| Dec'19 | Dec'18 | Dec'17 | Dec'16 | Dec'15 | Dec'14 | Dec'13 | Dec'12 | Dec'11 |
|---|---|---|---|---|---|---|---|---|
OPERATING ACTIVITIES | ||||||||
Net Income (Loss), Including Portion Attributable to Noncontrolling Interest | ||||||||
29,844 | 41,874 | -17,143 | 53,437 | 7,428 | -9,793 | -7,319 | -12,202 | -61,422 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||
Accounts Receivable, Credit Loss Expense (Reversal) | ||||||||
21,800 | 22,200 | 13,300 | 9,931 | 8,047 | 9,347 | 7,787 | 11,912 | 12,080 |
Depreciation and amortization | ||||||||
42,976 | 40,168 | 28,561 | - | - | - | - | - | - |
Depreciation | ||||||||
- | - | - | 10,547 | 8,987 | 8,858 | 9,978 | 8,037 | 10,913 |
Amortization | ||||||||
- | - | - | 3,700 | 3,501 | 3,692 | 2,340 | 1,341 | 1,219 |
Impairment charge | ||||||||
0 | 0 | 12,045 | 0 | 0 | - | - | - | - |
Stock-based compensation | ||||||||
13,376 | 9,261 | 7,680 | 6,502 | 4,952 | 4,037 | 3,303 | 3,747 | 4,006 |
Equity method investment loss | ||||||||
- | - | - | - | 0 | - | - | - | - |
Write off of derivative premium | ||||||||
0 | 0 | 1,300 | 0 | 0 | - | - | - | - |
Accretion of debt discount | ||||||||
1,243 | 1,243 | 678 | 217 | - | - | - | - | - |
Loss on extinguishment of debt | ||||||||
- | - | - | - | 259 | - | - | - | - |
Loss on extinguishment of debt | ||||||||
0 | 0 | -543 | 0 | 0 | -203 | - | - | - |
Gain on legal settlement | ||||||||
0 | 0 | 1,333 | 0 | 0 | - | - | - | - |
Non-cash lease income | ||||||||
- | - | - | - | 14 | -355 | 215 | 198 | 303 |
Deferred income taxes | ||||||||
7,385 | -2,294 | 6,050 | -38,141 | 245 | -2,499 | 53 | -1,033 | 13 |
Change in fair value of acquisition-related contingent consideration | ||||||||
-230 | -700 | -2,605 | - | 0 | - | - | - | - |
Other non-cash items | ||||||||
-1,018 | -254 | 39 | -457 | - | - | - | - | - |
Amortization of investment premium | ||||||||
- | - | - | - | - | - | - | -268 | -561 |
Goodwill impairment | ||||||||
- | - | - | - | - | - | - | - | 45,999 |
Changes in operating assets and liabilities: | ||||||||
Healthcare and other accounts receivable | ||||||||
55,027 | 35,742 | 15,455 | 8,707 | 7,677 | 12,795 | 4,597 | 3,635 | 6,653 |
Inventory | ||||||||
-1,585 | 1,991 | -665 | 753 | -188 | -299 | -340 | 885 | 548 |
Prepaid expenses and other assets | ||||||||
-1,742 | -3,517 | 694 | 1,050 | 3 | 128 | 637 | -691 | -3,661 |
Accounts payable | ||||||||
5,551 | 3,760 | -8,320 | 3,145 | -4,699 | 47 | 2,369 | 552 | -3,033 |
Accrued and other liabilities | ||||||||
-3,681 | -8,826 | -1,464 | -456 | -464 | 788 | -2,143 | -2,852 | -1,463 |
Net cash provided by operating activities | ||||||||
67,550 | 72,746 | 23,782 | 38,851 | 14,350 | 8,811 | 11,259 | 5,743 | 5,030 |
INVESTING ACTIVITIES | ||||||||
Liability associated with the Civil Investigative Demand | ||||||||
- | - | - | - | -6,400 | 6,400 | - | - | - |
Acquisition of business, net of cash acquired | ||||||||
44,766 | 3,750 | 161,479 | 24,970 | 0 | 14,100 | - | 28,155 | - |
