Business acquisitions, net of cash acquired | (14,452) | 0 | (76,133)
Payments to Acquire Equity Method Investments | (3,250) | 0 | 0
Purchases of investment securities | (10,034) | (32,825) | (26,040)
Proceeds from sale of investment securities | 18,000 | 28,900 | 41,292
Net cash (used in) provided by investing activities | (90,687) | (98,139) | (166,888)
CASH FLOWS FROM FINANCING ACTIVITIES: |  |  |
Proceeds from Long-term Lines of Credit | 0 | 150,000 | 0
Repayments of Long-term obligations | 0 | (150,000) | 0
Proceeds from exercise of stock options | 9,372 | 13,193 | 7,732
Finance Lease, Principal Payments | (607) | (357) | 0
Payment for Contingent Consideration Liability, Financing Activities | (17,300) | 0 | 0
Purchase of treasury stock | (8,335) | (12,876) | (18,639)
Net cash (used in) provided by financing activities | (16,870) | (40) | (10,907)
Effect of Exchange Rate on Cash [Abstract] |  |  |
Effect of exchange rate changes on cash | (3,251) | 2,854 | (234)
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect, Total | 156,730 | 127,427 | (76,111)
CASH AND CASH EQUIVALENTS, beginning of period | 396,097 | 268,670 | 344,781
CASH AND CASH EQUIVALENTS, end of period | 552,827 | 396,097 | 268,670
SUPPLEMENTAL DISCLSOURE OF CASH FLOW INFORMATION |  |  |
Cash paid during the year for income taxes | 19,562 | 31,628 | 9,675
Interest Paid, Excluding Capitalized Interest, Operating Activities | 858 | 1,753 | 549
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES |  |  |
Accounts payable for property and equipment | 9,338 | 2,211 | 13,912
Goodwill, Acquired During Period | 10,626 |  | 20,026
International Distributor |  |  |
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES |  |  |
Liabilities Assumed | 2,589 | $ 0 | 0
Pursuit Vascular LLC |  |  |
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES |  |  |
Goodwill, Acquired During Period |  |  | 19,100
Foreign Infusion System Supplier |  |  |
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES |  |  |
Fair value of assets acquired | 4,592 |  |
Cash paid for acquisitions, net of cash acquired | (14,452) |  |
Contingent consideration | 0 |  |
Goodwill, Period Increase (Decrease) | 10,626 |  |
Goodwill, Acquired During Period | 10,600 |  |
Liabilities Assumed | $ 766 |  |
Total Acquisitions |  |  |
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES |  |  |
Fair value of assets acquired |  |  | 91,019
Cash paid for acquisitions, net of cash acquired |  |  | (76,133)
Contingent consideration |  |  | (17,300)
Goodwill, Acquired During Period |  |  | 20,026
Liabilities Assumed |  |  | $ 17,612

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