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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
OPERATING ACTIVITIES      
Net income including non-controlling interests $ 27,724 $ 26,268 $ 26,489
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities:      
Depreciation and amortization 9,710 8,779 7,952
Provision for doubtful accounts 3,672 4,040 4,170
Equity-based awards compensation expense 5,032 4,962 4,491
Excess tax benefit from equity-based rewards 0 0 (947)
Deferred income tax (4,864) 2,979 5,953
Other 621 152 264
Changes in operating assets and liabilities:      
Increase in patient accounts receivable (3,447) (3,275) (5,519)
Increase in accounts receivable - other (3,022) (400) (852)
Decrease (increase) in other assets 2,086 (1,399) (1,375)
Increase (decrease) in accounts payable and accrued expenses 6,979 2,994 (7,011)
Increase in mandatorily redeemable non-controlling interests 11,579 5,598 2,509
Increase in other liabilities 456 352 1,396
Net cash provided by operating activities 56,526 51,050 37,520
INVESTING ACTIVITIES      
Purchase of fixed assets (7,095) (8,260) (6,263)
Purchase of businesses, net of cash acquired (36,682) (23,623) (18,965)
Sale of non-controlling interest, net of purchases 121 (670) (968)
Proceeds on sale of fixed assets 81 61 71
Net cash used in investing activities (43,575) (32,492) (26,125)
FINANCING ACTIVITIES      
Distributions to non-controlling interests (5,572) (5,718) (5,892)
Cash dividends paid to shareholders - funded (10,066) (8,510) (7,449)
Proceeds from revolving line of credit 93,000 168,000 103,000
Payments on revolving line of credit (85,000) (166,000) (93,500)
Payments to settle mandatorily redeemable non-controlling interests (2,361) (1,262) (6,115)
Principal payments on notes payable (1,227) (800) (884)
Tax benefit from equity-based rewards 0 0 947
Other 161 1 5
Net cash used in financing activities (11,065) (14,289) (9,888)
Net increase in cash and cash equivalents 1,886 4,269 1,507
Cash and cash equivalents - beginning of period 20,047 15,778 14,271
Cash and cash equivalents - end of period 21,933 20,047 15,778
Cash paid during the period for:      
Income taxes 8,543 10,584 7,779
Interest 2,113 784 884
Non-cash investing and financing transactions during the period:      
Purchase of business - seller financing portion 2,150 1,000 1,800
Acquisition of non-controlling interest - seller financing portion 0 387 0
Payment to settle redeemable non-controlling interest - financing portion 0 127 3,077
Receivable from sale of non-controlling interests $ 0 $ (138) $ 0