v3.26.1
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2026
Mar. 31, 2025
CASH FLOWS FROM OPERATING ACTIVITIES    
Net loss $ (24,732) $ (29,737)
Adjustments to reconcile net loss to net cash provided by operating activities:    
Depreciation and amortization 44,967 35,483
Noncash operating lease expense 16,298 14,431
Equity in earnings of joint ventures, net of dividends (1,069) (2,599)
Amortization of deferred financing costs and loan discount 779 728
Loss on sale and disposal of equipment 2,591 402
Lease abandonment charges 0 5,388
Amortization of cash flow hedge 0 1,033
Non-cash change in fair value of interest rate swap 0 2,106
Stock-based compensation 31,375 28,494
Change in valuation of contingent consideration (2,764) 0
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:    
Accounts receivable 9,375 (14,306)
Other current assets (6,172) (7,206)
Other assets (660) (1,691)
Deferred taxes (9,099) 5,137
Operating leases (13,299) (21,968)
Deferred revenue 234 128
Accounts payable, accrued expenses and other 31,148 25,658
Net cash provided by operating activities 78,972 41,481
CASH FLOWS FROM INVESTING ACTIVITIES    
Purchase of imaging facilities and other acquisitions, net of cash acquired (304,151) (3,794)
Purchase of property and equipment and other (69,932) (48,833)
Proceeds from sale of equipment 277 23
Equity contributions in existing and purchase of interest in joint ventures 0 (4,147)
Collection of notes receivable 2,833 0
Net cash used in investing activities (370,973) (56,751)
CASH FLOWS FROM FINANCING ACTIVITIES    
Principal payments on notes and leases payable (9,953) (1,718)
Payments on term loan debt (5,252) (5,000)
Distributions paid to noncontrolling interests (2,402) (913)
Proceeds from issuance of common stock upon exercise of options 103 121
Net cash used in financing activities (17,504) (7,510)
EFFECT OF EXCHANGE RATE CHANGES ON CASH (2,371) 83
NET DECREASE IN CASH AND CASH EQUIVALENTS (311,876) (22,697)
CASH AND CASH EQUIVALENTS, beginning of period 767,215 740,020
CASH AND CASH EQUIVALENTS, end of period 455,339 717,323
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION    
Cash paid during the period for interest 17,073 18,010
Cash paid during the period for income taxes $ 519 $ 272