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Income Taxes (Tables) | 12 Months Ended
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Dec. 31, 2018
Income Tax Disclosure [Abstract] |
Income tax provision (benefit) | Provision for income taxes consisted of the following for the years ended December 31:
|  | 2018 |  |  | 2017 |
Current |  |  |  |  |  |  |  |
Federal |  | $ | 21,058,703 |  |  | $ | 19,219,251 |
State |  |  | 9,646,172 |  |  |  | 5,336,885 |
|  |  | 30,704,875 |  |  |  | 24,556,136 |
Deferred |  |  |  |  |  |  |  |
Federal |  |  | (5,954,666 | ) |  |  | (18,718,113 | )
State |  |  | (2,390,569 | ) |  |  | (1,951,238 | )
|  |  | (8,345,235 | ) |  |  | (20,669,351 | )
Total provision for income taxes |  | $ | 22,359,640 |  |  | $ | 3,886,785 |
Deferred tax assets (liabilities) |
|  | 2018 |  |  | 2017 |
Deferred tax assets (liabilities) |  |  |  |  |  |  |  |
State taxes |  | $ | 1,886,010 |  |  | $ | 1,001,754 |
Stock options |  |  | 1,660,664 |  |  |  | 1,784,524 |
Accrued payroll and related cost |  |  | 238,633 |  |  |  | 185,130 |
Accrued hospital pool deficit |  |  | 168,413 |  |  |  | 282,913 |
Allowance for bad debts |  |  | 1,124,917 |  |  |  | - |
Investment in other entities |  |  | 884,922 |  |  |  | (1,437,061 | )
Net operating loss carryforward |  |  | 6,414,256 |  |  |  | 7,069,776 |
Property and equipment |  |  | (1,286,087 | ) |  |  | (1,286,452 | )
Acquired intangible assets |  |  | (24,084,892 | ) |  |  | (28,626,943 | )
Risk Pool Receivable |  |  | (2,434,573 | ) |  |  | - |
Other |  |  | (792,781 | ) |  |  | (504,307 | )
Net deferred tax liabilities before valuation allowance |  |  | (16,220,518 | ) |  |  | (21,530,666 | )
Valuation allowance |  |  | (3,395,417 | ) |  |  | (3,385,932 | )
Net deferred tax liabilities |  | $ | (19,615,935 | ) |  | $ | (24,916,598 | )
Provision for income taxes | The provision for income taxes differs from the amount computed by applying the federal income tax rate as follows for the years ended December 31:
|  | 2018 |  |  | 2017 |
Tax provision at U.S. Federal statutory rates |  |  | 21.0 | % |  |  | 35.0 | %
State income taxes net of federal benefit |  |  | 6.7 |  |  |  | 4.4 |
Non-deductible permanent items |  |  | 1.3 |  |  |  | (9.7 | )
Non-taxable entities |  |  | (0.7 | ) |  |  | (1.9 | )
Stock-based compensation |  |  | (1.8 | ) |  |  | 0.9 |
Change in valuation allowance |  |  |  |  |  |  | (2.9 | )
Entity Conversion |  |  | 0.5 |  |  |  | - |
Change in rate |  |  | - |  |  |  | (19.4 | )
Other |  |  | 0.1 |  |  |  | 1.4 |
Effective income tax rate |  |  | 27.1 | % |  |  | 7.8 | %

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- Definition Tabular disclosure of the components of income tax expense attributable to continuing operations for each year presented including, but not limited to: current tax expense (benefit), deferred tax expense (benefit), investment tax credits, government grants, the benefits of operating loss carryforwards, tax expense that results from allocating certain tax benefits either directly to contributed capital or to reduce goodwill or other noncurrent intangible assets of an acquired entity, adjustments of a deferred tax liability or asset for enacted changes in tax laws or rates or a change in the tax status of the entity, and adjustments of the beginning-of-the-year balances of a valuation allowance because of a change in circumstances that causes a change in judgment about the realizability of the related deferred tax asset in future years. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 740 -SubTopic 10 -Section 50 -Paragraph 9 -URI http://asc.fasb.org/extlink&oid=84230637&loc=d3e32639-109319 + Details
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