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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) | 9 Months Ended
--- | ---
Sep. 30, 2019 | Sep. 30, 2018
Cash flows from operating activities |  |
Net income | $ 18,952,664 | $ 62,208,688
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation and amortization | 13,792,581 | 14,819,627
Impairment of intangible | 1,994,000 | 0
Loss on disposal of property and equipment | 0 | 41,782
Provision for doubtful accounts | (1,363,415) | 0
Share-based compensation | 1,005,898 | 1,238,708
Gain on loan assumption | (2,250,000) | 0
Unrealized (gain) loss from investment in equity securities | (6,283) | 10,218
(Income) loss from equity method investments | (1,161,791) | 2,573,219
Deferred tax | (185,699) | 7,135,408
Changes in operating assets and liabilities, net of business combinations: |  |
Receivable, net | 1,905,076 | 4,484,115
Receivable, net – related parties | 5,864,052 | (43,360,966)
Other receivables | (13,719,229) | 0
Prepaid expenses and other current assets | (2,913,570) | (80,618)
Right-of-use assets | 1,877,353 | 0
Other assets | (524,689) | (26,931)
Accounts payable and accrued expenses | 4,868,437 | 31,701,367
Dividends payable | 0 | 0
Incentives payable | 0 | (16,500,000)
Fiduciary accounts payable | 195,544 | 0
Medical liabilities | (6,226,426) | (30,466,895)
Income taxes payable | (10,229,369) | (1,912,842)
Operating lease liabilities | (1,790,313) | 0
Net cash provided by operating activities | 10,084,821 | 31,864,880
Cash flows from investing activities |  |
Payments for business acquisitions, net of cash acquired | (49,402,514) | 0
Advances on loans receivable | (7,425,000) | (2,500,000)
Purchases of marketable securities | (21,095) | (9,013)
Purchases of investment - equity method | (2,949,000) | (16,673,840)
Purchases of a privately held entity that does not report net asset value per share | 0 | (405,000)
Purchases of property and equipment | (806,590) | (867,732)
Dividend received | 240,000 | 207,410
Net cash used in investing activities | (60,364,199) | (20,248,175)
Cash flows from financing activities |  |
Repayment of bank loan and lines of credit | (52,640,257) | (375,485)
Dividends paid | (60,670,309) | (16,725,799)
Change in noncontrolling interest capital | 0 | 27,300
Payment of capital lease obligations | (76,020) | (73,775)
Proceeds from the exercise of stock options and warrants | 2,400,330 | 3,574,046
Repurchase of shares | (40,000) | 0
Borrowings on line of credit and long-term debt | 289,600,000 | 8,000,000
Proceeds from common stock offering | 754,998 | 200,000
Cost of debt and equity issuance costs | (5,621,831) | 0
Net cash provided by (used in) financing activities | 173,706,911 | (5,373,713)
Net increase in cash, cash equivalents and restricted cash | 123,427,533 | 6,242,992
Cash, cash equivalents and restricted cash, beginning of period | 107,636,973 | 118,500,095
Cash, cash equivalents and restricted cash, end of period | 231,064,506 | 124,743,087
Supplementary disclosures of cash flow information: |  |
Cash paid for income taxes | 17,900,000 | 18,032,590
Cash paid for interest | 999,582 | 287,332
Supplemental disclosures of non-cash investing and financing activities |  |
Cashless exercise of stock options | 0 | 47
Deferred tax liability adjustment to goodwill | 11,539,600 | 1,110,456
APC stock issued in exchange for AMG | 414,250 | 0
Reconciliation of cash, cash equivalents, and restricted cash |  |
Cash and cash equivalents | 230,298,252 | 119,779,499
Restricted cash – short-term - distributions to former NMM shareholders | 20,150 | 4,218,176
Restricted cash – letters of credit | 746,104 | 745,412
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows | $ 107,636,973 | $ 118,500,095

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- Definition Amount of cash inflow (outflow) from financing activities, including discontinued operations. Financing activity cash flows include obtaining resources from owners and providing them with a return on, and a return of, their investment; borrowing money and repaying amounts borrowed, or settling the obligation; and obtaining and paying for other resources obtained from creditors on long-term credit. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3521-108585 + Details
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- Definition Amount of cash inflow (outflow) from investing activities, including discontinued operations. Investing activity cash flows include making and collecting loans and acquiring and disposing of debt or equity instruments and property, plant, and equipment and other productive assets. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3521-108585 + Details
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- Definition Amount of cash inflow (outflow) from operating activities, including discontinued operations. Operating activity cash flows include transactions, adjustments, and changes in value not defined as investing or financing activities. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 25 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3536-108585 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3521-108585 Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3602-108585 + Details
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- Definition The total of the cash outflow during the period which has been paid to third parties in connection with debt origination, which will be amortized over the remaining maturity period of the associated long-term debt and the cost incurred directly for the issuance of equity securities. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3291-108585 + Details
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- Definition The cash outflow to reacquire common stock during the period. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3291-108585 + Details
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- Definition Cash outflow in the form of capital distributions and dividends to common shareholders, preferred shareholders and noncontrolling interests. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3291-108585 + Details
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- Definition The cash outflow associated with the acquisition of a business, net of the cash acquired from the purchase. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3213-108585 + Details
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- Definition The cash outflow associated with the purchase of or advances to an equity method investments, which are investments in joint ventures and entities in which the entity has an equity ownership interest normally of 20 to 50 percent and exercises significant influence. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3213-108585 + Details
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- Definition Amount of cash outflow for purchase of marketable security. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 320 -SubTopic 10 -Section 45 -Paragraph 11 -URI http://asc.fasb.org/extlink&oid=109979856&loc=d3e26853-111562 + Details
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- Definition The cash outflow associated with the acquisition of long-lived, physical assets that are used in the normal conduct of business to produce goods and services and not intended for resale; includes cash outflows to pay for construction of self-constructed assets. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3213-108585 + Details
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- Definition The cash outflow associated with extending a long-term loan to a related party. Alternate caption: Payments for Advances to Affiliates. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 850 -SubTopic 10 -Section 50 -Paragraph 1 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=6457730&loc=d3e39549-107864 Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3213-108585 + Details
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- Definition Amount of distribution received from equity method investee for return of investment, classified as investing activities. Excludes distribution for return on investment, classified as operating activities. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 21D -URI http://asc.fasb.org/extlink&oid=109223946&loc=SL94080555-108585 Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3179-108585 + Details
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- Definition The cash inflow from the additional capital contribution to the entity. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3255-108585 + Details
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