v3.22.2.2
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Cash flows from operating activities    
Net income $ 50,060 $ 68,603
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 13,480 13,105
Amortization of debt issuance cost 703 900
Share-based compensation 10,477 4,322
Gain on sale of investments (2,272) (2,193)
Unrealized loss (gain) on investments 21,894 (22,826)
(Income) loss from equity method investments (4,397) 3,680
Impairment of beneficial interest 0 15,723
Unrealized (gain) loss on interest rate swaps (4,302) 1,069
Deferred tax (2,330) 6,847
Other 901 189
Changes in operating assets and liabilities, net of business combinations:    
Receivables, net (58,325) (10,686)
Receivables, net – related parties (21,832) (4,367)
Other receivables (31,988) (1,477)
Prepaid expenses and other current assets 3,228 5,064
Right-of-use assets 2,843 2,440
Other assets (682) (954)
Accounts payable and accrued expenses 765 14,362
Fiduciary accounts payable (4,029) (815)
Medical liabilities 37,491 (7,633)
Income taxes payable (14,555) (300)
Operating lease liabilities (3,059) (2,528)
Other long-term liabilities 3,118 0
Net cash (used in) provided by operating activities (2,811) 82,525
Cash flows from investing activities    
Payments for business acquisition, net of cash acquired (5,614) (2,575)
Proceeds from repayment of loans receivable – related parties 4,051 41
Purchase of marketable securities (1,750) (1,009)
Purchase of investment – equity method 0 (13,384)
Proceeds from sale of equity method investment 0 6,375
Purchases of property and equipment (22,054) (16,420)
Cash received from consolidation of VIE 0 3,322
Proceeds from sale of marketable securities 6,438 1,106
Distribution from investment - equity method 400 0
Contribution to investment - equity method (1,785) 0
Net cash used in investing activities (20,314) (22,544)
Cash flows from financing activities    
Dividends paid (12,676) (31,089)
Repayment of long-term debt (3,714) (238,254)
Payment of finance lease obligations (417) (81)
Proceeds from the exercise of stock options and warrants 2,784 6,601
Repurchase of shares (9,648) (5,739)
Proceeds from sale of non-controlling interest 67 48
Purchase of non-controlling interest (4,338) (75)
Borrowings on loans 1,986 180,000
Proceeds from sale of shares 0 40,133
Payment of debt issuance costs 0 (727)
Net cash used in financing activities (25,956) (49,183)
Net (decrease) increase in cash, cash equivalents and restricted cash (49,081) 10,798
Cash, cash equivalents, and restricted cash, beginning of period 233,097 193,970
Cash, cash equivalents, and restricted cash, end of period 184,016 204,768
Supplementary disclosures of cash flow information    
Cash paid for income taxes 41,811 24,800
Cash paid for interest 4,386 3,330
Supplemental disclosures of non-cash investing and financing activities    
Dividend declared included in dividend payable 0 71
Deferred tax liability adjustment to goodwill 0 1,786
Fixed asset obtained in exchange for finance lease liabilities 398 0
Common stock issued in business combination 1,000 0
Cancellation of restricted stock awards 0 334
Mortgage loan 16,275 0
Cashless exercise of warrants 694 0
Reconciliation of cash, cash equivalents, and restricted cash    
Cash and cash equivalents 184,016  
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $ 184,016 $ 204,768

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