typically , revenues are determined based on the number of visits conducted at the clinic and recognized at the point in time when services are performed . costs , typically salaries for our employees , are recorded when incurred . revenues from the industrial injury prevention business , which are also included in other revenues in the consolidated statements of net income , are derived from onsite services we provide to clients ' employees including injury prevention , rehabilitation , ergonomic assessments and performance optimization . revenue from the industrial injury prevention business is recognized when obligations under the terms of the contract are satisfied . revenues are recognized at an amount equal to the consideration we expect to receive in exchange for providing injury prevention services to its clients . the revenue is determined and recognized based on the number of hours and respective rate for services provided in a given period . additionally , other revenues include services we provide on-site , such as schools and industrial worksites , for physical or occupational therapy services , and athletic trainers and gym membership fees . contract terms and rates are agreed to in advance between us and the third parties . services are typically performed over the contract period and revenue is recorded at the point of service . if the services are paid in advance , revenue is recorded as a contract liability over the period of the agreement and recognized at the point in time , when the services are performed . in may 2014 , march 2016 , april 2016 , and december 2016 , the financial accounting standards board ( fasb ) issued accounting standards update ( asu ) 2014-09 , revenue from contracts with customers , asu 2016-08 , revenue from contracts with customers , principal versus agent considerations , asu 2016-10 , revenue from contracts with customers , identifying performance obligations and licensing , asu 2016-12 , revenue from contracts with customers , narrow scope improvements and practical expedients , and asu 2016-20 , technical corrections and improvements to topic 606 , revenue from contracts with customer ( collectively the standards ) , respectively , which supersede most of the current revenue recognition 25 requirements ( asc 606 ) . the core principle of the new guidance is that an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services . we implemented the new standards beginning january 1 , 2018 using a modified retrospective transition method . the principal change relates to how the new standard requires healthcare providers to estimate the amount of variable consideration to be included in the transaction price up to an amount which is probable that a significant reversal will not occur . the most common forms of variable consideration we experience are amounts for services provided that are ultimately not realizable from a customer . there were no changes to revenues or other revenues upon implementation . under the new standards , our estimate for unrealizable amounts will continue to be recognized as a reduction to revenue . the bad debt expense historically reported will not materially change . for asc 606 , there is an implied contract between us and the patient upon each patient visit . separate contractual arrangements exist between us and third party payors ( e.g . insurers , managed care programs , government programs , workers ' compensation ) which establish the amounts the third parties pay on behalf of the patients for covered services rendered . while these agreements are not considered contracts with the customer , they are used for determining the transaction price for services provided to the patients covered by the third party payors . the payor contracts do not indicate performance obligations for us , but indicate reimbursement rates for patients who are covered by those payors when the services are provided . at that time , we are obligated to provide services for the reimbursement rates stipulated in the payor contracts . the execution of the contract alone does not indicate a performance obligation . for self-paying customers , the performance obligation exists when we provide the services at established rates . the difference between our established rate and the anticipated reimbursement rate is accounted for as an offset to revenue – contractual allowance . we determine allowances for doubtful accounts based on the specific agings and payor classifications at each clinic . the provision for doubtful accounts is included in clinic operating costs in the statements of net income . patient accounts receivable , which are stated at the historical carrying amount net of contractual allowances , write-offs and allowance for doubtful accounts , includes only those amounts we estimate to be collectible . the following table details the revenue related to the various categories . replace_table_token_8_th contractual allowances . contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by both insurance companies and government sponsored healthcare programs for such services . medicare regulations