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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | 12 Months Ended
--- | --- | --- | ---
Jun. 30, 2022 | Mar. 31, 2022 | Jun. 30, 2021 | Mar. 31, 2021 | Jun. 30, 2022 | Jun. 30, 2021 | Dec. 31, 2021
OPERATING ACTIVITIES: |  |  |  |  |  |  |
Net income | $ 44,788 | $ 32,901 | $ 35,068 | $ 45,394 | $ 77,689 | $ 80,462 |
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |  |  |  |  |
Depreciation and amortization |  |  |  |  | 59,336 | 58,968 |
Non-cash impairment charges |  |  |  |  | 0 | 2,754 |
Deferred income tax provision (benefit) |  |  |  |  | 7,542 | (4,907) |
Share-based compensation |  |  |  |  | 13,027 | 22,033 |
Amortization of debt issuance costs and expenses associated with debt refinancing |  |  |  |  | 3,392 | 3,569 |
Non-cash lease expense |  |  |  |  | 1,393 | 2,528 |
Loss on disposal of property and equipment |  |  |  |  | 732 | 86 |
Gain from the sale of business | 0 |  | 679 |  | 0 | (42,197) |
Change in fair value of contingent consideration and others |  |  |  |  | (5,799) | (385) |
Changes in assets and liabilities: |  |  |  |  |  |  |
Accounts receivable |  |  |  |  | (9,632) | 10,802 |
Inventories |  |  |  |  | (17,576) | 2,893 |
Prepaid expenses and other current assets |  |  |  |  | (4,120) | (8,061) |
Other non-current assets |  |  |  |  | 6,738 | 4,067 |
Accounts payable, accrued expenses and other current liabilities |  |  |  |  | (14,556) | 27,277 |
Contract liabilities |  |  |  |  | 774 | 0 |
Other non-current liabilities |  |  |  |  | (8,118) | 482 |
Net cash provided by operating activities |  |  |  |  | 110,822 | 160,371 |
INVESTING ACTIVITIES: |  |  |  |  |  |  |
Purchases of property and equipment |  |  |  |  | (18,732) | (13,309) |
Proceeds from sale of Extremity Orthopedics business |  |  |  |  | 0 | 191,736 |
Acquired in-process research and development milestone |  |  |  |  | (4,742) | 0 |
Net proceeds from swaps designated as net investment hedges |  |  |  |  | 4,909 | 0 |
Cash paid for business acquisitions, net of cash acquired |  |  |  |  | 0 | (303,910) |
Net cash used in investing activities |  |  |  |  | (18,565) | (125,483) |
FINANCING ACTIVITIES: |  |  |  |  |  |  |
Proceeds from borrowings of long-term indebtedness |  |  |  |  | 23,000 | 2,200 |
Payments on debt |  |  |  |  | (23,000) | (102,200) |
Payment of debt issuance costs |  |  |  |  | 0 | (249) |
Purchases of treasury stock |  |  |  |  | (125,000) | 0 |
Proceeds from exercised stock options |  |  |  |  | 1,592 | 3,603 |
Cash taxes paid in net equity settlement |  |  |  |  | (23,204) | (3,844) |
Net cash used in financing activities |  |  |  |  | (146,612) | (100,490) |
Effect of exchange rate changes on cash and cash equivalents |  |  |  |  | (11,941) | (7,150) |
Net decrease in cash and cash equivalents |  |  |  |  | (66,296) | (72,752) |
Cash and cash equivalents at beginning of period |  | $ 513,448 |  | $ 470,166 | 513,448 | 470,166 | $ 470,166
Cash and cash equivalents at end of period | $ 447,152 |  | $ 397,414 |  | $ 447,152 | $ 397,414 | $ 513,448

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