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CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | 12 Months Ended
--- | --- | --- | ---
Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 | Dec. 31, 2019
OPERATING ACTIVITIES |  |  |  |  |
Net income including non-controlling interests | $ 15,763 | $ 13,069 | $ 33,864 | $ 45,244 |
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities: |  |  |  |  |
Depreciation and amortization |  |  | 8,066 | 7,377 |
Provision for doubtful accounts | 1,279 | 962 | 3,379 | 3,408 |
Equity-based awards compensation expense |  |  | 5,325 | 5,262 |
Deferred income taxes |  |  | (834) | 3,680 |
Loss on sale of fixed assets |  |  | 346 | 0 |
Gain on sale of partnership interest |  |  | (1,091) | (5,823) |
Write-off of goodwill - closed clinics | 0 | 0 | 1,859 | 0 | $ 0
Other |  |  | 0 | 120 |
Changes in operating assets and liabilities: |  |  |  |  |
Decrease (increase) in patient accounts receivable |  |  | 4,117 | (8,171) |
Decrease (increase) in accounts receivable - other |  |  | 730 | (1,006) |
Decrease (increase) in other assets |  |  | 5,404 | (2,744) |
Increase (decrease) in accounts payable and accrued expenses |  |  | 13,495 | (440) |
Decrease in other long-term liabilities |  |  | (58) | (443) |
Net cash provided by operating activities |  |  | 74,602 | 46,464 |
INVESTING ACTIVITIES |  |  |  |  |
Purchase of fixed assets |  |  | (5,494) | (7,428) |
Purchase of majority interest in businesses, net of cash acquired |  |  | (15,322) | (30,365) |
Purchase of redeemable non-controlling interest, temporary equity |  |  | (3,087) | (5,699) |
Purchase of non-controlling interest, permanent equity |  |  | (184) | (138) |
Proceeds on sale of redeemable non-controlling interest, temporary equity |  |  | 54 | 11,601 |
Proceeds on sales of partnership interest and clinics |  |  | 674 | 0 |
Proceeds on sale of fixed assets |  |  | 444 | 64 |
Net cash used in investing activities |  |  | (22,915) | (31,965) |
FINANCING ACTIVITIES |  |  |  |  |
Distributions to non-controlling interests, permanent and temporary equity |  |  | (14,223) | (10,862) |
Cash dividends paid to shareholders |  |  | (4,110) | (10,723) |
Proceeds from revolving line of credit |  |  | 134,000 | 110,000 |
Payments on revolving line of credit |  |  | (173,000) | (97,000) |
Principal payments on notes payable |  |  | (700) | (1,409) |
Medicare Accelerated and Advance Payment Funds |  |  | 12,924 | 0 |
Other |  |  | 3 | (17) |
Net cash used in financing activities |  |  | (45,106) | (10,011) |
Net increase in cash and cash equivalents |  |  | 6,581 | 4,488 |
Cash and cash equivalents - beginning of period |  |  | 23,548 | 23,368 | 23,368
Cash and cash equivalents - end of period | 30,129 | 27,856 | 30,129 | 27,856 | $ 23,548
Cash paid during the period for: |  |  |  |  |
Income taxes |  |  | 4,421 | 9,458 |
Interest |  |  | 1,202 | 1,412 |
Non-cash investing and financing transactions during the period: |  |  |  |  |
Purchase of businesses - seller financing portion |  |  | 796 | 4,300 |
Purchase of business - payable to common shareholders of acquired business |  |  | 0 | 502 |
Purchase of redeemable non-controlling interest - notes payable | 137 | 0 | 137 | 0 |
Payable due to purchase of redeemable non-controlling interest | $ 699 | $ 283 | 699 | 283 |
Receivables related to sale of partnership interest |  |  | 386 | 0 |
Notes receivables related to sale of partnership interest |  |  | $ 670 | $ 2,780 |

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