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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Cash Flows from Operating Activities:      
Net income (loss) $ 30,683 $ 37,631 $ (2,312)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:      
Depreciation and amortization 17,123 19,678 20,036
Provision for doubtful accounts 25,059 19,519 14,053
Non-cash compensation 16,295 16,401 11,824
401(k) employer match 8,754 6,875 6,089
Write-off of investment 0 196 0
Loss on disposal of property and equipment 0 582 775
Gain on sale of care centers 0 0 (184)
Deferred income taxes 52,178 24,547 (677)
Write off of deferred debt issuance costs/debt discount 0 0 2,512
Equity in earnings from equity method investments (3,381) (5,588) (9,823)
Amortization of deferred debt issuance costs/debt discount 735 740 959
Return on equity investment 5,321 4,323 5,610
Asset impairment charge 1,323 4,432 77,268
Changes in operating assets and liabilities, net of impact of acquisitions:      
Patient accounts receivable (59,731) (55,519) (36,493)
Other current assets (4,940) 4,231 6,455
Other assets (12,749) (11,415) (3,523)
Accounts payable (2,843) 3,970 7,639
Accrued expenses 31,843 (7,618) 8,406
Other long-term obligations 61 (726) (829)
Net cash provided by operating activities 105,731 62,259 107,785
Cash Flows from Investing Activities:      
Proceeds from sale of deferred compensation plan assets 622 230 1,229
Proceeds from the sale of property and equipment 249 0 20,000
Purchases of deferred compensation plan assets 0 0 (19)
Purchases of property and equipment (10,707) (15,717) (21,429)
Purchase of investments (476) (1,040) (3,485)
Proceeds from sale of investment 0 0 5,000
Acquisitions of businesses, net of cash acquired (33,715) (35,522) (69,130)
Proceeds from disposition of care centers 0 0 413
Net cash used in investing activities (44,027) (52,049) (67,421)
Cash Flows from Financing Activities:      
Proceeds from issuance of stock upon exercise of stock options and warrants 4,554 0 399
Proceeds from issuance of stock to employee stock purchase plan 2,382 2,483 2,204
Shares withheld upon stock vesting (6,939) 0 0
Tax benefit from stock options exercised and restricted stock vesting 0 7,241 2,073
Non-controlling interest distribution (216) (329) (436)
Proceeds from revolving line of credit 0 134,500 63,400
Repayments of revolving line of credit 0 (134,500) (78,400)
Proceeds from issuance of long-term obligations 0 0 100,000
Principal payments of long-term obligations (5,319) (5,000) (103,000)
Debt issuance costs 0 0 (2,553)
Purchase of company stock 0 (12,315) (4,581)
Assets contributed to equity investment 0 405 0
Net cash used in financing activities (5,538) (7,515) (20,894)
Net increase in cash and cash equivalents 56,166 2,695 19,470
Cash and cash equivalents at beginning of period 30,197 27,502 8,032
Cash and cash equivalents at end of period 86,363 30,197 27,502
Supplemental Disclosures of Cash Flow Information:      
Cash paid for interest 2,697 2,897 6,175
Cash paid for income taxes, net of refunds received $ 315 $ 755 $ (12,185)