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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) | 12 Months Ended
--- | ---
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019
Cash Flows Provided by (Used In) Operating Activities |  |  |  |
Net loss |  | $ (37,601,000) | $ (334,246,000) | $ (305,580,000)
Adjustments to reconcile net loss to net cash and restricted cash used in operating activities: |  |  |  |
Change in fair value of contingent consideration and indemnification asset |  | 13,281,000 | 3,860,000 | (3,997,000)
(Gain) loss on disposal of assets |  | 6,786,000 | 698,000 | (9,600,000)
(Gain) loss from equity method investees |  | (13,179,000) | (10,039,000) | 9,465,000
Depreciation and amortization expenses |  | 60,037,000 | 61,475,000 | 60,913,000
Impairment of equity method investments |  | 0 | 47,133,000 | 0
Stock-based compensation expense |  | 16,711,000 | 14,606,000 | 15,618,000
Deferred tax benefit |  | (526,000) | (1,132,000) | (23,124,000)
Amortization of contract cost assets |  | 13,041,000 | 21,195,000 | 5,723,000
Amortization of deferred financing costs |  | 18,045,000 | 14,780,000 | 9,370,000
Interest from customer advance for regulatory capital requirements |  | (323,000) | (1,869,000) | (1,300,000)
Gain on transfer of membership |  | (45,938,000) | 0 | 0
Goodwill impairment |  | 0 | 215,100,000 | 199,800,000
Loss on repayment of debt |  | 21,343,000 | 0 | 0
Loss on repayment of debt |  | 0 | 4,789,000 | 0
Other current operating cash inflows (outflows), net |  | 715,000 | 2,744,000 | (264,000)
Changes in assets and liabilities, net of acquisitions: |  |  |  |
Accounts receivable, net and contract assets |  | (5,779,000) | (47,017,000) | 6,326,000
Prepaid expenses and other current and non-current assets |  | 5,599,000 | 7,340,000 | 791,000
Contract cost assets |  | (18,979,000) | (11,400,000) | (23,057,000)
Accounts payable |  | 7,250,000 | 3,547,000 | (5,480,000)
Accrued liabilities |  | (324,000) | 8,801,000 | (21,852,000)
Accrued compensation and employee benefits |  | 3,538,000 | 11,143,000 | 9,246,000
Deferred revenue |  | (739,000) | (8,943,000) | (756,000)
Reserve for claims and performance-based arrangements |  | (3,799,000) | (36,108,000) | 33,555,000
Right-of-use operating assets |  | 8,844,000 | 11,934,000 | (20,811,000)
Operating lease liabilities |  | (6,522,000) | (2,782,000) | 27,724,000
Other long-term liabilities |  | (2,734,000) | 8,166,000 | (5,355,000)
Net cash and restricted cash provided by (used in) operating activities |  | 38,747,000 | (16,225,000) | (42,645,000)
Cash Flows Provided by (Used In) Investing Activities |  |  |  |
Cash paid for asset acquisitions and business combinations |  | (49,012,000) | (300,000) | (8,575,000)
Proceeds from transfer of membership and release of Passport escrow |  | 42,996,000 | 0 | 0
Loan for implementation funding |  | 0 | 1,000,000 | 5,400,000
Disposal of non-strategic assets and divestiture of discontinued operations, net |  | 3,490,000 | (2,287,000) | 0
Return of equity method investments |  | 14,218,000 | 0 | 0
Customer advance for regulatory capital requirements |  | 0 | 0 | (46,400,000)
Investments in equity method investees |  | 0 | 0 | (87,480,000)
Impact to cash and cash equivalents and restricted cash from initial consolidation |  | 0 | 159,755,000 | 0
Purchases of investments |  | (2,995,000) | (11,170,000) | (11,125,000)
Maturities and sales of investments |  | 500,000 | 143,441,000 | 2,575,000
Investments in internal-use software and purchases of property and equipment |  | (24,983,000) | (29,473,000) | (35,534,000)
Other investing activities |  | 0 | 106,000 | (495,000)
Net cash and restricted cash (used in) provided by investing activities |  | (15,786,000) | 261,072,000 | (181,634,000)
Cash Flows Used In Financing Activities |  |  |  |
Changes in working capital balances related to claims processing on behalf of partners |  | 61,162,000 | (6,044,000) | (104,268,000)
Amount received from escrow in asset acquisition |  | 0 | 0 | 500,000
Repayment and termination of Credit Agreement including settlement of warrants |  | (98,420,000) | 0 | 0
Proceeds from issuance of long term debt, net of offering costs |  | 0 | 30,062,000 | 62,648,000
Issuance of warrant liability |  | 0 | 0 | 7,092,000
Repayment and repurchase of 2021 Notes and financing fees |  | (429,000) | (16,606,000) | 0
Proceeds from stock option exercises |  | 13,289,000 | 2,577,000 | 1,092,000
Distributions to Sponsors |  | (1,300,000) | (20,000,000) | 0
Taxes withheld and paid for vesting of restricted stock units |  | (3,850,000) | (1,851,000) | (2,609,000)
Net cash and restricted cash used in financing activities |  | (29,548,000) | (11,862,000) | (35,545,000)
Effect of exchange rate on cash and cash equivalents and restricted cash |  | (52,000) | 65,000 | 30,000
Net increase (decrease) in cash and cash equivalents and restricted cash |  | (6,639,000) | 233,050,000 | (259,794,000)
Cash and cash equivalents and restricted cash as of beginning-of-period | [1] | 361,581,000 | 128,531,000 | 388,325,000
Cash and cash equivalents and restricted cash as of end-of-period | [1] | $ 354,942,000 | $ 361,581,000 | $ 128,531,000
[1] | See Note 5.

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