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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017
OPERATING ACTIVITIES |  |  |
Net income including non-controlling interests | $ 57,259 | $ 48,842 | $ 27,724
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities: |  |  |
Depreciation and amortization | 10,095 | 9,755 | 9,710
Provision for doubtful accounts | 4,858 | 4,603 | 3,672
Equity-based awards compensation expense | 6,985 | 5,939 | 5,032
Deferred income taxes | 4,651 | 4,813 | (4,864)
Gain on sale of partnership interest | (5,514) | 0 | 0
Gain on derecognition of Debt | 0 | (1,846) | 0
Other | 96 | 167 | 621
Changes in operating assets and liabilities: |  |  |
Increase in patient accounts receivable | (6,376) | (3,434) | (3,447)
Increase in accounts receivable - other | (2,499) | (1,087) | (3,022)
(Increase) decrease in other assets | (1,878) | 345 | 2,086
(Decrease) increase in accounts payable and accrued expenses | (4,209) | 4,876 | 6,979
Increase in mandatorily redeemable non-controlling interests | 0 | 0 | 11,579
(Decrease) increase in other liabilities | (1,020) | 32 | 456
Net cash provided by operating activities | 62,448 | 73,005 | 56,526
INVESTING ACTIVITIES |  |  |
Purchase of fixed assets | (10,189) | (7,193) | (7,095)
Purchase of majority interest in businesses | (30,597) | (16,367) | (36,682)
Purchase of redeemable non-controlling interest, temporary equity | (8,651) | 0 | 0
Purchase of non-controlling interest, permanent equity | (428) | (350) | 0
Sales of non controlling interest-permanent equity | 207 | 0 | 121
Proceeds on sale of partnership interest, net | 11,601 | 0 | 0
Proceeds on sale of fixed assets | 64 | 1 | 81
Net cash used in investing activities | (37,993) | (23,909) | (43,575)
FINANCING ACTIVITIES |  |  |
Distributions to non-controlling interests, permanent and temporary equity | (16,235) | (15,646) | (5,572)
Cash dividends paid to shareholders | (14,555) | (11,664) | (10,066)
Proceeds from revolving line of credit | 145,000 | 103,000 | 93,000
Payments on revolving line of credit | (137,000) | (119,000) | (85,000)
Payments to settle mandatorily redeemable non-controlling interests | 0 | (265) | (2,361)
Principal payments on notes payable | (1,433) | (4,044) | (1,227)
Other | (52) | (42) | 161
Net cash used in financing activities | (24,275) | (47,661) | (11,065)
Net increase in cash and cash equivalents | 180 | 1,435 | 1,886
Cash and cash equivalents - beginning of period | 23,368 | 21,933 | 20,047
Cash and cash equivalents - end of period | 23,548 | 23,368 | 21,933
Cash paid during the period for: |  |  |
Income taxes | 9,856 | 9,183 | 8,543
Interest | 1,890 | 2,357 | 2,113
Non-cash investing and financing transactions during the period: |  |  |
Purchase of businesses - seller financing portion | 4,300 | 950 | 2,150
Purchase of business - payable to common shareholders of acquired business | 502 | 0 | 0
Notes payable related to purchase of redeemable non-controlling interest, temporary equity | 283 | 0 | 0
Notes payable related to purchase of non-controlling interest, permanent equity | 103 | 0 | 0
Notes receivable related to sale of partnership interest - redeemable non-controlling interest | $ 2,870 | $ 0 | $ 0

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- Definition Amount of cash inflow from contractual arrangement with the lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=118932676&loc=d3e3255-108585 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.4-08.(f)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690 + Details
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- Definition Amount of cash inflow (outflow) from financing activities classified as other. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 3 -Subparagraph (SX 210.12-04(a)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e24072-122690 Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -URI http://asc.fasb.org/extlink&oid=118932676&loc=d3e3255-108585 Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=118932676&loc=d3e3291-108585 + Details
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- Definition The cash inflow from the sale of property, plant and equipment (capital expenditures), software, and other intangible assets. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=118932676&loc=d3e3179-108585 + Details
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- Definition The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 220 -SubTopic 10 -Section 45 -Paragraph 1A -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=118930883&loc=SL7669619-108580 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 50 -Paragraph 1A -Subparagraph (a)(1) -URI http://asc.fasb.org/extlink&oid=109239629&loc=SL4573702-111684 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 220 -SubTopic 10 -Section 45 -Paragraph 1B -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=118930883&loc=SL7669625-108580 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 50 -Paragraph 1A -Subparagraph (c)(1) -URI http://asc.fasb.org/extlink&oid=109239629&loc=SL4573702-111684 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 22 -URI http://asc.fasb.org/extlink&oid=115929826&loc=d3e8736-108599 Reference 6: http://www.xbrl.org/2003/role/exampleRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 55 -Paragraph 4J -URI http://asc.fasb.org/extlink&oid=116874947&loc=SL4591551-111686 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 2 -URI http://asc.fasb.org/extlink&oid=118932676&loc=d3e3000-108585 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 45 -Paragraph 19 -URI http://asc.fasb.org/extlink&oid=108774443&loc=SL4569616-111683 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=115929826&loc=d3e8933-108599 Reference 10: http://www.xbrl.org/2003/role/exampleRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 55 -Paragraph 4K -URI http://asc.fasb.org/extlink&oid=116874947&loc=SL4591552-111686 + Details
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- Definition Amount of expense (reversal of expense) for expected credit loss on accounts receivable. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 326 -SubTopic 20 -Section 50 -Paragraph 13 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=119407570&loc=SL82919249-210447 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 220 -SubTopic 10 -Section S99 -Paragraph 2 -Subparagraph (SX 210.5-03(5)) -URI http://asc.fasb.org/extlink&oid=116634182&loc=SL114868664-224227 + Details
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- Definition Amount of cash outflow for payment of an obligation from a lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=118932676&loc=d3e3291-108585 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.4-08.(f)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690 + Details
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- Definition The cash outflow for a borrowing supported by a written promise to pay an obligation. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=118932676&loc=d3e3291-108585 + Details
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- Definition Amount of noncash expense for share-based payment arrangement. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=118932676&loc=d3e3602-108585 + Details
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- Definition After tax amount of gain on sale or disposal of partnership interest. + References No definition available. + Details
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- Definition The amount of business acquisition cost of acquired entity debt issued on the date of acquisition. + References No definition available. + Details
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- Definition The cash outflow associated with the acquisition of a redeemable non-controlling interest. + References No definition available. + Details
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