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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019
OPERATING ACTIVITIES: |  |  |
Net income | $ 169,075 | $ 133,892 | $ 50,201
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 119,836 | 116,031 | 109,462
Non-cash in-process research and development expense | 0 | 519 | 64,916
Non-cash impairment charges | 2,754 | 0 | 5,764
Deferred income tax (benefit) provision | (2,755) | (64,138) | (19,046)
Share-based compensation | 36,210 | 19,590 | 21,255
Amortization of debt issuance costs and expenses associated with debt refinancing | 7,030 | 12,076 | 5,390
Non-cash lease expense | 3,834 | 2,955 | 5,060
Accretion of bond issuance discount | 0 | 15,415 | 0
Loss on disposal of property and equipment and construction in-progress | 2,240 | 7,855 | 1,821
Gain from the sale of business | (41,798) | 0 | 0
Change in fair value of contingent consideration and others | (2,162) | 951 | 1,119
Changes in assets and liabilities: |  |  |
Accounts receivable | 7,265 | 52,105 | (9,428)
Inventories | 5,374 | (48,348) | (43,308)
Prepaid expenses and other current assets | (21,143) | 1,632 | 13,071
Other non-current assets | 7,875 | 13,735 | 13,156
Accounts payable, accrued expenses and other current liabilities | 32,874 | (57,512) | 14,666
Contract liabilities | 28 | (37) | (607)
Other non-current liabilities | (14,110) | (2,889) | (2,059)
Net cash provided by operating activities | 312,427 | 203,832 | 231,433
INVESTING ACTIVITIES: |  |  |
Purchases of property and equipment | (48,022) | (38,890) | (69,537)
Proceeds from sale of Extremity Orthopedics Business | 190,468 | 0 | 0
Acquired in-process research and development and intangibles | (58) | (25,000) | (64,995)
Proceeds from note receivable | 0 | 0 | 752
Cash paid for business acquisitions, net of cash acquired | (303,910) | 0 | (30,509)
Proceeds from sales of property and equipment | 3 | 3,657 | 37
Net proceeds (payments) on swaps designated as net investment hedges | 76 | (7,840) | 1,584
Net cash used in investing activities | (161,443) | (68,073) | (162,668)
FINANCING ACTIVITIES: |  |  |
Proceeds from borrowings of long-term indebtedness | 25,500 | 171,500 | 236,900
Payments on debt | (125,500) | (441,000) | (246,100)
Purchase of option hedge on convertible notes | 0 | (104,248) | 0
Proceeds from convertible notes issuance | 0 | 575,000 | 0
Proceeds from sale of stock purchase warrants | 0 | 44,563 | 0
Payment of debt issuance costs | (249) | (24,347) | 0
Purchase of treasury stock | 0 | (100,000) | 0
Proceeds from exercised stock options | 6,824 | 5,232 | 6,948
Cash taxes paid in net equity settlement | (4,801) | (5,075) | (6,514)
Net cash (used in) provided by financing activities | (98,226) | 121,625 | (8,766)
Effect of exchange rate changes on cash and cash equivalents | (9,476) | 13,871 | 74
Net increase in cash and cash equivalents | 43,282 | 271,255 | 60,073
Cash and cash equivalents at beginning of period | 470,166 | 198,911 | 138,838
Cash and cash equivalents at end of period | $ 513,448 | $ 470,166 | $ 198,911

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