adjustments related to liabilities from recent acquisitions, higher SG&A expenses as a percentage of sales, and higher intangible impairment expense, partially offset by increased sales.
LIQUIDITY AND CAPITAL RESOURCES
Capital Commitments, Contractual Obligations and Cash Flows
At September 30, 2019 and December 31, 2018, we had cash and cash equivalents of approximately $37.3 million and $67.4 million respectively, of which approximately $34.0 million and $57.3 million, respectively, were held by foreign subsidiaries. For each of our foreign subsidiaries, we make an evaluation as to whether the earnings are intended to be repatriated to the United States or held by the foreign subsidiary for permanent reinvestment. We are not permanently reinvested with respect to our historic unremitted foreign earnings; a deferred tax liability has been accrued for the earnings that are available to be repatriated to the United States.
In addition, cash held by our subsidiary in China is subject to local laws and regulations that require government approval for the transfer of such funds to entities located outside of China. As of September 30, 2019, and December 31, 2018, we had cash and cash equivalents of approximately $12.0 million and $18.6 million, respectively, within our subsidiary in China.
Cash flows provided by operating activities. Cash provided by operating activities during the nine-month periods ended September 30, 2019 and 2018 was primarily the result of net income excluding non-cash items, partially offset by changes in working capital. Our working capital as of September 30, 2019 and December 31, 2018 was approximately $288.1 million and $254.5 million, respectively. The increase in working capital as of September 30, 2019 compared to December 31, 2018 was primarily the result of an increase in trade receivables, inventories, prepaid expenses and other assets and income tax refund receivables, as well as decreases in accrued expenses and the current portion of long-term debt, partially offset by the recording of current operating lease liabilities as a result of the adoption of ASC 842 and a decrease in cash. As of September 30, 2019, and December 31, 2018, we had a current ratio of 2.88 to 1 and 2.45 to 1, respectively.
During the nine-month period ended September 30, 2019, our inventory balance increased approximately $19.2 million, from approximately $197.5 million as of December 31, 2018 to approximately $216.8 million as of September 30, 2019. The increase in the inventory balance was primarily due to increased inventory levels associated with increased sales and the initial placement of inventory in our new warehouse and distribution facility in Reading, United Kingdom. The trailing twelve-month inventory turns as of September 30, 2019 was 2.73, compared to 2.80 for the twelve-month period ended December 31, 2018.
Cash flows provided by financing activities. Cash provided by financing activities for the nine-month period ended September 30, 2019 was approximately $33.7 million compared to cash provided by financing activities of approximately $140.4 million for the nine-month period ended September 30, 2018, a decrease of approximately $106.7 million. The decrease was primarily the result of a reduction in the proceeds from the issuance of common stock associated with our public equity offering of 4,025,000 shares of common stock completed in July 2018 (from which we received net proceeds of approximately $205.0 million) and additional net borrowings in 2019 to fund the acquisition of Brightwater and the payment of certain contingent liabilities associated with our acquisition of Cianna Medical.
As of September 30, 2019, we had outstanding borrowings of approximately $440.5 million under the Third Amended Credit Agreement, with additional available borrowings of approximately $191.1 million, based on the leverage ratio required pursuant to the Third Amended Credit Agreement. Our interest rate as of September 30, 2019 was a fixed rate of 2.37% on $175 million as a result of an interest rate swap (see Note 11 to our consolidated financial statements included in Part I, Item 1 of this report) and a variable floating rate of 3.29% on $265.5 million. Our interest rate as of December 31, 2018 was a fixed rate of 2.12% on $175 million as a result of an interest rate swap and a variable floating rate of 3.52% on $213.5 million. See Note 10 to our consolidated financial statements included in Part I, Item 1 of this report for additional details regarding the Third Amended Credit Agreement and our long-term debt.