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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions | 6 Months Ended
--- | ---
Jun. 30, 2024 | Jun. 30, 2023
Cash flows from operating activities: |  |
Net income | $ 52.7 | $ 58.9
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation and amortization | 68.5 | 58.1
Non-cash lease expense | 18.7 | 17.9
Non-cash interest expense, net | 3.1 | 13.1
Equity-based compensation expense | 20.0 | 8.8
Net loss (gain) on disposals, consolidations and deconsolidations | 6.8 | 1.7
Loss on debt extinguishment | 5.1 | 0.0
Deferred income taxes | 7.6 | (11.5)
Equity in earnings of unconsolidated affiliates, net of distributions received | 0.2 | (0.8)
Changes in operating assets and liabilities, net of acquisitions and divestitures: |  |
Accounts receivable | (12.1) | (5.1)
Medicare accelerated payments and deferred governmental grants | 0.0 | (1.2)
Other operating assets and liabilities | (47.1) | (13.3)
Net cash provided by operating activities | 123.5 | 126.6
Cash flows from investing activities: |  |
Purchases of property and equipment | (47.9) | (50.1)
Payments for acquisitions, net of cash acquired | (264.6) | (43.5)
Proceeds from disposals of facilities and other assets | 1.5 | 26.1
Purchases of equity investments | (1.7) | (48.4)
Proceeds from sales of equity investments | 4.0 | 0.0
Other investing activities | (18.5) | (26.0)
Net cash used in investing activities | (327.2) | (141.9)
Cash flows from financing activities: |  |
Principal payments on long-term debt | (973.8) | (31.5)
Borrowings of long-term debt | 1,295.4 | 26.5
Payments of debt issuance costs | (14.9) | (1.4)
Distributions to non-controlling interest holders | (80.7) | (76.9)
Proceeds related to ownership transactions with non-controlling interest holders | 1.0 | 0.6
Other financing activities | (5.7) | (7.5)
Net cash provided by (used in) financing activities | 221.3 | (90.2)
Net increase (decrease) in cash and cash equivalents | 17.6 | (105.5)
Cash and cash equivalents at beginning of period | 195.9 | 282.9
Cash and cash equivalents at end of period | $ 213.5 | $ 177.4

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