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CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2019
Sep. 30, 2018
OPERATING ACTIVITIES    
Net income including non-controlling interests $ 45,244 $ 35,169
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities:    
Depreciation and amortization 7,377 7,335
Provision for doubtful accounts 3,408 3,102
Equity-based awards compensation expense 5,262 4,453
Deferred income taxes 3,680 (3,099)
Gain on sale of partnership interest (5,823) 0
Other 120 128
Changes in operating assets and liabilities:    
Increase in patient accounts receivable (8,171) (1,092)
Increase in accounts receivable - other (1,006) (3,954)
(Increase) decrease in other assets (2,744) 233
(Decrease) increase in accounts payable and accrued expenses (440) 9,742
(Decrease) increase in other liabilities (443) 1,988
Net cash provided by operating activities 46,464 54,005
INVESTING ACTIVITIES    
Purchase of fixed assets (7,428) (5,307)
Purchase of majority interest in businesses (30,365) (16,303)
Purchase of redeemable non-controlling interest, temporary equity (5,699) 0
Purchase of non-controlling interest, permanent equity (138) (272)
Proceeds on sale of partnership interest, net 11,601 0
Proceeds on sale of fixed assets 64 2
Net cash used in investing activities (31,965) (21,880)
FINANCING ACTIVITIES    
Distributions to non-controlling interests, permanent and temporary equity (10,862) (10,470)
Cash dividends paid to shareholders (10,723) (8,746)
Proceeds from revolving line of credit 110,000 79,000
Payments on revolving line of credit (97,000) (79,000)
Payments to settle mandatorily redeemable non-controlling interests 0 (265)
Principal payments on notes payable (1,409) (2,294)
Other (17) (42)
Net cash used in financing activities (10,011) (21,817)
Net increase in cash and cash equivalents 4,488 10,308
Cash and cash equivalents - beginning of period 23,368 21,933
Cash and cash equivalents - end of period 27,856 32,241
Cash paid during the period for:    
Income taxes 9,458 8,957
Interest 1,412 1,705
Non-cash investing and financing transactions during the period:    
Purchase of businesses - seller financing portion 4,300 950
Purchase of business - payable to common shareholders of acquired business 502 0
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 283 0
Notes receivable related to sale of partnership interest - redeemable non-controlling interest $ 2,870 $ 0