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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2016
Dec. 31, 2015
Dec. 31, 2014
CASH FLOWS FROM OPERATING ACTIVITIES      
Net income $ 8,004 $ 8,638 $ 1,685
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 66,610 60,611 59,258
Provision for bad debts 45,387 36,033 29,807
Gain on return of common stock (5,032) 0 0
Equity in earnings of joint ventures (9,767) (8,927) (6,970)
Distributions from joint ventures 2,926 7,731 7,358
Amortization and write off of deferred financing costs and loan discount 5,045 5,369 5,732
Loss on sale and disposal of equipment 767 866 1,113
Loss on early extinguishment of senior notes 0 0 15,927
Gain on sale of imaging centers 0 (5,434) 0
Stock-based compensation 5,826 7,647 2,500
Changes in operating assets and liabilities, net of assets acquired and liabilities assumed in purchase transactions:      
Accounts receivable (47,055) (34,514) (43,973)
Other current assets 11,038 (14,198) (5,514)
Other assets 1,267 (3,813) (281)
Deferred taxes 3,446 4,036 655
Deferred rent (1,668) 7,011 2,180
Deferred revenue (82) (366) 620
Accounts payable and accrued expenses and other 4,929 (3,653) (9,093)
Net cash provided by operating activities 91,641 67,037 61,004
CASH FLOWS FROM INVESTING ACTIVITIES      
Purchase of imaging facilities (6,641) (90,792) (9,428)
Purchase of property and equipment (59,251) (42,964) (41,740)
Proceeds from sale of equipment 481 1,282 1,088
Proceeds from sale of imaging facilities 0 35,500 0
Proceeds from sale of internal use software 301 443 0
Cash contribution from partner in JV formation 994 0 0
Equity contributions in existing and purchase of interest in joint ventures (1,374) (265) (3,562)
Net cash used in investing activities (65,490) (96,796) (53,642)
CASH FLOWS FROM FINANCING ACTIVITIES      
Principal payments on notes and leases payable (11,880) (9,773) (23,913)
Proceeds from borrowings 476,504 73,869 210,000
Payments on senior notes (469,086) (23,727) (211,344)
Deferred financing costs (945) 0 (6,650)
Net (payments) proceeds on revolving credit facility 0 (15,300) 15,300
Dividends paid to noncontrolling interests (492) (729) (148)
Proceeds from the sale of non-controlling interests 992 5,005 0
Purchase on non-controlling interests (1,153) 0 (196)
Proceeds from issuance of common stock upon exercise of options/warrants 150 594 1,546
Net cash (used in) provided by financing activities (5,910) 29,939 (15,405)
EFFECT OF EXCHANGE RATE CHANGES ON CASH (49) (41) (62)
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS 20,192 139 (8,105)
CASH AND CASH EQUIVALENTS, beginning of period 446 307 8,412
CASH AND CASH EQUIVALENTS, end of period 20,638 446 307
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION      
Cash paid during the period for interest 37,487 36,028 41,584
Cash paid during the period for income taxes 2,798 1,781 1,070
SUPPLEMENTAL SCHEDULE OF NON-CASH INVESTING AND FINANCING ACTIVITIES      
Purchase of equipment and leasehold improvements not yet paid for 28,800 $ 32,400 $ 19,400
Capital lease debt related to radiology equipment 1,300    
Non-cash gain from return of common stock 5,000    
Transfer of fixed assets to new joint venture $ 2,700