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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
OPERATING ACTIVITIES |  |  |
Net income including non-controlling interests | $ 48,842 | $ 27,724 | $ 26,268
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities: |  |  |
Depreciation and amortization | 9,755 | 9,710 | 8,779
Provision for doubtful accounts | 4,603 | 3,672 | 4,040
Equity-based awards compensation expense | 5,939 | 5,032 | 4,962
Deferred income taxes | 4,813 | (4,864) | 2,979
Other | 167 | 621 | 152
Gain on derecognition of Debt | (1,846) | 0 | 0
Changes in operating assets and liabilities: |  |  |
Increase in patient accounts receivable | (3,434) | (3,447) | (3,275)
Increase in accounts receivable - other | (1,087) | (3,022) | (400)
Decrease (increase) in other assets | 345 | 2,086 | (1,399)
Increase in accounts payable and accrued expenses | 4,876 | 6,979 | 2,994
Increase in mandatorily redeemable non-controlling interests | 0 | 11,579 | 5,598
Increase in other liabilities | 32 | 456 | 352
Net cash provided by operating activities | 73,005 | 56,526 | 51,050
INVESTING ACTIVITIES |  |  |
Purchase of fixed assets | (7,193) | (7,095) | (8,260)
Purchase of businesses, net of cash acquired | (16,367) | (36,682) | (23,623)
(Purchase) Sale of non-controlling interest | (350) | 121 | (670)
Proceeds on sale of fixed assets | 1 | 81 | 61
Net cash used in investing activities | (23,909) | (43,575) | (32,492)
FINANCING ACTIVITIES |  |  |
Distributions to non-controlling interests, permanent and temporary equity | (15,646) | (5,572) | (5,718)
Cash dividends paid to shareholders | (11,664) | (10,066) | (8,510)
Proceeds from revolving line of credit | 103,000 | 93,000 | 168,000
Payments on revolving line of credit | (119,000) | (85,000) | (166,000)
Payments to settle mandatorily redeemable non-controlling interests | (265) | (2,361) | (1,262)
Principal payments on notes payable | (4,044) | (1,227) | (800)
Other | (42) | 161 | 1
Net cash used in financing activities | (47,661) | (11,065) | (14,289)
Net increase in cash and cash equivalents | 1,435 | 1,886 | 4,269
Cash and cash equivalents - beginning of period | 21,933 | 20,047 | 15,778
Cash and cash equivalents - end of period | 23,368 | 21,933 | 20,047
Cash paid during the period for: |  |  |
Income taxes | 9,183 | 8,543 | 10,584
Interest | 2,357 | 2,113 | 784
Non-cash investing and financing transactions during the period: |  |  |
Purchase of business - seller financing portion | 950 | 2,150 | 1,000
Acquisition of non-controlling interest - seller financing portion | 0 | 0 | 387
Payment to settle redeemable non-controlling interest - financing portion | 0 | 0 | 127
Receivable from sale of non-controlling interests | $ 0 | $ 0 | $ (138)

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