and the various third party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in our clinics . we estimate contractual allowances based on our interpretation of the applicable regulations , payor contracts and historical calculations . each month we estimate our contractual allowance for each clinic based on payor contracts and the historical collection experience of the clinic and applies an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic . based on our historical experience , calculating the contractual allowance reserve percentage at the payor level is sufficient to allow us to provide the necessary detail and accuracy with our collectability estimates . story_separator_special_tag for both periods of 2018 , in accordance with current accounting guidance , the revaluation of redeemable non-controlling interest , net of tax , is not included in net income but rather charged directly to retained earnings , but is included in the earnings per basic and diluted share calculation . see table below . 30 for 2018 , our adjusted ebitda increased by 7.1 % to $ 62.1 million from $ 57.9 million in 2017. see definition and reconciliation of adjusted ebitda in the following table . replace_table_token_12_th replace_table_token_13_th * mandatorily redeemable non-controlling interests the above table details the calculation of basic and diluted earnings per share attributable to our shareholders and reconciles net income attributable to our shareholders calculated in accordance with gaap to adjusted ebitda and operating results , non-gaap measures defined below . we believe providing operating results and adjusted ebitda are useful information to our investors for the purposes of comparing our period-to-period results . in addition , we believe that providing operating results allows our investors to compare 31 our results with other similar businesses since most do not have redeemable instruments and therefore have different liability and equity structures . we use operating results , which eliminates the mrnci – change in redemption which is a current non-cash item that can be subject to volatility and unusual costs , as one of the principal measures to evaluate and monitor financial performance period over period . adjusted ebitda is defined as earnings before gain on derecognition of debt , interest income , interest expense – mandatorily redeemable non-controlling interests – change in redemption value , interest expense – debt and other , taxes , depreciation , amortization and equity-based awards compensation expense . operating results and adjusted ebitda are not measures of financial performance under gaap . operating results and adjusted ebitda should not be considered in isolation or as an alternative to , or substitute for , net income attributable to usph shareholders presented in the consolidated financial statements . net patient revenues net patient revenues increased to $ 417.7 million for 2018 from $ 389.2 million for 2017 , an increase of $ 28.5 million , or 7.3 % . the increase in net patient revenues of $ 28.5 million consisted of an increase of $ 4.7 million from new clinics and $ 23.8 million from mature clinics . during 2018 , we acquired one multi-clinic group consisting of four clinics and five other single clinic practices for a total of 9 clinics . the net patient revenues from acquired clinics are included in our results of operations since the respective date of their acquisition . see above table and discussion under —executive summary detailing our multi-clinic acquisitions . total patient visits increased to 3,958,000 for 2018 from 3,705,000 for 2017. the growth in patient visits was attributable to 43,000 visits in new clinics and an increase of 210,000 visits for mature clinics primarily due to 2017 new clinics . the average net patient revenue per visit slightly increased to $ 105.55 in 2018 from $ 105.05 in 2017. net patient revenues are based on established billing rates less allowances and discounts for patients covered by contractual programs and workers ' compensation . net patient revenues reflect contractual and other adjustments , which we evaluate monthly , relating to patient discounts from certain payors . payments received under these contractual programs and workers ' compensation are based on predetermined rates and are generally less than the established billing rates of the clinics . other revenues other revenues , consisting primarily of industrial injury prevention business and management fees revenue , increased by $ 11.4 million , from $ 24.8 million in 2017 to $ 36.2 million in 2018. the revenues from the recently acquired industrial injury prevention business were $ 25.5 million in 2018 and $ 14.9 million in 2017. revenues from management contracts were $ 8.3 million for 2018 as compared to $ 7.4 million for 2017. other miscellaneous revenue was $ 2.4 million for 2018 and $ 2.5 million for 2017. operating costs operating costs were $ 352.2 million , or 77.6 % of net revenues , for 2018 and $ 323.4 million , or 78.1 % of net revenues , for 2017. the dollar increase was attributable to $ 5.3 