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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) | 3 Months Ended | 6 Months Ended | 9 Months Ended | 12 Months Ended
--- | --- | --- | --- | ---
Sep. 30, 2021 | Mar. 31, 2021 | Sep. 30, 2020 | Mar. 31, 2020 | Jun. 30, 2021 | Sep. 30, 2021 | Sep. 30, 2020 | Dec. 31, 2020
Cash flows from operating activities: |  |  |  |  |  |  |  |
Net (loss) income | $ (22,002,000) | $ (13,445,000) | $ (11,703,000) | $ (865,000) |  | $ (55,028,000) | $ 18,306,000 |
Adjustments to reconcile net (loss) income to net cash used in operating activities: |  |  |  |  |  |  |  |
Depreciation and amortization |  |  |  |  |  | 614,000 | 1,297,000 |
Remeasurement of acquisition-related contingent consideration |  |  |  |  |  | 0 | 3,327,000 |
Remeasurement of financing-related contingent consideration |  |  |  |  |  | 0 | 435,000 |
Amortization of debt discount and debt issuance costs | 312,000 |  | 1,642,000 |  |  | 937,000 | 4,835,000 |
Change in deferred taxes |  |  |  |  |  | (11,322,000) | (4,582,000) |
Stock-based compensation expense |  |  |  |  |  | 6,088,000 | 1,705,000 |
Gain from the disposition of the hospital products | 0 |  | 0 |  | $ 0 | 0 | (45,760,000) |
Gain from the release of certain liabilities | 0 |  | 0 |  |  | (166,000) | 0 |
Other adjustments |  |  |  |  |  | 1,056,000 | 306,000 |
Net changes in assets and liabilities |  |  |  |  |  |  |  |
Accounts receivable |  |  |  |  |  | 0 | 8,281,000 |
Inventories |  |  |  |  |  | 0 | (1,352,000) |
Prepaid expenses and other current assets |  |  |  |  |  | (54,000) | 1,759,000 |
Research and development tax credit receivable |  |  |  |  |  | 3,079,000 | 2,036,000 |
Accounts payable & other current liabilities |  |  |  |  |  | (201,000) | (4,051,000) |
Accrued expenses |  |  |  |  |  | 2,421,000 | (6,625,000) |
Earn-out payments for contingent consideration in excess of acquisition-date fair value |  |  |  |  |  | 0 | (5,323,000) |
Royalty payments for contingent consideration payable in excess of original fair value |  |  |  |  |  | 0 | (866,000) |
Other assets and liabilities |  |  |  |  |  | (2,228,000) | (3,337,000) |
Net cash used in operating activities |  |  |  |  |  | (54,804,000) | (29,609,000) |
Cash flows from investing activities: |  |  |  |  |  |  |  |
Purchases of property and equipment |  |  |  |  |  | (26,000) | (33,000) |
Proceeds from the disposition of the hospital products |  |  |  |  |  | 16,500,000 | 17,250,000 |
Proceeds from sales of marketable securities |  |  |  |  |  | 83,726,000 | 30,075,000 |
Purchases of marketable securities |  |  |  |  |  | (58,591,000) | (124,254,000) |
Net cash provided by (used in) investing activities |  |  |  |  |  | 41,609,000 | (76,962,000) |
Cash flows from financing activities: |  |  |  |  |  |  |  |
Proceeds from the February 2020 private placement |  |  |  |  |  | 0 | 60,570,000 |
Proceeds from the May 2020 public offering |  |  |  |  |  | 0 | 116,924,000 |
Proceeds from stock option exercises and employee stock purchase plan |  |  |  |  |  | 263,000 | 2,006,000 |
Net cash provided by financing activities |  |  |  |  |  | 263,000 | 179,500,000 |
Effect of foreign currency exchange rate changes on cash and cash equivalents |  |  |  |  |  | (621,000) | 406,000 |
Net change in cash and cash equivalents |  |  |  |  |  | (13,553,000) | 73,335,000 |
Cash and cash equivalents at January 1, |  | $ 71,722,000 |  | $ 9,774,000 | $ 71,722,000 | 71,722,000 | 9,774,000 | $ 9,774,000
Cash and cash equivalents at September 30, | $ 58,169,000 |  | $ 83,109,000 |  |  | 58,169,000 | 83,109,000 | $ 71,722,000
Supplemental disclosures of cash flow information: |  |  |  |  |  |  |  |
Interest paid |  |  |  |  |  | 6,469,000 | 6,469,000 |
Income taxes paid (refund) |  |  |  |  |  | $ 68,000 | $ (1,788,000) |

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