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Interim Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
9 Months Ended
Sep. 30, 2016
Sep. 30, 2015
Cash Flows From Operating Activities:    
Net income $ 36,675 $ 38,167
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 28,847 27,442
Provision for doubtful accounts receivable 5,774 5,474
Equity in earnings of unconsolidated investments (4,926) (3,924)
Distributions from unconsolidated investments 7,163 6,488
Gains on sale of restricted marketable securities (804) (449)
Deferred income taxes 909 (4,795)
Stock–based compensation 502 1,557
Changes in operating assets and liabilities, net of the effect of acquisitions:    
Restricted Cash and Cash Equivalents (15,507) (8,897)
Accounts receivable 1,667 (8,485)
Income tax receivable (1,003) 4,114
Inventories 122 (439)
Prepaid expenses and other assets (704) (228)
Trade accounts payable (2,769) 230
Accrued payroll (14,759) (575)
Amounts due to third party payors 2,353 3,480
Other current liabilities and accrued risk reserves 4,981 2,674
Other noncurrent liabilities (84) 726
Deferred revenue 837 770
Net cash provided by operating activities 49,274 63,330
Cash Flows From Investing Activities:    
Additions to property and equipment (50,466) (38,953)
Investments in unconsolidated limited liability companies (1,282) (373)
Investments in notes receivable (2,419) (5,477)
Collections of notes receivable 845 333
Change in restricted cash and cash equivalents 9,455 7,423
Purchase of restricted marketable securities (34,747) (49,993)
Sale of restricted marketable securities 30,963 39,601
Net cash used in investing activities (47,651) (47,439)
Cash Flows From Financing Activities:    
Tax (expense) benefit from stock–based compensation (1,134) 585
Principal payments under capital lease obligations (2,440) (2,299)
Dividends paid to preferred stockholders (6,502)
Dividends paid to common stockholders (18,977) (15,367)
Issuance of common shares 10,070 8,231
Repurchase of common shares (8,195)
Entrance fee deposits (196) (11)
Change in deposits 253 486
Net cash used in financing activities (20,619) (14,877)
Net (Decrease) Increase in Cash and Cash Equivalents (18,996) 1,014
Cash and Cash Equivalents, Beginning of Period 38,208 69,767
Cash and Cash Equivalents, End of Period $ 19,212 $ 70,781