million in operating costs for new clinics , an additional $ 15.1 million related to a mature clinics , $ 7.4 million related to the addition of the industrial injury prevention business , and an increase of $ 1.0 million related to management contracts . the 2017 closure costs of $ 0.6 million , included in operating costs , are primarily due to the closure of a single clinic acquired partnership due to the loss of a significant management contract . ( see table detailing acquisition dates above under – executive summary ) . each component of clinic operating costs is discussed below : operating costs—salaries and related costs salaries and related costs increased to $ 259.2 million for 2018 from $ 237.1 million for 2017 , an increase of $ 22.1 million , or 9.3 % . approximately $ 3.3 million of the increase was attributable to new clinics , $ 12.6 million of the increase was due to higher costs at various mature clinics primarily due to an increase in salaries and related costs in 2017 new clinics which had a full year of activity in 2018 , $ 5.4 million was due to higher salary costs at the industrial injury prevention businesses primarily due to the acquisition in april of 2018 and $ 0.8 million related to management contracts . salaries and related costs as a percentage of net revenues was 57.1 % for 2018 and 57.3 % for 2017 . 32 operating costs—rent , supplies , contract labor and other rent , supplies , contract labor and other costs increased to $ 88.4 million for 2018 from $ 82.1 million for 2017 , an increase

gain on derecognition of debt gain on derecognition of debt was $ 1.8 million for the year 2018 as a liability relating to some former physical therapy partners is no longer deemed payable . provision for income taxes the provision for income tax in 2018 was $ 11.4 million , inclusive of a $ 0.5 million benefit related to the reconciliation of the 2017 federal and state returns to our book provision . without this benefit , the provision for income taxes as a percentage of income before taxes less net income attributable to non-controlling interest was 25.7 % . the income tax expense in 2017 was $ 6.0 million . included in 2017 is a tax benefit of $ 4.3 million due to the revaluation of deferred tax assets and liabilities due to the tcja . also , included in 2017 was a charge of $ 0.3 million related to a detailed reconciliation of the federal and state taxes payable and receivable accounts along with federal and state deferred tax assets and liability accounts at december 31 , 2016. without this reconciliation charge and prior to the $ 4.3 million tax benefit , the provision for income taxes as a percentage of income before taxes less net income attributable to non-controlling interest was 35.6 % . as reported , the provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest was 24.6 % in 2018 and 21.3 % in 2017. net income attributable to non-controlling interests net income attributable to non-controlling interests was $ 13.9 million in 2018 and $ 5.5 million in 2017. net income attributable to non-controlling interests ( permanent equity ) was $ 5.5 million in 2018 as compared to $ 5.2 million in 2017. net income attributable to redeemable non-controlling interests ( temporary equity ) was $ 8.4 million in 2018 and $ 0.2 million in 2017 .


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```gain on derecognition of debt gain on derecognition of debt was $ 1.8 million for the year 2018 as a liability relating to some former physical therapy partners is no longer deemed payable . provision for income taxes the provision for income tax in 2018 was $ 11.4 million , inclusive of a $ 0.5 million benefit related to the reconciliation of the 2017 federal and state returns to our book provision . without this benefit , the provision for income taxes as a percentage of income before taxes less net income attributable to non-controlling interest was 25.7 % . the income tax expense in 2017 was $ 6.0 million . included in 2017 is a tax benefit of $ 4.3 million due to the revaluation of deferred tax assets and liabilities due to the tcja . also , included in 2017 was a charge of $ 0.3 million related to a detailed reconciliation of the federal and state taxes payable and receivable accounts along with federal and state deferred tax assets and liability accounts at december 31 , 2016. without this reconciliation charge and prior to the $ 4.3 million tax benefit , the provision for income taxes as a percentage of income before taxes less net income attributable to non-controlling interest was 35.6 % . as reported , the provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest was 24.6 % in 2018 and 21.3 % in 2017. net income attributable to non-controlling interests net income attributable to non-controlling interests was $ 13.9 million in 2018 and $ 5.5 million in 2017. net income attributable to non-controlling interests ( permanent equity ) was $ 5.5 million in 2018 as compared to $ 5.2 million in 2017. net income attributable to redeemable non-controlling interests ( temporary equity ) was $ 8.4 million in 2018 and $ 0.2 million in 2017 .
