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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended
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Dec. 31, 2024 | Dec. 31, 2023 | Dec. 31, 2022
Cash flows from operating activities |  |  |
Net income | $ 49,932 | $ 57,849 | $ 45,741
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 27,927 | 17,748 | 17,543
Amortization of debt issuance cost | 1,828 | 1,061 | 939
Share-based compensation | 34,536 | 22,040 | 16,101
Non-cash lease expense | 5,278 | 7,183 | 3,759
Change in fair value of contingent consideration liabilities | 3,526 | 0 | 0
Gain on debt extinguishment | (2,398) | 0 | 0
Unrealized (gain) loss on investments | (731) | 4,782 | 25,506
Income from equity method investments, net | (4,451) | (5,579) | (5,622)
Unrealized gain on interest rate swaps | 0 | (201) | (4,235)
Gain on sale or distribution of investments | 0 | (1,246) | (2,272)
Deferred tax | (4,249) | (12,444) | (14,278)
Loss on consolidation of equity method investment | 0 | 0 | 901
Impairment of beneficial interest |  | 422 | 0
Other | 4,613 |  |
Changes in operating assets and liabilities, net of acquisition amounts: |  |  |
Receivable, net | (44,388) | (26,735) | (38,194)
Receivable, net – related parties | 8,623 | 6,167 | 4,229
Other receivable | 24,670 | 311 | 8,196
Prepaid expenses and other current assets | (10,854) | (2,956) | 818
Other assets | (8,875) | 2,864 | (243)
Accounts payable and accrued expenses | (30,919) | (170) | (49)
Fiduciary accounts payable | 487 | (328) | (2,470)
Medical liabilities | 10,570 | 18,610 | 22,786
Income taxes payable/receivable | (8,622) | (14,477) | 6,917
Operating lease liabilities | (4,825) | (6,674) | (3,945)
Other liabilities | 520 | 0 | 0
Net cash provided by operating activities | 52,198 | 68,227 | 82,128
Cash flows from investing activities |  |  |
Payments for business and asset acquisition, net of cash acquired | (146,260) | (6,512) | (16,352)
Proceeds from repayment of promissory notes, including those with related parties | 256 | 2,676 | 4,067
Purchases of marketable securities | (109) | (2,151) | (1,854)
Proceeds from sale of marketable securities | 124 | 491 | 31,671
Issuance of promissory notes | (26,000) | (26,473) | 0
Purchases of property and equipment | (8,031) | (28,529) | (22,940)
Purchases of investments –privately held | (2,500) | (4,000) | 0
Purchases of investments – equity method | (5,968) | (325) | 0
Purchase of call option issued in conjunction with equity method investment | (3,907) | 0 | 0
Distribution from investment - equity method | 0 | 0 | 400
Contribution to investment - equity method | 0 | (700) | (2,105)
Net cash used in investing activities | (192,395) | (65,523) | (7,113)
Cash flows from financing activities |  |  |
Dividends paid | (4,036) | (62,074) | (14,030)
Repayments on long-term debt | (18,500) | (204,681) | (3,865)
Borrowings on long-term debt | 171,875 | 284,527 | 3,598
Payment of finance lease obligations | (670) | (675) | (561)
Proceeds from exercise of stock options and warrants | 755 | 1,522 | 8,633
Proceeds from ESPP purchases | 271 | 0 | 0
Taxes paid from net share settlement of restricted stock | (4,662) | 0 | 0
Repurchase of treasury shares | (937) | (10,192) | (9,250)
Purchase of non-controlling interest | (40) | (78) | (5,046)
Proceeds from sale of noncontrolling interest | 150 | 0 | 436
Cost of debt issuances | 0 | (3,928) | 0
Payment of financing obligation | (8,542) | 0 | 0
Payment of contingent consideration liabilities | (518) | (1,000) | 0
Net cash provided by (used in) financing activities | 135,146 | 3,421 | (20,085)
Net (decrease) increase in cash, cash equivalents, and restricted cash | (5,051) | 6,125 | 54,930
Cash, cash equivalents, and restricted cash, beginning of year | 294,152 | 288,027 | 233,097
Cash, cash equivalents and restricted cash, end of year | 289,101 | 294,152 | 288,027
Supplemental disclosures of cash flow information |  |  |
Cash paid for taxes | 43,936 | 56,567 | 47,311
Cash paid for interest | 30,419 | 14,251 | 6,672
Supplemental disclosures of non-cash investing and financing activities |  |  |
Right-of-use assets obtained in exchange for operating lease liabilities | 14,117 | 25,124 | 0
Common stock issued in business combination | 21,952 | 800 | 1,000
Common stock issued for contingent consideration payment | 4,023 | 0 | 0
Acquisition of business through loan conversion | 5,175 | 0 | 0
Draw on letter of credit through Revolver Loan | 4,732 | 0 | 0
Tax impact from APC dividends to APC Shareholders | 0 | 3,076 | 0
Distribution of real estate investments | 0 | 152,767 | 0
Mortgage loan | 0 | 0 | 16,275
Reconciliation of cash, cash equivalents, and restricted cash |  |  |
Cash and cash equivalents | 288,455 | 293,807 | 288,027
Restricted cash | 646 | 345 | 0
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows | $ 289,101 | $ 294,152 | $ 288,027

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- Definition Amount of cash paid for interest, excluding capitalized interest, classified as operating activity. Includes, but is not limited to, payment to settle zero-coupon bond for accreted interest of debt discount and debt instrument with insignificant coupon interest rate in relation to effective interest rate of borrowing attributable to accreted interest of debt discount. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Topic 230 -SubTopic 10 -Name Accounting Standards Codification -Section 45 -Paragraph 17 -Subparagraph (d) -Publisher FASB -URI https://asc.fasb.org/1943274/2147482740/230-10-45-17 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Topic 230 -SubTopic 10 -Name Accounting Standards Codification -Section 45 -Paragraph 25 -Subparagraph (e) -Publisher FASB -URI https://asc.fasb.org/1943274/2147482740/230-10-45-25 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Topic 230 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 2 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482913/230-10-50-2 + Details
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- Definition Mortgage loan related to property sales in noncash investing and financing activities. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 50 -Paragraph 4 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482913/230-10-50-4 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 50 -Paragraph 3 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482913/230-10-50-3 Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 50 -Paragraph 5 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482913/230-10-50-5 + Details
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