Purchases of property and equipment and investment in internally developed software | ||||||||
30,707 | 24,637 | 13,697 | 10,899 | 13,600 | 12,781 | 8,169 | 5,962 | 3,954 |
Purchase of derivative instrument | ||||||||
0 | 0 | 1,322 | 0 | 0 | - | - | - | - |
Investment in equity method investee | ||||||||
0 | 464 | 690 | 312 | 0 | - | - | - | - |
Net cash used in investing activities | ||||||||
-75,473 | -28,851 | -177,188 | -36,181 | -13,600 | -26,881 | -8,169 | -6,416 | -5,713 |
FINANCING ACTIVITIES | ||||||||
Purchases of short-term available-for-sale investments | ||||||||
- | - | - | - | - | - | - | 11,935 | 49,657 |
Sale or maturity of short-term available-for-sale investments | ||||||||
- | - | - | - | - | - | - | 39,636 | 47,898 |
Proceeds related to the exercising of stock options and employee stock purchase plan | ||||||||
7,610 | 12,186 | 6,071 | 2,519 | 1,222 | 1,400 | 847 | - | - |
Payments of tax withholdings related to vesting of share-based awards | ||||||||
4,955 | 2,910 | 1,933 | 2,333 | 1,575 | 349 | - | - | - |
Principal payments on long-term debt | ||||||||
5,125 | 2,050 | 25,840 | 1,438 | 938 | 26,434 | - | - | - |
Proceeds from the exercise of employee stock options and employee stock purchase plan contributions | ||||||||
- | - | - | - | - | - | - | 440 | 509 |
Issuance of long-term debt | ||||||||
0 | 0 | 205,000 | 0 | 0 | 41,838 | - | - | - |
Proceeds from borrowings on revolving credit facility | ||||||||
- | - | - | 14,500 | 0 | - | - | - | - |
Repayments on revolving loans | ||||||||
0 | 0 | 3,000 | 11,500 | 0 | - | - | - | - |
Payments of debt issuance costs | ||||||||
0 | 0 | 6,213 | 0 | 0 | - | - | - | - |
Principal payments on finance lease obligations | ||||||||
1,909 | 3,740 | 2,863 | 321 | 480 | 529 | 84 | - | - |
Acquisition of noncontrolling interests | ||||||||
0 | 2,885 | 4,765 | 0 | 0 | - | - | - | - |
Net cash provided by/(used in) financing activities | ||||||||
-4,379 | 601 | 166,457 | 1,427 | -1,771 | 15,926 | 763 | 440 | 509 |
Effect of exchange rate changes on cash | ||||||||
27 | 371 | -81 | -31 | 0 | - | - | - | - |
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect | ||||||||
-12,275 | 44,867 | 12,970 | 4,066 | -1,021 | -2,144 | 3,853 | -233 | -174 |
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION | ||||||||
Non-cash purchases of property and equipment | ||||||||
3,302 | 505 | 498 | 0 | 0 | - | - | - | - |
Non-cash fair value of common stock returned in legal settlement | ||||||||
0 | 0 | 2,753 | 0 | 0 | - | - | - | - |
Non-cash fair value of equity issued for acquisition of business | ||||||||
2,142 | 0 | 117,440 | 2,885 | 0 | - | - | - | - |
Non-cash fair value of non-trade receivables exchanged for investment in equity method investee | ||||||||
0 | 395 | 0 | 0 | - | - | - | - | - |
Cash paid for interest | ||||||||
8,029 | 7,836 | 3,888 | 1,273 | 1,044 | 856 | 132 | 295 | - |
Cash paid for taxes | ||||||||
-89 | 763 | 1,648 | 359 | 384 | 148 | 112 | 135 | 171 |
Capital lease obligations | ||||||||
- | - | - | - | - | - | - | - | 0 |