| | | | | | | | |
| | Year Ended December 31 | |
| | 2018 | | | 2017 | |
| | | | |
Operating Activities | | (Amounts in Thousands) | |
Net loss | | $ | (279,547 | ) | | $ | (207,181 | ) |
Adjustments to reconcile net loss to net cash (used in) provided by operating activities: | | | | | | | | |
Depreciation and amortization | | | 230,802 | | | | 154,772 | |
Provision for bad debts | | | 580,378 | | | | 284,765 | |
Equity-based compensation expense | | | 2,180 | | | | 2,180 | |
Deferred tax, net | | | (29,589 | ) | | | (244,051 | ) |
Non-cash interest expense | | | 7,963 | | | | 2,342 | |
Amortization of deferred gains | | | (15,093 | ) | | | (6,214 | ) |
Gain on sale-leaseback transaction, net | | | (3,931 | ) | | | – | |
Gain on sale of assets and business | | | (31,274 | ) | | | (1,953 | ) |
Other | | | – | | | | (6,682 | ) |
Increase (decrease) in cash resulting from a change in: | | | | | | | | |
Patient accounts receivable | | | (563,349 | ) | | | (315,064 | ) |
Establishment of accounts receivable of recent acquisitions | | | – | | | | (128,634 | ) |
Other assets | | | 73,516 | | | | (50,816 | ) |
Accounts payable, accrued expenses, and other liabilities | | | 267,598 | | | | 494,372 | |
| | | | |
Net cash provided by (used in) operating activities | | | 239,654 | | | | (22,164 | ) |
Investing Activities | | | | | | | | |
Purchase of property and equipment | | | (200,895 | ) | | | (83,403 | ) |
Proceeds from sale of assets and business | | | 57,851 | | | | – | |
Purchase ofavailable-for-sale securities | | | (7,500 | ) | | | – | |
Cost of acquisitions, net of cash acquired | | | (1,082 | ) | | | (440,623 | ) |
Increase in noncurrent other assets | | | (4,413 | ) | | | (51,209 | ) |
| | | | |
Net cash used in investing activities | | | (156,039 | ) | | | (575,235 | ) |
Financing Activities | | | | | | | | |
Payment of debt issuance costs | | | – | | | | (16,598 | ) |
Proceeds from issuance of debt | | | 38,648 | | | | 15,000 | |
Proceeds under revolving credit facility | | | 30,000 | | | | 650,000 | |
Payments under revolving credit facility | | | (80,000 | ) | | | (35,000 | ) |
Repayments of debt and capital lease obligations | | | (87,448 | ) | | | (65,994 | ) |
Distributions | | | (12,320 | ) | | | (89 | ) |
Proceeds from preferred equity issuance | | | – | | | | 100,000 | |
Net proceeds from sale-leaseback transaction | | | 42,823 | | | | – | |
Repurchases of equity interests | | | (5,275 | ) | | | – | |
Cash paid for the repurchase ofnon-controlling interests | | | (2,348 | ) | | | – | |
Other | | | (2,525 | ) | | | (745 | ) |
| | | | |
Net cash (used in) provided by financing activities | | | (78,445 | ) | | | 646,574 | |
| | | | |
Net increase in cash and cash equivalents | | | 5,170 | | | | 49,175 | |
Cash and cash equivalents at beginning of year | | | 69,088 | | | | 19,913 | |
| | | | |
Cash and cash equivalents at end of year | | $ | 74,258 | | | $ | 69,088 | |
| | | | |