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UNAUDITED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 9 Months Ended
--- | ---
Sep. 30, 2024 | Sep. 30, 2023
OPERATING ACTIVITIES |  |
Net income including non-controlling interest | $ 33,106 | $ 38,513
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities: |  |
Depreciation and amortization | 12,996 | 11,582
Provision for credit losses | 5,065 | 4,600
Equity-based awards compensation expense | 5,837 | 5,451
Amortization of debt issue costs | 317 | 315
Change in deferred income taxes | 605 | 5,393
Change in revaluation of put-right liability | 136 | 344
Change in fair value of contingent earn-out consideration | 5,332 | (197)
Equity of earnings in unconsolidated affiliate | (750) | (806)
Loss (gain) on sale of fixed assets | 280 | (106)
Others | (169) | 0
Changes in operating assets and liabilities: |  |
Increase in patient accounts receivable | (8,870) | (5,415)
Increase in accounts receivable - other | (960) | (1,631)
(Increase) decrease in other current and long term assets | (1,808) | 2,489
Increase (decrease) in accounts payable and accrued expenses | 5,003 | (5,609)
(Decrease) increase in other long-term liabilities | (589) | 220
Net cash provided by operating activities | 55,531 | 55,143
INVESTING ACTIVITIES |  |
Purchase of fixed assets | (6,697) | (7,074)
Purchase of majority interest in businesses, net of cash acquired | (41,196) | (22,994)
Purchase of redeemable non-controlling interest, temporary equity | (6,957) | (7,804)
Purchase of non controlling interest, permanent equity | (756) | (262)
Proceeds on sale of redeemable non-controlling interest, temporary equity | 229 | 815
Proceeds on sale of non-controlling interest, permanent equity | 26 | 30
Distributions from unconsolidated affiliate | 838 | 681
Other | (84) | 7
Net cash used in investing activities | (54,597) | (36,601)
FINANCING ACTIVITIES |  |
Cash dividends paid to shareholders | (19,898) | (17,683)
Distributions to non-controlling interest, permanent and temporary equity | (11,399) | (11,777)
Principal payments on notes payable | (1,726) | (2,874)
Payments on term loan | (3,750) | (2,813)
Payments on revolving facility | 0 | (55,000)
Proceeds from issuance of common stock pursuant to the secondary public offering, net of issuance costs | 0 | 163,646
Proceeds from revolving facility | 0 | 24,000
Other | (27) | 50
Net cash (used in) provided by financing activities | (36,800) | 97,549
Net (decrease) increase in cash and cash equivalents | (35,866) | 116,091
Cash and cash equivalents - beginning of period | 152,825 | 31,594
Cash and cash equivalents - end of period | 116,959 | 147,685
Cash paid during the period for: |  |
Income taxes | 5,759 | 2,731
Interest paid | 5,630 | 6,992
Non-cash investing and financing transactions during the period: |  |
Purchase of interest in businesses - seller financing portion | 7,395 | 1,860
Initial contingent consideration related to purchase of interest of businesses | 5,940 | 200
Offset of notes receivable associated with purchase of redeemable non-controlling interest | 627 | 0
Notes payable related to purchase of redeemable non-controlling interest, temporary equity | 66 | 1,017
Notes payable related to purchase of non-controlling interest, permanent equity | 0 | 200
Notes receivable related to sale of redeemable non-controlling interest, temporary equity | 2,075 | 3,064
Notes receivable related to the sale of non-controlling interest, permanent equity | $ 282 | $ 397

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