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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
OPERATING ACTIVITIES    
Net income including non-controlling interest and earnings from unconsolidated affiliates, net $ 40,059 $ 43,481
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:    
Depreciation and amortization 10,950 8,519
Provision for credit losses 4,192 3,922
Equity-based awards compensation expense 5,462 6,280
Deferred income taxes 6,077 1,292
Change in revaluation of put-right liability (771) 0
Change in fair value of contingent earn-out consideration (2,000) 0
(Gain) loss on sale of clinics and fixed assets (643) 113
Earnings in unconsolidated affiliate (983) 0
Unrealized gain on cash flow hedge (5,942) 0
Changes in operating assets and liabilities:    
Increase in patient accounts receivable (7,585) (7,513)
(Increase) decrease in accounts receivable - other (4,551) (738)
(Decrease) increase in other assets 1,669 (195)
(Decrease) Increase in accounts payable and accrued expenses (4,568) 4,529
(Decrease) increase in other long-term liabilities (128) 811
Net cash provided by operating activities 41,238 60,501
INVESTING ACTIVITIES    
Purchase of fixed assets (7,290) (5,996)
Purchase of majority interest in businesses, net of cash acquired (18,573) (22,589)
Purchase of redeemable non-controlling interest, temporary equity (14,096) (14,916)
Purchase of non-controlling interest, permanent equity (280) (1,093)
Proceeds on sales of partnership interest, clinics and fixed assets 740 136
Distributions from unconsolidated affiliate 1,220 0
Sale of non-controlling interest - permanent 0 131
Proceeds on sales of redeemable non-controlling interest-temporary 401 69
Net cash used in investing activities (37,878) (44,258)
FINANCING ACTIVITIES    
Distributions to non-controlling interest, permanent and temporary equity (11,760) (14,330)
Cash dividends paid to shareholders (15,990) (13,934)
Proceeds from revolving line of credit 61,000 193,000
Proceeds from term loan 150,000 0
Payments on revolving line of credit (175,000) (176,000)
Principal payments on notes payable (496) (4,662)
(Payment) receipt of Medicare Accelerated and Advance Funds 0 (14,054)
Payment of deferred financing costs (1,779) 0
Other 12 7
Net cash used in financing activities 5,987 (29,973)
Net decrease in cash and cash equivalents 9,347 (13,730)
Cash and cash equivalents - beginning of period 28,567 32,918
Cash and cash equivalents - end of period 37,914 19,188
Cash paid during the period for:    
Income taxes 7,529 10,777
Interest paid 2,159 1,195
Non-cash investing and financing transactions during the period:    
Purchase of businesses - seller financing portion 824 1,800
Notes payable related to purchase of redeemable non-controlling interest, temporary equity 1,074 1,302
Notes payable related to purchase of non-controlling interest, permanent equity 576 0
Notes receivable related to sale of partnership interest - redeemable non-controlling interest $ 1,580 $ 914