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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015
OPERATING ACTIVITIES: |  |  |
Net income (loss) | $ 64,743 | $ 74,564 | $ (3,519)
Adjustments to reconcile net (loss) income to net cash provided by operating activities: |  |  |
Loss from discontinued operations, net of tax | 0 | 0 | 10,370
Depreciation and amortization | 88,945 | 72,665 | 58,863
Non-cash impairment charges | 3,290 | 0 | 380
Deferred income tax benefit | (67,304) | (6,474) | (351)
Non-cash valuation allowance | 0 | 0 | 37,210
Share-based compensation | 21,550 | 17,310 | 15,450
Amortization of debt issuance costs | 2,722 | 2,529 | 2,264
Non-cash interest expense | 0 | 8,074 | 7,911
Realized loss on sale of sale of short-term investment | 2,287 | 0 | 0
Loss on disposal of property and equipment | 6,989 | 1,765 | 481
Gain on divestiture of business | (2,645) | 0 | 0
Change in fair value of contingent consideration and others | (4,710) | (13) | (177)
Gain on bargain purchase | 0 | 0 | (1,111)
Payment of accreted interest | 0 | (42,786) | (384)
Changes in assets and liabilities, net of business acquisitions: |  |  |
Accounts receivable | (89,698) | (17,518) | (16,231)
Inventories | 99 | (9,576) | (3,759)
Prepaid expenses and other current assets | (33,808) | 14,912 | (233)
Other non-current assets | (914) | (475) | 610
Accounts payable, accrued expenses and other current liabilities | 95,321 | (414) | 8,208
Deferred revenue | 3,874 | 1,251 | 136
Other non-current liabilities | 23,803 | 591 | 945
Net cash provided by operating activities of continuing operations | 114,544 | 116,405 | 117,063
Net cash used in operating activities of discontinued operations | 0 | 0 | (12,209)
Net cash provided by operating activities | 114,544 | 116,405 | 104,854
INVESTING ACTIVITIES: |  |  |
Change in restricted cash | 0 | 4,165 | (4,087)
Proceeds from sale of short-term investments | 16,951 | 0 | 0
Proceeds from note receivable | 483 | 0 | 0
Cash used in business acquisitions, net of cash acquired | (1,241,946) | 225 | (328,888)
Purchases of property and equipment | (43,503) | (47,328) | (33,413)
Proceeds from sales of property and equipment | 293 | 316 | 1,438
Proceeds from divestiture of business | 46,387 | 0 | 0
Net cash used in investing activities of continuing operations | (1,221,335) | (42,622) | (364,950)
Net cash used in investing activities of discontinued operations | 0 | 0 | (7,060)
Net cash used in investing activities | (1,221,335) | (42,622) | (372,010)
FINANCING ACTIVITIES: |  |  |
Borrowings under senior credit facility | 1,307,000 | 680,000 | 545,000
Repayments under senior credit facility | (117,000) | (511,250) | (465,625)
Net cash paid for contingent consideration | (4,661) | 0 | 0
Proceeds from the issuance of common stock, net of issuance costs | 0 | 0 | 219,669
Distribution to SeaSpine | 0 | 0 | (47,013)
Payment of liability component of convertible notes | 0 | (184,313) | (2,519)
Payment of capital lease obligation | 0 | (653) | (709)
Debt issuance costs | (19,043) | (4,530) | (1,426)
Proceeds from exercised stock options | 9,774 | 10,481 | 7,345
Cash taxes paid in net equity settlement | (7,123) | (4,851) | (6,580)
Net cash provided by (used in) financing activities | 1,168,947 | (15,116) | 248,142
Effect of exchange rate changes on cash and cash equivalents | 10,724 | (4,744) | (4,848)
Net increase (decrease) in cash and cash equivalents | 72,880 | 53,923 | (23,862)
Cash and cash equivalents at beginning of period | 102,055 | 48,132 | 71,994
Cash and cash equivalents at end of period | $ 174,935 | $ 102,055 | $ 48,132

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- Definition Amount of increase (decrease) in prepaid expenses, and assets classified as other. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3602-108585 + Details
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- Definition The net cash inflow or outflow for the increase (decrease) associated with funds that are not available for withdrawal or use (such as funds held in escrow) and are associated with underlying transactions that are classified as investing activities. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3213-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3179-108585 + Details
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- Definition Amount of cash inflow (outflow) from financing activities, including discontinued operations. Financing activity cash flows include obtaining resources from owners and providing them with a return on, and a return of, their investment; borrowing money and repaying amounts borrowed, or settling the obligation; and obtaining and paying for other resources obtained from creditors on long-term credit. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3574-108585 + Details
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- Definition Amount of cash inflow (outflow) from investing activities, including discontinued operations. Investing activity cash flows include making and collecting loans and acquiring and disposing of debt or equity instruments and property, plant, and equipment and other productive assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3574-108585 + Details
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- Definition Amount of cash inflow (outflow) of investing activities, excluding discontinued operations. Investing activity cash flows include making and collecting loans and acquiring and disposing of debt or equity instruments and property, plant, and equipment and other productive assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3574-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3521-108585 + Details
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- Definition Amount of cash inflow (outflow) from operating activities, including discontinued operations. Operating activity cash flows include transactions, adjustments, and changes in value not defined as investing or financing activities. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3602-108585 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 25 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3536-108585 + Details
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- Definition Amount of cash inflow (outflow) from operating activities, excluding discontinued operations. Operating activity cash flows include transactions, adjustments, and changes in value not defined as investing or financing activities. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3602-108585 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 25 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3536-108585 + Details
