v3.23.3
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2023
Sep. 30, 2022
Cash flows from operating activities    
Net income $ 57,943 $ 46,624
Adjustments to reconcile net income to net cash provided by (used in) operating activities:    
Depreciation and amortization 12,846 13,480
Amortization of debt issuance cost 711 703
Share-based compensation 13,364 10,477
Gain on sale of equity securities 0 (2,272)
Unrealized loss on investments 6,898 21,894
Income from equity method investments (3,104) (4,397)
Unrealized gain on interest rate swaps (1,022) (4,302)
Deferred tax (3,936) (3,054)
Other 0 901
Changes in operating assets and liabilities, net of business combinations:    
Receivables, net (46,261) (58,325)
Receivables, net – related parties (21,801) (21,832)
Other receivables 2,303 (31,988)
Prepaid expenses and other current assets (1,246) 3,228
Loan receivable, non-current (40) 0
Right-of-use assets 5,223 2,843
Other assets (180) (682)
Accounts payable and accrued expenses (1,119) 765
Fiduciary accounts payable (1,808) (4,029)
Medical liabilities 10,108 37,491
Income taxes payable/receivable 25,154 (10,395)
Operating lease liabilities (5,215) (3,059)
Other long-term liabilities 109 3,118
Net cash provided by (used in) operating activities 48,927 (2,811)
Cash flows from investing activities    
Payments for business and asset acquisitions, net of cash acquired (4,674) (5,614)
Proceeds from repayment of loans receivable – related parties 2,200 4,051
Purchase of marketable securities (2,125) (1,750)
Issuance of loan receivable (25,000) 0
Purchase of investments - privately held (2,000) 0
Purchase of investments - equity method (325) 0
Purchases of property and equipment (21,472) (22,054)
Proceeds from sale of marketable securities 0 6,438
Distribution from investment - equity method 0 400
Contribution to investment - equity method (700) (1,785)
Net cash used in investing activities (54,096) (20,314)
Cash flows from financing activities    
Dividends paid (2,266) (12,676)
Repayment of long-term debt (461) (3,714)
Payment of finance lease obligations (505) (417)
Proceeds from the exercise of stock options and warrants 1,250 2,784
Repurchase of shares (9,689) (9,648)
Proceeds from sale of non-controlling interest 0 67
Purchase of non-controlling interest (50) (4,338)
Borrowings on loans 3,149 1,986
Net cash used in financing activities (8,572) (25,956)
Net decrease in cash and cash equivalents (13,741) (49,081)
Cash and cash equivalents beginning of period 288,027 233,097
Cash and cash equivalents end of period 274,286 184,016
Supplementary disclosures of cash flow information    
Cash paid for income taxes 7,881 41,811
Cash paid for interest 9,670 4,386
Supplemental disclosures of non-cash investing and financing activities    
Right-of-use assets obtained in exchange for operating lease liabilities 6,626 0
Tax impact from APC dividends to APC Shareholders 3,076 0
Fixed asset obtained in exchange for finance lease liabilities 0 398
Common stock issued in business combination 0 1,000
Mortgage loan 0 16,275
Cashless exercise of warrants 0 694
Reconciliation of cash, cash equivalents, and restricted cash    
Cash and cash equivalents 273,941 184,016
Restricted cash 345 0
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $ 274,286 $ 184,016

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