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Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands | 6 Months Ended
--- | ---
Jun. 30, 2022 | Jun. 30, 2021
Cash flows from operating activities: |  |
Net income | $ 5,948 | $ 52,653
(Loss) income from discontinued operations | 3,812 | (16,768)
Adjustments to reconcile net income (loss) to net cash from operating activities: |  |
Depreciation and amortization | 17,544 | 16,137
Amortization of premiums, discounts and issuance costs | 857 | 1,838
Loss on early extinguishment of debt | 57,016 | 14,532
Stock-based compensation expense | 8,771 | 9,452
Deferred income taxes | (1,894) | (17,033)
Other | (1,577) | (1,205)
Gain on sale of building | 0 | (7,280)
Changes in assets and liabilities: |  |
Accounts receivable | (15,950) | (26,005)
Prepaid expenses and other current assets | 17,044 | 40,800
Other long-term assets | 6,970 | (1,859)
Accounts payable and accrued expenses | (90,986) | (54,453)
Income taxes receivable | (12,254) | (28,165)
Long-term professional liabilities | (2,768) | (715)
Other liabilities | (867) | (10,413)
Net cash used in operating activities – continuing operations | (8,334) | (28,484)
Net cash used in provided by operating activities - discontinued operations | (6,741) | (117)
Net cash used in operating activities | (15,075) | (28,601)
Cash flows from investing activities: |  |
Acquisition payments, net of cash acquired | (28,167) | (7,207)
Purchases of investments | (12,983) | (8,355)
Proceeds from maturities or sales of investments | 14,039 | 10,745
Purchases of property and equipment | (13,703) | (18,536)
Proceeds from sale of building | 0 | 24,728
Other | 1,189 | 0
Net cash (used in) provided by investing activities - continuing operations | (39,625) | 1,375
Net cash provided by investing activities-discontinued operations | 0 | 2,350
Net cash (used in) provided by investing activities | (39,625) | 3,725
Cash flows from financing activities: |  |
Borrowings on credit agreement | 475,000 | 0
Payments on credit agreement | (321,500) | 0
Payments on term loan | (3,125) | 0
Redemption of senior notes, including call premium | (1,046,880) | (759,848)
Proceeds from senior notes and term loan | 650,000 |
Payments for financing costs | (8,394) |
Payment on Finance lease obligation | (1,262) | (1,106)
Proceeds from issuance of common stock | 2,838 | 2,578
Repurchases of common stock | (65,564) | (2,245)
Other | 284 | (189)
Net cash used in financing activities - continuing operations | (318,603) | (760,810)
Net cash used in financing activities - discontinued operations | 0 | 0
Net cash used in financing activities | (318,603) | (760,810)
Net decrease in cash and cash equivalents | (373,303) | (785,686)
Cash and cash equivalents at beginning of period | 387,391 | 1,123,843
Cash and cash equivalents at end of period | $ 14,088 | $ 338,157

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