Related-Party Transactions

9 Months Ended

Sep. 30, 2024

Related Party Transactions [Abstract]

Related-Party Transactions

13.Related-Party Transactions

Equity Method Investments

During the three and nine months ended September 30, 2023, the Company recognized approximately $4.3 million and $16.2 million, respectively, in management fees from LaSalle Medical Associates – IPA line of business (“LMA”). On August 31, 2023, the management service agreement with LMA’s IPA was terminated. LMA is accounted for under the equity method based on the 25% equity ownership interest held in LMA’s IPA line of business (see Note 5 — “Investments in Other Entities - Equity Method”).

During the three months ended September 30, 2024 and 2023, the Company paid approximately $0.8 million and $0.8 million, respectively, to Pacific Medical Imaging & Oncology Center, Inc. (“PMIOC”) for provider services. During the nine months ended September 30, 2024 and 2023, the Company paid approximately $2.2 million and $1.9 million, respectively, to PMIOC for provider services. PMIOC provides covered services on behalf of the Company’s RBOs to enrollees of the plans. PMIOC is accounted for under the equity method based on the 40% equity ownership interest held (see Note 5 — “Investments in Other Entities - Equity Method”).

During each of the three months ended September 30, 2024 and 2023, the Company paid approximately $0.3 million and $0.3 million, respectively, for provider services to an equity method investment in which the Company has a 25% equity ownership in (see Note 5 — “Investments in Other Entities - Equity Method”). During the nine months ended September 30, 2024 and 2023, the Company paid approximately $0.7 million and $0.8 million, respectively, for provider services.

During the three and nine months ended September 30, 2024, the Company incurred expenses of approximately $0.6 million and $1.2 million, respectively, in management fees to I Health. The Company has a management service agreement with I Health. I Health is accounted for under the equity method based on the 25% equity ownership interest held (see Note 5 — “Investments in Other Entities - Equity Method”).

Astrana Board Members and Officers

During the three months ended September 30, 2024 and 2023, the Company recognized approximately $0.4 million and $0.5 million, respectively, in revenue, net of costs, from Arroyo Vista Family Health Center (“Arroyo Vista”). During the nine months ended September 30, 2024 and 2023, the Company recognized approximately $1.5 million and $1.3 million, respectively, in revenue, net of costs. Revenue consisted of management fees and surplus from shared risk arrangements. Expenses consisted of fees for provider services. Arroyo Vista’s chief executive officer is a member of the Company’s board of directors.

During the three months ended September 30, 2024 and 2023, the Company incurred rent expenses of approximately $1.3 million and $0.8 million, respectively, from certain properties that are managed by Allied Pacific Holdings Investment Management, LLC. During the nine months ended September 30, 2024 and 2023, the Company incurred $3.0 million and $2.5 million, respectively, in rent expense from the same properties. As of September 30, 2024, and December 31, 2023, the Company’s operating right-of-use asset balance included $2.0 million and $14.1 million, respectively, and the Company’s operating lease liabilities included $2.0 million and $14.5 million, respectively, for certain properties that are managed by Allied Pacific Holdings Investment Management, LLC. These properties were previously consolidated and eliminated by Astrana until they were spun off on December 26, 2023. The chief executive officer of Allied Pacific Holdings Investment Management, LLC is a member of the Company’s board of directors.

During the nine months ended September 30, 2024, Allied Pacific Holdings Investment Management, LLC paid APC $5.3 million for taxes associated with the APC Excluded Assets spin-off on December 26, 2023.

During the three months ended September 30, 2024 and 2023, the Company incurred approximately $0.4 million and $0.5 million, respectively, in expenses payable to Third Way Health for call center and credentialing services. During the nine months ended September 30, 2024 and 2023, the Company incurred approximately $2.1 million and $0.9 million, respectively, in expenses for call center services. As of September 30, 2024 and December 31, 2023, via a Simple Agreement for Future Equity, the Company funded $6.0 million and $3.5 million, respectively, in Third Way Health. The investment is included in investments in privately held entities in the accompanying condensed consolidated balance sheets. One of Astrana’s officers is a board member of Third Way Health.

