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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