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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 Loss | $ (117,688) | $ (29,655) | $ (74,286)
Depreciation and amortization | 219,512 | 228,774 | 235,151
Amortization of Inventory Step-up | 0 | 0 | 26,519
Operating Lease, Right-of-Use Asset, Amortization Expense | 21,344 | 21,910 | 23,651
Provision for doubtful accounts | 5,800 | 838 | 1,036
Provision for warranty and returns | 1,130 | 21,582 | 4,902
Stock compensation | 46,883 | 40,563 | 36,025
Loss on Disposition of Property Plant Equipment, net | 2,522 | 2,109 | 2,010
Debt issuance cost amortization | 6,807 | 6,814 | 6,972
Change in fair value of contingent earn-out | (5,399) | (16,247) | (32,091)
Sparepartsusage | 18,298 | 17,050 | 11,924
Other | 7,393 | 8,066 | (213)
Increase (Decrease) in Accounts Receivable | (46,844) | 48,635 | (19,151)
Increase (Decrease) in Inventories | 16,829 | (6,079) | (201,095)
Increase (Decrease) in Prepaid Expense and Other Assets | (8,829) | 11,672 | 22,903
Increase (Decrease) in Other Operating Assets | (23,154) | (24,695) | (21,290)
Accounts payable | 12,531 | (68,301) | 37,472
Accrued liabilities | 20,668 | (14,479) | (55,834)
Income taxes, including excess tax benefits and deferred income taxes | 26,230 | (82,356) | (66,734)
Net cash provided by (used in)operating activities | 204,033 | 166,201 | (62,129)
CASH FLOWS FROM INVESTING ACTIVITIES: |  |  |
Purchases of property, plant and equipment | (79,373) | (83,893) | (90,311)
Proceeds from sale of assets | 746 | 1,501 | 989
Intangible asset additions | (10,833) | (9,777) | (9,018)
Business acquisitions, net of cash acquired | 0 | 0 | (1,844,164)
Purchases of investment securities | 0 | 0 | (3,397)
Proceeds from sale of investment securities | 500 | 4,222 | 36,433
Net cash used in by investing activities | (88,960) | (87,947) | (1,909,468)
CASH FLOWS FROM FINANCING ACTIVITIES: |  |  |
Proceeds from issuance of long-term debt, net of lender debt issuance costs | 0 | 0 | 1,664,362
Repayments of Long-term obligations | (51,000) | (29,688) | (22,375)
Payments of Debt Issuance Costs | 0 | 0 | (2,177)
Proceeds from exercise of stock options | 10,939 | 4,022 | 8,785
Payments on finance leases | (1,147) | (963) | (680)
Payment for Contingent Consideration Liability, Financing Activities | (2,600) | 0 | 0
Purchase of treasury stock | (11,992) | (9,350) | (10,883)
Net cash (used in) provided by financing activities | (55,800) | (35,979) | 1,637,032
Effect of Exchange Rate on Cash [Abstract] |  |  |
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Continuing Operations | (4,929) | 3,163 | (9,478)
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect, Total | 54,344 | 45,438 | (344,043)
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents | 308,566 | 254,222 | 208,784
SUPPLEMENTAL DISCLSOURE OF CASH FLOW INFORMATION |  |  |
Cash paid during the year for income taxes | 25,253 | 35,809 | 27,504
Interest Paid, Excluding Capitalized Interest, Operating Activities | 99,717 | 95,913 | 63,713
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES |  |  |
Accounts payable for property, plant and equipment | $ 7,443 | $ 6,570 | 4,854
Business Combination, Consideration Transferred, Equity Interests Issued and Issuable |  |  | (575,975)
Foreign Infusion System Supplier |  |  |
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES |  |  |
Fair value of assets acquired |  |  | 1,606,300
Cash paid for acquisitions, net of cash acquired |  |  | (1,844,164)
Contingent consideration |  |  | (55,158)
Goodwill, Period Increase (Decrease) |  |  | 1,462,752
Liabilities Assumed |  |  | $ 593,755

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