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- Definition The portion of profit or loss for the period, net of income taxes, which is attributable to the parent. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3602-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 260 -SubTopic 10 -Section 50 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=6371337&loc=d3e3550-109257 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 942 -SubTopic 225 -Section S99 -Paragraph 1 -Subparagraph (SX 210.9-04(22)) -URI http://asc.fasb.org/extlink&oid=6879574&loc=d3e536633-122882 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 944 -SubTopic 225 -Section S99 -Paragraph 1 -Subparagraph (SX 210.7-04(18)) -URI http://asc.fasb.org/extlink&oid=6879464&loc=d3e573970-122913 Reference 5: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 225 -SubTopic 10 -Section S99 -Paragraph 2 -Subparagraph (SX 210.5-03(20)) -URI http://asc.fasb.org/extlink&oid=63488584&loc=d3e20235-122688 + Details
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- Definition Amount of income (expense) included in net income that results in no cash inflow (outflow), classified as other. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3602-108585 + Details
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- Definition Amount of cash outflow, not made soon after acquisition date of business combination, to settle contingent consideration liability up to amount recognized at acquisition date, including, but not limited to, measurement period adjustment and less amount paid soon after acquisition date. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (f) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3291-108585 + Details
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- Definition The net amount paid (received) by the reporting entity through acquisition or sale and maturities of short-term investments with an original maturity that is three months or less which qualify for treatment as an investing activity based on management's intention and intended by management to be liquidated, if necessary, within the current operating cycle. Includes cash flows from securities classified as trading securities that were acquired for reasons other than sale in the short-term. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 9 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3098-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 8 -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3095-108585 + Details
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- Definition The cash outflow paid to third parties in connection with debt origination, which will be amortized over the remaining maturity period of the associated long-term debt. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (e) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3291-108585 + Details
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- Definition The cash outflow associated with the acquisition of a business, net of the cash acquired from the purchase. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3213-108585 + Details
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- Definition The cash outflow associated with the acquisition of long-lived, physical assets that are used in the normal conduct of business to produce goods and services and not intended for resale; includes cash outflows to pay for construction of self-constructed assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3213-108585 + Details
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- Definition The cash inflow associated with principal collections from a borrowing supported by a written promise to pay an obligation. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3179-108585 + Details
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- Definition The cash inflow associated with the amount received from the sale of a portion of the company's business, for example a segment, division, branch or other business, during the period. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3179-108585 + Details
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- Definition The cash inflow from the additional capital contribution to the entity. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3255-108585 + Details
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- Definition The cash inflow from amounts received from issuance of long-term debt that is wholly or partially secured by collateral. Excludes proceeds from tax exempt secured debt. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3255-108585 + Details
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- Definition The cash inflow from the sale of long-lived, physical assets that are used in the normal conduct of business to produce goods and services and not intended for resale. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3179-108585 + Details
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- Definition Amount of cash inflow from exercise of stock options granted under share-based compensation arrangement. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3255-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 718 -SubTopic 10 -Section 50 -Paragraph 2A -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=96867065&loc=SL79508275-113901 + Details
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- Definition The cash outflow from the repayment of a long-term debt instrument which can be exchanged for a specified amount of another security, typically the entity's common stock, at the option of the issuer or the holder. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3291-108585 + Details
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- Definition The cash outflow for the obligation for a lease meeting the criteria for capitalization (with maturities exceeding one year or beyond the operating cycle of the entity, if longer). + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3291-108585 + Details
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- Definition The cash outflow to repay long-term debt that is wholly or partially secured by collateral. Excludes repayments of tax exempt secured debt. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3291-108585 + Details
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- Definition The aggregate amount of noncash, equity-based employee remuneration. This may include the value of stock or unit options, amortization of restricted stock or units, and adjustment for officers' compensation. As noncash, this element is an add back when calculating net cash generated by operating activities using the indirect method. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=98514028&loc=d3e3602-108585 + Details
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