During the three months ended September 30, 2024 and 2023, the Company paid approximately $0.1 million and $0.2 million, respectively, to Sunny Village Care Center for services as a provider. During the nine months ended September 30, 2024 and 2023, the Company paid approximately $0.3 million and $1.0 million, respectively, for provider services. The Company has provider contracts with Sunny Village Care Center. Sunny Village Care Center shares common ownership with certain Astrana board members.

During the three and nine months ended September 30, 2024, Astrana paid approximately $0.7 million to purchase Astrana’s stock from a board member. During the nine months ended September 30, 2023, Astrana paid approximately $9.5 million to purchase Astrana’s stock from a board member.

During the three months ended September 30, 2024 and 2023, the Company incurred rent expenses of approximately $0.1 million and $0.1 million, respectively, from First Commonwealth Property, LLC for an office lease. During the nine months ended September 30, 2024 and 2023, the Company incurred rent expenses of approximately $0.1 million and $0.1 million, respectively. First Commonwealth Property, LLC shares common ownership with certain board members of APC and AHM.

As of September 30, 2024 and December 31, 2023, the Company’s operating right-of-use asset balance included $0.7 million and $0.8 million, respectively, and the Company’s operating lease liabilities included $0.8 million and $0.8 million, respectively, for certain properties owned by First Commonwealth Property, LLC.

The Company has agreements with Health Source MSO Inc., a California corporation (“HSMSO”), Aurion Corporation (“Aurion”), and AHMC Healthcare Inc. (“AHMC”) for services provided to the Company. One of the Company’s board members is an officer of AHMC, HSMSO, and Aurion. Aurion is also partially owned by one of the Company’s board members. Revenue with AHMC and HSMSO consists of capitation, risk pool, and miscellaneous fees and expenses consisting of claims expenses, management fees, and consulting fees.

The following tables set forth revenue recognized and fees incurred related to AHMC, HSMSO, and Aurion for the three and nine months ended September 30, 2024 and 2023 (in thousands):

	Three Months Ended September 30, 2024							Three Months Ended September 30, 2023
	AHMC		HSMSO		Aurion			AHMC			HSMSO			Aurion
Revenue	$	11,167	$	626	$	—		$	5,619		$	326		$	—
Expenses		9,169		—		50			6,445			(200	)		75
Net	$	1,998	$	626	$	(50	)	$	(826	)	$	526		$	(75	)

	Nine Months Ended September 30, 2024							Nine Months Ended September 30, 2023
	AHMC		HSMSO		Aurion			AHMC		HSMSO		Aurion
Revenue	$	33,944	$	1,239	$	—		$	37,337	$	950	$	—
Expenses		24,134		—		200			18,505		35		225
Net	$	9,810	$	1,239	$	(200	)	$	18,832	$	915	$	(225	)

The Company and AHMC have a risk-sharing agreement with certain AHMC hospitals to share the surplus and deficits of each of the hospital pools. Under this agreement, during the three months ended September 30, 2024 and 2023, the Company had recognized risk pool revenues of $9.4 million and $4.2 million, respectively. During the nine months ended September 30, 2024 and 2023, the Company had recognized risk pool revenues of $28.5 million and $33.0 million, respectively. The Company had a risk pool receivable balance of $74.7 million and $54.0 million as of September 30, 2024 and December 31, 2023, respectively.

APC Board Members

During the three months ended September 30, 2024 and 2023, the Company paid an aggregate of approximately $4.6 million and $11.6 million, respectively, to board members for provider services which included approximately $0.8 million and $0.7 million, respectively, to Astrana board members and officers who are also board members and officers of APC. During the nine months ended September 30, 2024 and 2023, the Company paid an aggregate of approximately $14.1 million and $30.5 million, respectively, to board members for provider services which included approximately $2.2 million and $2.3 million, respectively, to Astrana board members and officers who are also board members and officers of APC.

In addition, affiliates wholly owned by the Company’s key personnel are reported in the accompanying condensed consolidated statements of income on a consolidated basis, together with the Company’s subsidiaries, and therefore, the Company does not separately disclose transactions between such affiliates and the Company’s subsidiaries as related-party transactions.

Intercompany Transactions

Because of corporate practice of medicine laws, the Company uses designated shareholder professional corporations, of which the sole shareholder is a member of the Company’s key personnel, to engage in certain transactions and make intercompany loans from time to time.

For equity method investments, see Note 5 — “Investment in Other Entities - Equity Method”.