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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands | 3 Months Ended
--- | ---
Mar. 31, 2025 | Mar. 31, 2024
Cash flows from operating activities |  |
Net income | $ 6,221 | $ 16,862
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation and amortization | 6,849 | 5,096
Amortization of debt issuance cost | 691 | 458
Share-based compensation | 7,811 | 5,748
Non-cash lease expense | 1,287 | 3,155
Change in fair value of contingent consideration liabilities | 1,407 | 0
Loss on debt extinguishment | 375 | 0
Unrealized loss (gain) on investments | 44 | (1,099)
Loss (income) from equity method investments | 867 | (632)
Deferred tax | (358) | (7,248)
Other | (557) | 6,795
Changes in operating assets and liabilities, net of business combinations: |  |
Receivables, net | (10,368) | (26,128)
Receivables, net - related parties | (6,589) | (3,374)
Other receivables | 3,688 | (1,403)
Prepaid expenses and other current assets | 2,674 | (4,255)
Other assets | (314) | 92
Accounts payable and accrued expenses | 8 | 905
Fiduciary accounts payable | (3,383) | 56
Medical liabilities | 3,319 | (808)
Income taxes receivable | 3,514 | 14,542
Operating lease liabilities | (1,090) | (3,083)
Other long-term liabilities | 531 | 298
Net cash provided by operating activities | 16,627 | 5,977
Cash flows from investing activities |  |
Payments for business acquisition, net of cash acquired | 0 | (50,649)
Proceeds from repayment of promissory notes, including those with related parties | 600 | 6
Purchase of marketable securities | (24) | (27)
Issuance of loan receivable | 0 | (20,000)
Purchases of property and equipment | (3,070) | (369)
Distribution from investment - equity method | 100 | 0
Net cash used in investing activities | (2,394) | (71,039)
Cash flows from financing activities |  |
Dividends paid | (5,455) | (95)
Borrowings on long-term debt | 412,000 | 110,000
Repayment of long-term debt | (428,232) | (3,500)
Payment of finance lease obligations | (147) | (179)
Deferred financing cost | (17,241) | 0
Proceeds from ESPP purchases | 301 | 0
Taxes paid from net share settlement of restricted stock | (4,052) | 0
Repurchase of subsidiary's shares | (1,316) | 0
Proceeds from sale of non-controlling interest | 0 | 150
Purchase of non-controlling interest | (28) | (25)
Net cash (used in) provided by financing activities | (44,170) | 106,351
Net (decrease) increase in cash, cash equivalents, and restricted cash | (29,937) | 41,289
Cash, cash equivalents, and restricted cash, beginning of period | 289,101 | 294,152
Cash, cash equivalents, and restricted cash, end of period | 259,164 | 335,441
Supplemental disclosures of cash flow information |  |
Cash paid for income taxes | 4,338 | 194
Cash paid for interest | 7,360 | 6,430
Supplemental disclosures of non-cash investing and financing activities |  |
Business acquisition in accounts payable and accrued liabilities | 0 | 63,935
Right-of-use assets obtained in exchange for operating lease liabilities | 5,729 | 4,910
Common stock issued in business combination | 0 | 21,952
Purchase of investments - equity method in accounts payable and accrued liabilities and other liabilities | 0 | 9,487
Draw on letter of credit through Revolver Loan | 0 | 4,759
Dividend paid in the form of common stock | 21,935 | 0
Reconciliation of cash, cash equivalents, and restricted cash |  |
Cash and cash equivalents | 258,517 | 334,796
Restricted cash | 647 | 645
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows | $ 259,164 | $ 335,441

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