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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)