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CONSOLIDATED STATEMENTS OF CASH FLOWS $ in Thousands | 12 Months Ended
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Dec. 31, 2022 USD ($) | Dec. 31, 2021 USD ($) | Dec. 31, 2020 USD ($)
Cash flows from operating activities |  |  |
Net income | $ 45,741 | $ 46,055 | $ 122,083
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 17,543 | 17,517 | 18,350
Amortization of debt issuance cost | 939 | 1,078 | 1,347
Share-based compensation | 16,101 | 6,745 | 3,383
Gain on sale of investments | (2,272) | (2,193) | (99,839)
Loss (gain) on consolidation of equity method investment | 901 | (2,752) | 0
Gain on contingent equity securities | 0 | (4,270) | 0
Unrealized loss on investments | 25,506 | 10,845 | 11
Gain from investment in warrants | 0 | (1,145) | 0
Loss (income) from equity method investments, net | (5,622) | 4,306 | (3,694)
Impairment of beneficial interest | 0 | 15,723 | 0
Unrealized (gain) loss on interest rate swaps | (4,235) | 1,071 | 0
Loss of disposal of property and equipment | 0 | 0 | 91
Deferred tax | (14,278) | 7,671 | 396
Other |  | 189 | 0
Changes in operating assets and liabilities, net of acquisition amounts: |  |  |
Receivable, net | (38,194) | (1,518) | 4,134
Receivable, net – related parties | 4,229 | (20,116) | (1,123)
Other receivable | 8,196 | (5,351) | 12,589
Prepaid expenses and other current assets | 818 | 2,708 | (6,432)
Right-of-use assets | 3,759 | 3,133 | 3,325
Other assets | (243) | (1,529) | (5,530)
Accounts payable and accrued expenses | (49) | 3,217 | 8,204
Fiduciary accounts payable | (2,470) | 892 | 7,615
Medical liabilities | 22,786 | 5,279 | (8,691)
Income taxes payable/receivable | 6,917 | (14,005) | (7,083)
Operating lease liabilities | (3,945) | (3,215) | (2,973)
Net cash provided by operating activities | 82,128 | 70,335 | 46,163
Cash flows from investing activities |  |  |
Payments for business acquisition, net of cash acquired | (16,352) | (2,585) | (11,354)
Proceeds from repayment of loans receivable - related parties | 4,067 | 56 | 16,500
Advances on loans receivable | 0 | 0 | (145)
Purchases of marketable securities | (1,854) | (28,000) | (1,793)
Purchases of investments – equity method | 0 | (13,622) | (9,969)
Proceeds from sale of equity method investment | 0 | 6,375 | 52,743
Purchases of property and equipment | (22,940) | (19,223) | (1,164)
Proceeds from sale of fixed assets | 0 | 0 | 50
Proceeds from sale of marketable securities | 31,671 | 67,612 | 50,625
Cash recorded from consolidation of VIE | 0 | 5,927 | 0
Distribution from investment - equity method | 400 | 0 | 0
Contribution to investment - equity method | (2,105) | 0 | 0
Net cash (used in) provided by investing activities | (7,113) | 16,540 | 95,493
Cash flows from financing activities |  |  |
Dividends paid | (14,030) | (31,089) | (51,319)
Repayments on long-term debt | (3,865) | (238,326) | (9,500)
Payment of finance lease obligations | (561) | (208) | (105)
Proceeds from exercise of stock options and warrants | 8,633 | 9,061 | 10,802
Repurchase of common stock | (9,250) | (5,739) | (537)
Proceeds from sale of common stock | 0 | 40,134 | 0
Purchase of non-controlling interest | (5,046) | (1,471) | (1,037)
Proceeds from sale of noncontrolling interest | 436 | 48 | 0
Borrowings on loans | 3,598 | 180,569 | 0
Cost of debt and equity issuances | 0 | (727) | 0
Net cash used in financing activities | (20,085) | (47,748) | (51,696)
Net increase in cash, cash equivalents, and restricted cash | 54,930 | 39,127 | 89,960
Cash, cash equivalents, and restricted cash, beginning of year | 233,097 | 193,970 | 104,010
Cash, cash equivalents and restricted cash, end of year | 288,027 | 233,097 | 193,970
Supplemental disclosures of cash flow information |  |  |
Cash paid for income taxes | 47,311 | 37,201 | 62,002
Cash paid for interest | 6,672 | 4,158 | 8,510
Supplemental disclosures of non-cash investing and financing activities |  |  |
Dividend declared included in dividend payable | 0 | 71 | 485
Issuance of financing obligation for business combinations | 0 | 12,706 | 0
Cashless exercise of warrants | 694 | 0 | 599
Fixed asset obtained in exchange for finance lease liabilities | 971 | 0 | 0
Common stock issued in business combination | 1,000 | 0 | 0
Mortgage loan | 16,275 | 0 | 0
Cancellation of Restricted Stock Awards | 0 | 334 | 0
Deferred tax liability adjustment related to warrant exercises | 0 | 0 | 690
Preferred shares received from sale of equity method investment | 0 | 0 | 36,179
Beneficial interest acquired from sale of equity method investment | 0 | 0 | 15,723
Reconciliation of cash, cash equivalents, and restricted cash |  |  |
Cash and cash equivalents | 288,027 | 233,097 | 193,470
Restricted cash – long-term - letters of credit | 0 | 0 | 500
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows | $ 288,027 | $ 233,097 | $ 193,970

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