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 Suspicious Activity Report : typically , revenues are determined based on the number of visits conducted at the clinic and recognized at the point in time when services are performed . costs , typically salaries for our employees , are recorded when incurred . revenues from the industrial injury prevention business , which are also included in other revenues in the consolidated statements of net income , are derived from onsite services we provide to clients ' employees including injury prevention , rehabilitation , ergonomic assessments and performance optimization . revenue from the industrial injury prevention business is recognized when obligations under the terms of the contract are satisfied . revenues are recognized at an amount equal to the consideration we expect to receive in exchange for providing injury prevention services to its clients . the revenue is determined and recognized based on the number of hours and respective rate for services provided in a given period . additionally , other revenues include services we provide on-site , such as schools and industrial worksites , for physical or occupational therapy services , and athletic trainers and gym membership fees . contract terms and rates are agreed to in advance between us and the third parties . services are typically performed over the contract period and revenue is recorded at the point of service . if the services are paid in advance , revenue is recorded as a contract liability over the period of the agreement and recognized at the point in time , when the services are performed . in may 2014 , march 2016 , april 2016 , and december 2016 , the financial accounting standards board ( fasb ) issued accounting standards update ( asu ) 2014-09 , revenue from contracts with customers , asu 2016-08 , revenue from contracts with customers , principal versus agent considerations , asu 2016-10 , revenue from contracts with customers , identifying performance obligations and licensing , asu 2016-12 , revenue from contracts with customers , narrow scope improvements and practical expedients , and asu 2016-20 , technical corrections and improvements to topic 606 , revenue from contracts with customer ( collectively the standards ) , respectively , which supersede most of the current revenue recognition 25 requirements ( asc 606 ) . the core principle of the new guidance is that an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services . we implemented the new standards beginning january 1 , 2018 using a modified retrospective transition method . the principal change relates to how the new standard requires healthcare providers to estimate the amount of variable consideration to be included in the transaction price up to an amount which is probable that a significant reversal will not occur . the most common forms of variable consideration we experience are amounts for services provided that are ultimately not realizable from a customer . there were no changes to revenues or other revenues upon implementation . under the new standards , our estimate for unrealizable amounts will continue to be recognized as a reduction to revenue . the bad debt expense historically reported will not materially change . for asc 606 , there is an implied contract between us and the patient upon each patient visit . separate contractual arrangements exist between us and third party payors ( e.g . insurers , managed care programs , government programs , workers ' compensation ) which establish the amounts the third parties pay on behalf of the patients for covered services rendered . while these agreements are not considered contracts with the customer , they are used for determining the transaction price for services provided to the patients covered by the third party payors . the payor contracts do not indicate performance obligations for us , but indicate reimbursement rates for patients who are covered by those payors when the services are provided . at that time , we are obligated to provide services for the reimbursement rates stipulated in the payor contracts . the execution of the contract alone does not indicate a performance obligation . for self-paying customers , the performance obligation exists when we provide the services at established rates . the difference between our established rate and the anticipated reimbursement rate is accounted for as an offset to revenue – contractual allowance . we determine allowances for doubtful accounts based on the specific agings and payor classifications at each clinic . the provision for doubtful accounts is included in clinic operating costs in the statements of net income . patient accounts receivable , which are stated at the historical carrying amount net of contractual allowances , write-offs and allowance for doubtful accounts , includes only those amounts we estimate to be collectible . the following table details the revenue related to the various categories . replace_table_token_8_th contractual allowances . contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by both insurance companies and government sponsored healthcare programs for such services . medicare regulations and the various third party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in our clinics . we estimate contractual allowances based on our interpretation of the applicable regulations , payor contracts and historical calculations . each month we estimate our contractual allowance for each clinic based on payor contracts and the historical collection experience of the clinic and applies an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic . based on our historical experience , calculating the contractual allowance reserve percentage at the payor level is sufficient to allow us to provide the necessary detail and accuracy with our collectability estimates . story_separator_special_tag for both periods of 2018 , in accordance with current accounting guidance , the revaluation of redeemable non-controlling interest , net of tax , is not included in net income but rather charged directly to retained earnings , but is included in the earnings per basic and diluted share calculation . see table below . 