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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
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Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021
Cash flows from operating activities |  |  |
Net income | $ 57,849 | $ 45,741 | $ 46,055
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 17,748 | 17,543 | 17,517
Amortization of debt issuance cost | 1,061 | 939 | 1,078
Share-based compensation | 22,040 | 16,101 | 6,745
Non-cash lease expense | 7,183 | 3,759 | 3,133
(Income) loss from equity method investments, net | (5,579) | (5,622) | 4,306
Unrealized loss on investments | 4,782 | 25,506 | 10,845
Unrealized (gain) loss on interest rate swaps | (201) | (4,235) | 1,071
Gain on sale or distribution of investments | (1,246) | (2,272) | (2,193)
Deferred tax | (12,444) | (14,278) | 7,671
Loss (gain) on consolidation of equity method investment | 0 | 901 | (2,752)
Gain on contingent equity securities | 0 | 0 | (4,270)
Gain from investment in warrants | 0 | 0 | (1,145)
Impairment of beneficial interest | 0 | 0 | 15,723
Other | 422 | 0 | 189
Changes in operating assets and liabilities, net of acquisition amounts: |  |  |
Receivable, net | (26,735) | (38,194) | (1,518)
Receivable, net – related parties | 6,167 | 4,229 | (20,116)
Other receivable | 311 | 8,196 | (5,351)
Prepaid expenses and other current assets | (2,956) | 818 | 2,708
Other assets | 2,864 | (243) | (1,529)
Accounts payable and accrued expenses | (170) | (49) | 3,217
Fiduciary accounts payable | (328) | (2,470) | 892
Medical liabilities | 18,610 | 22,786 | 5,279
Income taxes payable/receivable | (14,477) | 6,917 | (14,005)
Operating lease liabilities | (6,674) | (3,945) | (3,215)
Net cash provided by operating activities | 68,227 | 82,128 | 70,335
Cash flows from investing activities |  |  |
Payments for business and asset acquisition, net of cash acquired | (6,512) | (16,352) | (2,585)
Proceeds from repayment of loans receivable - related parties | 2,676 | 4,067 | 56
Purchases of marketable securities | (2,151) | (1,854) | (28,000)
Proceeds from sale of marketable securities | 491 | 31,671 | 67,612
Issuance of loans receivable | (26,473) | 0 | 0
Purchases of investments –privately held | (4,000) | 0 | 0
Purchases of property and equipment | (28,529) | (22,940) | (19,223)
Purchases of investments – equity method | (325) | 0 | (13,622)
Proceeds from sale of equity method investment | 0 | 0 | 6,375
Distribution from investment - equity method | 0 | 400 | 0
Contribution to investment - equity method | (700) | (2,105) | 0
Cash recorded from consolidation of VIE | 0 | 0 | 5,927
Net cash (used in) provided by investing activities | (65,523) | (7,113) | 16,540
Cash flows from financing activities |  |  |
Dividends paid | (62,074) | (14,030) | (31,089)
Repayments on long-term debt | (204,681) | (3,865) | (238,326)
Borrowings on long-term debt | 284,527 | 3,598 | 180,569
Payment of finance lease obligations | (675) | (561) | (208)
Proceeds from exercise of stock options and warrants | 1,522 | 8,633 | 9,061
Repurchase of shares | (10,192) | (9,250) | (5,739)
Proceeds from sale of common stock | 0 | 0 | 40,134
Purchase of non-controlling interest | (78) | (5,046) | (1,471)
Proceeds from sale of noncontrolling interest | 0 | 436 | 48
Cost of debt issuances | (3,928) | 0 | (727)
Payment of contingent consideration liabilities | (1,000) | 0 | 0
Net cash provided by (used in) financing activities | 3,421 | (20,085) | (47,748)
Net increase in cash, cash equivalents, and restricted cash | 6,125 | 54,930 | 39,127
Cash, cash equivalents, and restricted cash, beginning of year | 288,027 | 233,097 | 193,970
Cash, cash equivalents and restricted cash, end of year | 294,152 | 288,027 | 233,097
Supplemental disclosures of cash flow information |  |  |
Cash paid for income taxes | 56,567 | 47,311 | 37,201
Cash paid for interest | 14,251 | 6,672 | 4,158
Supplemental disclosures of non-cash investing and financing activities |  |  |
Right-of-use assets obtained in exchange for operating lease liabilities | 25,124 | 0 | 0
Tax impact from APC dividends to APC Shareholders | 3,076 | 0 | 0
Distribution of real estate investments | 152,767 | 0 | 0
Dividend declared included in dividend payable | 0 | 0 | 71
Issuance of financing obligation for business combinations | 0 | 0 | 12,706
Cashless exercise of warrants | 0 | 694 | 0
Fixed asset obtained in exchange for finance lease liabilities | 486 | 971 | 0
Common stock issued in business combination | 800 | 1,000 | 0
Mortgage loan | 0 | 16,275 | 0
Cancellation of Restricted Stock Awards | 0 | 0 | 334
Reconciliation of cash, cash equivalents, and restricted cash |  |  |
Cash and cash equivalents | 293,807 | 288,027 | 233,097
Restricted cash | 345 | 0 | 0
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows | $ 294,152 | $ 288,027 | $ 233,097

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