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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | 12 Months Ended
--- | --- | --- | ---
Sep. 30, 2021 | Sep. 30, 2020 | Sep. 30, 2021 | Sep. 30, 2020 | Dec. 31, 2020
OPERATING ACTIVITIES |  |  |  |  |
Net income including non-controlling interest | $ 14,123 | $ 15,763 | $ 43,481 | $ 33,864 |
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities: |  |  |  |  |
Depreciation and amortization |  |  | 8,519 | 8,066 |
Provision for credit losses | 1,358 | 1,279 | 3,922 | 3,379 |
Equity-based awards compensation expense |  |  | 6,280 | 5,325 |
Deferred income taxes |  |  | 1,292 | (834) |
Loss on sale of fixed assets |  |  | 113 | 346 |
Gain on sale of partnership interest |  |  | 0 | (1,091) |
Derecognition (write-off) of goodwill - closed clinics | 0 | 0 | 0 | 1,859 | $ 1,859
Changes in operating assets and liabilities: |  |  |  |  |
(Increase) decrease in patient accounts receivable |  |  | (7,513) | 4,117 |
(Increase) decrease in accounts receivable - other |  |  | (738) | 730 |
(Increase) decrease in other assets |  |  | (195) | 5,404 |
Increase in accounts payable and accrued expenses |  |  | 4,529 | 13,495 |
Increase (decrease) in other long-term liabilities |  |  | 811 | (58) |
Net cash provided by operating activities |  |  | 60,501 | 74,602 |
INVESTING ACTIVITIES |  |  |  |  |
Purchase of fixed assets |  |  | (5,996) | (5,494) |
Purchase of majority interest in businesses, net of cash acquired |  |  | (22,589) | (15,322) |
Purchase of redeemable non-controlling interest - temporary equity |  |  | (14,916) | (3,087) |
Purchase of non-controlling interest, permanent equity |  |  | (1,093) | (184) |
Proceeds on sale of redeemable non-controlling interest, temporary equity |  |  | 69 | 54 |
Proceeds on sales of partnership interest, clinics and fixed assets |  |  | 136 | 1,118 |
Sales of non-controlling interest-permanent |  |  | 131 | 0 |
Net cash used in investing activities |  |  | (44,258) | (22,915) |
FINANCING ACTIVITIES |  |  |  |  |
Distributions to non-controlling interest, permanent and temporary equity |  |  | (14,330) | (14,223) |
Cash dividends paid to shareholders |  |  | (13,934) | (4,110) |
Proceeds from revolving line of credit |  |  | 193,000 | 134,000 |
Payments on revolving line of credit |  |  | (176,000) | (173,000) |
Principal payments on notes payable |  |  | (4,662) | (700) |
(Payment) receipt of Medicare Accelerated and Advance Funds |  |  | (14,054) | 12,924 |
Short swing profit settlement |  |  | 20 | 0 |
Other |  |  | (13) | 3 |
Net cash used in financing activities |  |  | (29,973) | (45,106) |
Net (decrease) increase in cash and cash equivalents |  |  | (13,730) | 6,581 |
Cash and cash equivalents - beginning of period |  |  | 32,918 | 23,548 | 23,548
Cash and cash equivalents - end of period | 19,188 | 30,129 | 19,188 | 30,129 | $ 32,918
Cash paid during the period for: |  |  |  |  |
Income taxes |  |  | 10,777 | 4,421 |
Interest |  |  | 1,195 | 1,202 |
Non-cash investing and financing transactions during the period: |  |  |  |  |
Purchase of businesses - seller financing portion |  |  | 1,800 | 796 |
Purchase of redeemable non-controlling interest - notes payable | 1,302 | 137 | 1,302 | 137 |
Notes payable due to purchase of non-controlling interest, permanent equity | $ 0 | $ 699 | 0 | 699 |
Receivables related to sale of partnership interest |  |  | 0 | 386 |
Note receivables related to sale of partnership interest |  |  | $ 914 | $ 670 |

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