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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands | 9 Months Ended
--- | ---
Sep. 30, 2024 | Sep. 30, 2023
Cash flows from operating activities |  |
Net income | $ 57,709 | $ 57,943
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation and amortization | 19,801 | 12,846
Amortization of debt issuance cost | 1,374 | 711
Share-based compensation | 19,301 | 13,364
Non-cash lease expense | 3,946 | 5,223
Gain on debt extinguishment | (2,398) | 0
Unrealized (gain) loss on investments | (415) | 6,898
Income from equity method investments | (2,887) | (3,104)
Unrealized gain on interest rate swaps | 0 | (1,022)
Deferred tax | (7,596) | (3,936)
Other | 8,394 | 0
Changes in operating assets and liabilities, net of business combinations: |  |
Receivables, net | (37,927) | (46,261)
Receivables, net - related parties | (17,588) | (21,801)
Other receivables | (2,986) | 2,303
Prepaid expenses and other current assets | (7,825) | (1,246)
Loan receivable, non-current | 0 | (40)
Other assets | (2,996) | (180)
Accounts payable and accrued expenses | 25,866 | (1,119)
Fiduciary accounts payable | (1,696) | (1,808)
Medical liabilities | 21,517 | 10,108
Income taxes receivable | (7,266) | 25,154
Operating lease liabilities | (3,611) | (5,215)
Other long-term liabilities | 429 | 109
Net cash provided by operating activities | 63,146 | 48,927
Cash flows from investing activities |  |
Payments for business acquisition, net of cash acquired | (115,494) | (4,674)
Proceeds from repayment of promissory notes, including those with related parties | 256 | 2,200
Purchase of marketable securities | (82) | (2,125)
Proceeds from sale of marketable securities | 124 | 0
Purchase of investments - privately held | (2,500) | (2,000)
Purchase of investment – equity method | (5,968) | (325)
Purchase of call option issued in conjunction with equity method investment | (3,907) | 0
Issuance of promissory notes | (26,000) | (25,000)
Purchases of property and equipment | (5,500) | (21,472)
Contribution to investment - equity method | 0 | (700)
Net cash used in investing activities | (159,071) | (54,096)
Cash flows from financing activities |  |
Dividends paid | (2,114) | (2,266)
Borrowings on long-term debt | 171,875 | 0
Repayment of long-term debt | (14,750) | (461)
Payment of finance lease obligations | (534) | (505)
Proceeds from the exercise of stock options | 232 | 1,250
Proceeds from ESPP purchases | 271 | 0
Taxes paid from net share settlement of restricted stock | (3,975) | 0
Repurchase of treasury shares | (717) | (9,689)
Proceeds from sale of non-controlling interest | 150 | 0
Purchase of non-controlling interest | (25) | (50)
Borrowings on loans | 0 | 3,149
Net cash provided by (used in) financing activities | 150,413 | (8,572)
Net increase (decrease) in cash and cash equivalents | 54,488 | (13,741)
Cash, cash equivalents, and restricted cash, beginning of period | 294,152 | 288,027
Cash, cash equivalents, and restricted cash, end of period | 348,640 | 274,286
Supplemental disclosures of cash flow information |  |
Cash paid for income taxes | 38,270 | 7,881
Cash paid for interest | 23,190 | 9,670
Supplemental disclosures of non-cash investing and financing activities |  |
Fixed assets obtained in exchange for finance lease liabilities | 152 | 0
Right-of-use assets obtained in exchange for operating lease liabilities | 13,303 | 6,626
Common stock issued in business combination | 21,952 | 0
Common stock issued for contingent consideration payment | 4,023 | 0
Tax impact from APC dividends to APC Shareholders | 0 | 3,076
Draw on letter of credit through Revolver Loan | 4,732 | 0
Reconciliation of cash, cash equivalents, and restricted cash |  |
Cash and cash equivalents | 347,994 | 273,941
Restricted cash | 646 | 345
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows | $ 348,640 | $ 274,286

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- Definition Amount of cash equivalents restricted as to withdrawal or usage, classified as noncurrent. Cash equivalents include, but are not limited to, short-term, highly liquid investments that are both readily convertible to known amounts of cash and so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Topic 210 -SubTopic 10 -Name Accounting Standards Codification -Section S99 -Paragraph 1 -Subparagraph (SX 210.5-02(17)) -Publisher FASB -URI https://asc.fasb.org/1943274/2147480566/210-10-S99-1 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Topic 954 -SubTopic 210 -Name Accounting Standards Codification -Section 45 -Paragraph 4 -Publisher FASB -URI https://asc.fasb.org/1943274/2147477220/954-210-45-4 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Topic 954 -SubTopic 210 -Name Accounting Standards Codification -Section 50 -Paragraph 2 -Publisher FASB -URI https://asc.fasb.org/1943274/2147478600/954-210-50-2 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Name Accounting Standards Codification -Section 45 -Paragraph 5 -SubTopic 210 -Topic 954 -Publisher FASB -URI https://asc.fasb.org/1943274/2147477220/954-210-45-5 Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef -Topic 230 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 8 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482913/230-10-50-8 + Details
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