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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2015 | Dec. 31, 2014 | Dec. 31, 2013
OPERATING ACTIVITIES |  |  |
Net income including noncontrolling interests | $ 31,691 | $ 30,424 | $ 20,996
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities: |  |  |
Depreciation and amortization | 7,952 | 6,740 | 5,562
Provision for doubtful accounts | 4,170 | 4,112 | 4,384
Equity-based awards compensation expense | 4,491 | 3,363 | 2,743
Loss (gain) on sale of business and fixed assets | 84 | 35 | 7,335
Excess tax benefit from equity-based awards | (947) | (948) | (695)
Deferred income tax | 7,001 | 6,275 | 2,369
Write-off of goodwill - closed clinic | 180 | 135 | 0
Changes in operating assets and liabilities: |  |  |
Increase in patient accounts receivable | (5,519) | (5,388) | (5,389)
Increase in accounts receivable - other | (852) | 341 | (5)
(Increase) decrease in other assets | (1,477) | (2,493) | 1,803
(Decrease) increase in accounts payable and accrued expenses | (7,013) | 1,868 | 4,833
(Decrease) increase in other liabilities | 1,482 | 730 | 859
Net cash provided by operating activities | 41,243 | 45,194 | 44,795
INVESTING ACTIVITIES |  |  |
Purchase of fixed assets | (6,263) | (5,167) | (4,637)
Purchase of businesses, net of cash acquired | (18,965) | (12,270) | (46,628)
Acquisitions of non-controlling interests | (7,083) | (5,490) | (1,876)
Sale of non-controlling interests | 0 | 0 | 233
Proceeds on sale of business and fixed assets, net | 71 | 47 | 459
Net cash used in investing activities | (32,240) | (22,880) | (52,449)
FINANCING ACTIVITIES |  |  |
Distributions to non-controlling interests (including redeemable non-controlling interests) | (9,632) | (9,913) | (9,164)
Cash dividends to shareholders | (7,449) | (5,873) | (4,838)
Proceeds from revolving line of credit | 103,000 | 134,300 | 150,800
Payments on revolving line of credit | (93,500) | (139,800) | (128,200)
Principal payments on notes payable | (884) | (825) | (459)
Tax benefit from stock based awards | 947 | 948 | 695
Other | 22 | 222 | 47
Net cash (used in) provided by financing activities | (7,496) | (20,941) | 8,881
Net increase in cash and cash equivalents | 1,507 | 1,373 | 1,227
Cash and cash equivalents - beginning of period | 14,271 | 12,898 | 11,671
Cash and cash equivalents - end of period | 15,778 | 14,271 | 12,898
Cash paid during the period for: |  |  |
Income taxes | 7,779 | 9,253 | 4,111
Interest | 884 | 1,103 | 352
Non-cash investing and financing transactions during the period: |  |  |
Purchase of business - seller financing portion | 1,800 | 400 | 1,300
Acquisition of noncontrolling interest - seller financing portion | 3,077 | 67 | 0
Revaluation of redeemable non-controlling interests | $ 529 | $ 1,841 | $ 0

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- Definition Amount of cash outflow for payment of an obligation from a lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3291-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.4-08.(f)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690 + Details
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