For the first quarter of 2021, transformational and restructuring related expenses totaled $4.9 million, compared to $16.1 million for the first quarter of 2020. Of the expense recorded during the first quarter of 2021, $3.7 million related to third-party consulting fees, while the remainder related primarily to contract termination fees and position eliminations.
Adjusted EBITDA from continuing operations, which is defined as earnings from continuing operations before interest, loss on early extinguishment of debt, taxes, depreciation and amortization, and transformational and restructuring related expenses, was $45.5 million for the 2021 first quarter, compared to $33.1 million for the prior-year period. Funds received from the provider relief fund established by the CARES Act impacted Adjusted EBITDA positively by approximately $4 million for the 2021 first quarter.
Depreciation and amortization expense was $8.0 million for the first quarter of 2021 compared to $6.8 million for the first quarter of 2020.
Investment and other income was $6.0 million for the first quarter of 2021 compared to a loss of $1.0 million for the first quarter of 2020. This increase primarily represents the reimbursement related to the transition services being provided to the buyers of the Company’s former anesthesiology and radiology medical groups.
Interest expense was $17.6 million for the first quarter of 2021 compared to $27.7 million for the first quarter of 2020. This decline primarily reflects the Company’s January 7, 2021 redemption of its $750 million in outstanding principle amount of 5.25% senior notes due 2023 (the “2023 Notes”).
Loss on early extinguishment of debt, related to the redemption of the 2023 Notes, was $14.5 million for the first quarter of 2021, which included cash premiums and accelerated amortization of deferred financing costs.
Mednax generated income from continuing operations of $5.4 million, or $0.06 per diluted share, for the 2021 first quarter, based on a weighted average 85.5 million shares outstanding. This compares with a loss from continuing operations of $18.5 million, or $0.22 per diluted share, for the 2020 first quarter, based on a weighted average 82.8 million shares outstanding.
For the first quarter of 2021, Mednax reported Adjusted EPS from continuing operations of $0.24, compared to $0.06 for the first quarter of 2020. For these periods, Adjusted EPS from continuing operations is defined as diluted income from continuing operations per common and common equivalent share excluding non-cash amortization expense, stock-based compensation expense, transformational and restructuring related expenses, loss on early extinguishment of debt and discrete tax items.
Financial Position and Cash Flow – Continuing Operations
Mednax had cash and cash equivalents of $270 million at March 31, 2021, compared to $1.12 billion on December 31, 2020, and net accounts receivable were $246 million. Mednax used $764 million in cash in January 2021 to redeem its $750 million 2023 Notes, including cash premiums and accrued interest.