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Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands | 6 Months Ended
--- | ---
Jun. 30, 2024 | Jun. 30, 2023
Cash flows from operating activities: |  |
Net income | $ (148,990) | $ 42,488
Adjustments to reconcile net income to net cash from operating activities: |  |
Depreciation and amortization | 19,099 | 17,898
Amortization of premiums, discounts and issuance costs | 440 | 733
Goodwill impairment | 154,243 | 0
Fixed assets impairments | 20,112 | 0
Intangible assets impairments | 7,679 | 0
Loss on disposal of businesses | 10,873 | 0
Stock-based compensation expense | 5,019 | 6,135
Deferred income taxes | (25,028) | 8,376
Other | (1,678) | (900)
Changes in assets and liabilities: |  |
Accounts receivable | (934) | 28,900
Prepaid expenses and other current assets | 3,703 | 2,141
Other long-term assets | 16,955 | 5,052
Accounts payable and accrued expenses | (82,917) | (97,315)
Income taxes payable | 11,735 | (12,028)
Long-term professional liabilities | 8,039 | 838
Other liabilities | (11,630) | (10,356)
Net cash used in operating activities - continuing operations | (13,280) | (8,038)
Net cash used in operating activities - discontinued operations | (4,995) | (3,825)
Net cash used in operating activities | (18,275) | (11,863)
Cash flows from investing activities: |  |
Acquisition payments, net of cash acquired | (8,167) | (1,667)
Purchases of investments | (39,915) | (17,761)
Proceeds from maturities or sales of investments | 31,244 | 12,810
Purchases of property and equipment | (12,292) | (15,130)
Net cash used in investing activities | (29,130) | (21,748)
Cash flows from financing activities: |  |
Borrowings on line of credit | 235,500 | 421,000
Payments on line of credit | (235,500) | (384,000)
Payments on term loan | (6,250) | (6,250)
Payment on finance lease obligation | (1,391) | (1,404)
Proceeds from issuance of common stock | 2,009 | 2,689
Repurchases of common stock | (898) | (786)
Other | 79 | (1,613)
Net cash (used in) provided by financing activities | (6,451) | 29,636
Net decrease in cash and cash equivalents | (53,856) | (3,975)
Cash and cash equivalents at beginning of period | 73,258 | 9,824
Cash and cash equivalents at end of period | $ 19,402 | $ 5,849

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