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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019
OPERATING ACTIVITIES |  |  |
Net income including non-controlling interest and earnings from unconsolidated affiliates, net | $ 57,924 | $ 52,491 | $ 57,259
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities: |  |  |
Depreciation and amortization | 11,591 | 10,533 | 10,095
Provision for credit losses | 5,305 | 4,623 | 4,858
Equity-based awards compensation expense | 7,867 | 7,917 | 6,985
Deferred income taxes | 5,688 | (258) | 4,651
Gain on sale of partnership interest | 0 | (1,091) | (5,514)
Derecognition (write-off) of goodwill - closed clinics | 0 | 1,859 | 0
Earnings in unconsolidated affiliate | (112) | 0 | 0
Other | (134) | 281 | 96
Changes in operating assets and liabilities: |  |  |
(Increase) decrease in patient accounts receivable | (9,417) | 899 | (6,376)
(Increase) decrease in accounts receivable - other | (1,538) | 1,661 | (2,499)
(Increase) decrease in other assets | (633) | 4,161 | (1,878)
Increase (decrease) in accounts payable and accrued expenses | 4,657 | 12,427 | (4,209)
Increase (decrease) in other long-term liabilities | (4,792) | 4,492 | (1,020)
Net cash provided by operating activities | 76,406 | 99,995 | 62,448
INVESTING ACTIVITIES |  |  |
Purchase of fixed assets | (8,201) | (7,639) | (10,189)
Purchase of majority interest in businesses, net of cash acquired | (86,823) | (23,907) | (30,597)
Purchase of redeemable non-controlling interest - temporary equity | (28,465) | (20,385) | (8,651)
Purchase of non-controlling interest, permanent equity | (1,274) | (238) | (428)
Proceeds on sale of redeemable non-controlling interest, temporary equity | 69 | 127 | 207
Proceeds on sales of partnership interest, clinics and fixed assets | 275 | 839 | 11,665
Distributions from unconsolidated affiliate | 152 | 0 | 0
Sales of non-controlling interest-permanent | 131 | 0 | 0
Net cash used in investing activities | (124,136) | (51,203) | (37,993)
FINANCING ACTIVITIES |  |  |
Distributions to non-controlling interest, permanent and temporary equity | (16,931) | (18,331) | (16,235)
Cash dividends paid to shareholders | (18,765) | (4,110) | (14,555)
Proceeds from revolving line of credit | 316,000 | 214,000 | 145,000
Payments on revolving line of credit | (218,000) | (244,000) | (137,000)
Principal payments on notes payable | (4,899) | (1,037) | (1,433)
(Payment) receipt of Medicare Accelerated and Advance Funds | (14,054) | 14,054 | 0
Other | 28 | 2 | (52)
Net cash provided by (used in) financing activities | 43,379 | (39,422) | (24,275)
Net (decrease) increase in cash and cash equivalents | (4,351) | 9,370 | 180
Cash and cash equivalents - beginning of period | 32,918 | 23,548 | 23,368
Cash and cash equivalents - end of period | 28,567 | 32,918 | 23,548
Cash paid during the period for: |  |  |
Income taxes | 12,214 | 7,677 | 9,856
Interest | 1,352 | 1,202 | 1,890
Non-cash investing and financing transactions during the period: |  |  |
Purchase of businesses - seller financing portion | 3,050 | 1,121 | 4,300
Purchase of business - payable to common shareholders of acquired business | 0 | 0 | 502
Notes payable related to purchase of redeemable non-controlling interest, temporary equity | 1,759 | 136 | 283
Notes payable due to purchase of non-controlling interest, permanent equity | 0 | 699 | 103
Notes receivable related to sale of partnership interest - redeemable non-controlling interest | 914 | 0 | 2,870
Note receivables related to sale of partnership interest | $ 0 | $ 994 | $ 0

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