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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2025 | Dec. 31, 2024 | Dec. 31, 2023
OPERATING ACTIVITIES |  |  |
Net income including non-controlling interest | $ 58,005 | $ 45,600 | $ 37,220
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities: |  |  |
Depreciation and amortization | 22,391 | 18,681 | 15,695
Provision for credit losses | 7,647 | 6,912 | 6,172
Equity-based awards compensation expense | 8,270 | 7,823 | 7,236
Amortization of debt issue costs | 422 | 422 | 420
Change in deferred income taxes | 11,406 | 5,365 | 4,490
Change in revaluation of put-right liability | 1,322 | 82 | (2,582)
Change in fair value of contingent earn-out consideration | (6,244) | 219 | 1,550
Equity of earnings in unconsolidated affiliate | (1,477) | (1,014) | (955)
Loss on sale of clinics and fixed assets | 383 | 836 | 166
Loss on sale of partnership | 123 | 0 | 0
Impairment of goodwill and other intangible assets | 0 | 0 | 17,495
Impairment of assets held for sale | 0 | 2,418 | 0
Changes in operating assets and liabilities: |  |  |
Patient accounts receivable, net | (11,955) | (5,346) | (5,645)
Accounts receivable - other | 2,895 | (6,548) | (356)
Other current and long term assets | (10,418) | (818) | (197)
Accounts payable and accrued expenses | (7,798) | 1,713 | 15
Other long-term liabilities | 86 | (1,405) | 1,254
Net cash provided by operating activities | 75,058 | 74,940 | 81,978
INVESTING ACTIVITIES |  |  |
Purchase of fixed assets | (14,071) | (9,186) | (9,294)
Purchase of majority interest in businesses, net of cash acquired | (15,674) | (133,087) | (26,582)
Purchase of redeemable non-controlling interest, temporary equity | (9,917) | (8,052) | (10,986)
Purchase of non controlling interest, permanent equity | (273) | (1,004) | (281)
Proceeds on sale of non-controlling interest, permanent equity | 30 | 26 | 102
Repayment of notes receivable related to sales of redeemable non-controlling interest | 531 | 551 | 510
Proceeds on sale of partnership interest - redeemable non-controlling interest, temporary equity | 186 | 79 | 875
Distributions from unconsolidated affiliate | 1,411 | 1,080 | 830
Proceeds on sale of partnership interest, clinics and fixed assets | 700 | 0 | 0
Other | 364 | 143 | (189)
Net cash used in investing activities | (36,713) | (149,450) | (45,015)
FINANCING ACTIVITIES |  |  |
Proceeds from issuance of common stock pursuant to the secondary public offering, net of issuance costs | 0 | 0 | 163,646
Proceeds from revolving facility | 189,500 | 19,000 | 24,000
Distributions to non-controlling interest, permanent and temporary equity | (19,269) | (14,711) | (16,100)
Cash dividends paid to shareholders | (27,362) | (26,540) | (24,128)
Payments on revolving facility | (170,000) | (8,000) | (55,000)
Payments on term loan | (9,375) | (3,750) | (3,750)
Cash used for the repurchase of common stock | (5,566) | 0 | 0
Principal payments on notes payable | (2,065) | (2,952) | (4,400)
Net cash (used in) provided by financing activities | (44,137) | (36,953) | 84,268
Net (decrease) increase in cash and cash equivalents | (5,792) | (111,463) | 121,231
Cash and cash equivalents - beginning of period | 41,362 | 152,825 | 31,594
Cash and cash equivalents - end of period | 35,570 | 41,362 | 152,825
Cash paid during the period for: |  |  |
Income taxes | 14,348 | 4,823 | 4,926
Interest paid | 9,431 | 7,209 | 8,655
Non-cash investing and financing transactions during the period: |  |  |
Purchase of businesses - seller financing portion | 300 | 2,060 | 1,815
Liabilities assumed associated with a purchase of a business | 0 | 670 | 524
Fair market value of initial contingent consideration related to purchase of businesses | 5,292 | 17,672 | 200
Notes payable related to purchase of redeemable non-controlling interest, temporary equity | 173 | 71 | 1,087
Payable related to the purchase of redeemable non-controlling interest, temporary equity | 3,934 | 0 | 0
Offset to notes receivable associated with purchase of redeemable non-controlling interest | 358 | 726 | 0
Notes receivable related to sale of redeemable non-controlling interest | 0 | 1,890 | 4,136
Notes payable related to the purchase of non-controlling interest, permanent equity | 0 | 0 | 200
Payable related to the purchase of non-controlling interest, permanent equity | 8,144 | 0 | 0
Notes receivable related to the sale of non-controlling interest, permanent equity | 73 | 282 | 458
Issuance of restricted stock related to purchase of business | $ 0 | $ 1,500 | $ 0

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- Definition Amount of change in fair value of a contingent consideration liability, including, but not limited to, differences arising upon settlement. + References No definition available. + Details
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- Definition The cash inflow associated with the distributions from unconsolidated affiliate. + References No definition available. + Details
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- Definition Fair market value of initial contingent consideration related to purchase of businesses. + References No definition available. + Details
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- Definition Gain (loss) on revaluation of put-right liability. + References No definition available. + Details
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- Definition Amount of gain (loss) from sale and disposal of integrated set of activities and assets capable of being conducted and managed for purpose of providing return in form of dividend. + References No definition available. + Details
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- Definition The fair value of restricted stock issued in noncash financing activities. + References No definition available. + Details
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- Definition The amount of business acquisition cost of acquired entity debt issued on the date of acquisition. + References No definition available. + Details
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- Definition The amount of business acquisition cost of acquired entity debt issued (temporary equity) on the date of acquisition. + References No definition available. + Details
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- Definition Amount of cash inflow from a noncontrolling interest. Includes, permanent equity. + References No definition available. + Details
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- Definition The amount of offset to notes receivable associated with purchase of redeemable non-controlling interest. + References No definition available. + Details
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- Definition The amount of business acquisition cost of acquired entity debt issued on the date of acquisition. + References No definition available. + Details
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- Definition Amount payable related to the purchase of redeemable non-controlling interest, temporary equity + References No definition available. + Details
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- Definition The cash outflow associated with the acquisition of a redeemable non-controlling interest. + References No definition available. + Details
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- Definition The cash inflow associated with the sales of non-controlling interest-permanent. + References No definition available. + Details
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- Definition Purchase of business - seller financing portion in noncash investing or financing activities. + References No definition available. + Details
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- Definition The cash outflow associated with repayment of notes receivable related to sales of redeemable non-controlling interest. + References No definition available. + Details
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