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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 9 Months Ended
--- | ---
Sep. 30, 2022 | Sep. 30, 2021
Cash Flows Used In Operating Activities |  |  |
Net income (loss) |  | $ (7,815) | $ (31,954)
Adjustments to reconcile net loss to net cash and restricted cash used in operating activities: |  |  |
Change in fair value of contingent consideration |  | (5,822) | (819)
Loss (gain) on discontinued operations |  | 463 | (1,904)
Gain from equity method investees |  | (3,940) | (12,725)
Depreciation and amortization expenses |  | 47,414 | 45,122
Stock-based compensation expense |  | 19,350 | 11,754
Deferred tax benefit |  | (46,385) | (288)
Amortization of contract cost assets |  | 14,768 | 9,928
Amortization of deferred financing costs |  | 1,762 | 13,399
Gain on transfer of membership |  | 0 | (22,969)
Loss on extinguishment/repayment of debt, net |  | 10,192 | 19,158
Change in tax receivable agreement liability |  | 42,870 | 0
Other current operating cash inflows (outflows), net |  | 2,163 | 472
Changes in assets and liabilities, net of acquisitions: |  |  |
Accounts receivable, net and contract assets |  | (34,796) | (52,878)
Prepaid expenses and other current and non-current assets |  | (2,409) | (140)
Contract cost assets |  | (6,732) | (8,439)
Accounts payable |  | 5,936 | 8,164
Accrued liabilities |  | (27,903) | (13,893)
Accrued compensation and employee benefits |  | (14,451) | (12,811)
Deferred revenue |  | (4,741) | 3,103
Reserve for claims and performance-based arrangements |  | (35,596) | 16,784
Right-of-use operating assets |  | 831 | 6,408
Operating lease liabilities |  | (1,223) | (4,589)
Other long-term liabilities |  | (1,184) | 1,208
Net cash and restricted cash used in operating activities |  | (47,248) | (27,909)
Cash Flows Provided by (Used In) Investing Activities |  |  |
Cash paid for asset acquisitions and business combinations |  | (245,021) | (1,889)
Proceeds from transfer of membership and release of Passport escrow |  | 22,969 | 42,996
Disposal of non-strategic assets and divestiture of discontinued operations, net |  | (9,164) | 3,490
Return of equity method investments |  | 4,175 | 14,218
Purchases of investments |  | 0 | (2,994)
Maturities and sales of investments |  | 0 | 500
Investments in internal-use software and purchases of property and equipment |  | (27,618) | (17,739)
Net cash and restricted cash provided by (used in) investing activities |  | (254,659) | 38,582
Cash Flows Provided by (Used In) Financing Activities |  |  |
Changes in working capital balances related to claims processing on behalf of partners |  | (48,322) | 1,105
Repayment of Credit Agreement including settlement of warrants |  | 0 | (98,420)
Proceeds from stock option exercises |  | 3,280 | 11,566
Proceeds from issuance of long term debt, net of offering costs |  | 219,740 | 0
Distributions to Sponsors |  | (14,884) | (1,300)
Taxes withheld and paid for vesting of equity awards |  | (17,419) | (3,397)
Net cash and restricted cash provided by (used in) financing activities |  | 142,395 | (90,446)
Effect of exchange rate on cash and cash equivalents and restricted cash |  | (612) | (53)
Net decrease in cash and cash equivalents and restricted cash |  | (160,124) | (79,826)
Cash and cash equivalents and restricted cash as of beginning-of-period | [1] | 354,942 | 361,581
Cash and cash equivalents and restricted cash as of end-of-period | [1] | $ 194,818 | $ 281,755
[1] | As a result of the closing of the sale of True Health during the first quarter of 2021, the consolidated statement of operations and related financial information reflect the Company’s operations and assets and liabilities of True Health as discontinued operations. Cash flows and comprehensive income have not been adjusted and are included in the consolidated statements of cash flows and consolidated statements of comprehensive income (loss) for the nine months ended September 30, 2021. See Note 5.

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