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Deferred tax assets (liabilities) (Detail) - USD ($) | Dec. 31, 2018 | Dec. 31, 2017
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Deferred tax assets (liabilities): |  |
State taxes | $ 1,886,010 | $ 1,001,754
Stock options | 1,660,664 | 1,784,524
Accrued payroll and related costs | 238,633 | 185,130
Accrued hospital pool deficit | 168,413 | 282,913
Allowance for bad debts | 1,124,917 | 0
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) | 0
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)

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