30 for 2018 , our adjusted ebitda increased by 7.1 % to $ 62.1 million from $ 57.9 million in 2017. see definition and reconciliation of adjusted ebitda in the following table . replace_table_token_12_th replace_table_token_13_th * mandatorily redeemable non-controlling interests the above table details the calculation of basic and diluted earnings per share attributable to our shareholders and reconciles net income attributable to our shareholders calculated in accordance with gaap to adjusted ebitda and operating results , non-gaap measures defined below . we believe providing operating results and adjusted ebitda are useful information to our investors for the purposes of comparing our period-to-period results . in addition , we believe that providing operating results allows our investors to compare 31 our results with other similar businesses since most do not have redeemable instruments and therefore have different liability and equity structures . we use operating results , which eliminates the mrnci – change in redemption which is a current non-cash item that can be subject to volatility and unusual costs , as one of the principal measures to evaluate and monitor financial performance period over period . adjusted ebitda is defined as earnings before gain on derecognition of debt , interest income , interest expense – mandatorily redeemable non-controlling interests – change in redemption value , interest expense – debt and other , taxes , depreciation , amortization and equity-based awards compensation expense . operating results and adjusted ebitda are not measures of financial performance under gaap . operating results and adjusted ebitda should not be considered in isolation or as an alternative to , or substitute for , net income attributable to usph shareholders presented in the consolidated financial statements . net patient revenues net patient revenues increased to $ 417.7 million for 2018 from $ 389.2 million for 2017 , an increase of $ 28.5 million , or 7.3 % . the increase in net patient revenues of $ 28.5 million consisted of an increase of $ 4.7 million from new clinics and $ 23.8 million from mature clinics . during 2018 , we acquired one multi-clinic group consisting of four clinics and five other single clinic practices for a total of 9 clinics . the net patient revenues from acquired clinics are included in our results of operations since the respective date of their acquisition . see above table and discussion under —executive summary detailing our multi-clinic acquisitions . total patient visits increased to 3,958,000 for 2018 from 3,705,000 for 2017. the growth in patient visits was attributable to 43,000 visits in new clinics and an increase of 210,000 visits for mature clinics primarily due to 2017 new clinics . the average net patient revenue per visit slightly increased to $ 105.55 in 2018 from $ 105.05 in 2017. net patient revenues are based on established billing rates less allowances and discounts for patients covered by contractual programs and workers ' compensation . net patient revenues reflect contractual and other adjustments , which we evaluate monthly , relating to patient discounts from certain payors . payments received under these contractual programs and workers ' compensation are based on predetermined rates and are generally less than the established billing rates of the clinics . other revenues other revenues , consisting primarily of industrial injury prevention business and management fees revenue , increased by $ 11.4 million , from $ 24.8 million in 2017 to $ 36.2 million in 2018. the revenues from the recently acquired industrial injury prevention business were $ 25.5 million in 2018 and $ 14.9 million in 2017. revenues from management contracts were $ 8.3 million for 2018 as compared to $ 7.4 million for 2017. other miscellaneous revenue was $ 2.4 million for 2018 and $ 2.5 million for 2017. operating costs operating costs were $ 352.2 million , or 77.6 % of net revenues , for 2018 and $ 323.4 million , or 78.1 % of net revenues , for 2017. the dollar increase was attributable to $ 5.3 million in operating costs for new clinics , an additional $ 15.1 million related to a mature clinics , $ 7.4 million related to the addition of the industrial injury prevention business , and an increase of $ 1.0 million related to management contracts . the 2017 closure costs of $ 0.6 million , included in operating costs , are primarily due to the closure of a single clinic acquired partnership due to the loss of a significant management contract . ( see table detailing acquisition dates above under – executive summary ) . each component of clinic operating costs is discussed below : operating costs—salaries and related costs salaries and related costs increased to $ 259.2 million for 2018 from $ 237.1 million for 2017 , an increase of $ 22.1 million , or 9.3 % . approximately $ 3.3 million of the increase was attributable to new clinics , $ 12.6 million of the increase was due to higher costs at various mature clinics primarily due to an increase in salaries and related costs in 2017 new clinics which had a full year of activity in 2018 , $ 5.4 million was due to higher salary costs at the industrial injury prevention businesses primarily due to the acquisition in april of 2018 and $ 0.8 million related to management contracts . salaries and related costs as a percentage of net revenues was 57.1 % for 2018 and 57.3 % for 2017 . 32 operating costs—rent , supplies , contract labor and other rent , supplies , contract labor and other costs increased to $ 88.4 million for 2018 from $ 82.1 million for 2017 , an increase

