Related-Party Transactions

12 Months Ended

Dec. 31, 2024

Related Party Transactions [Abstract]

Related-Party Transactions

15.Related-Party Transactions

Equity Method Investments

During the years ended December 31, 2023, and 2022, the Company recognized approximately $16.7 million and $21.2 million, respectively, in management fee income, from 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 25% equity ownership interest held by APC (see Note 6—“Investments in Other Entities”).

During the years ended December 31, 2024, 2023, and 2022, the Company paid approximately $3.2 million, $2.7 million, and $2.7 million, respectively, to Pacific Medical Imaging and Oncology Center, Inc. (“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 40% equity ownership interest held by APC (see Note 6—“Investments in Other Entities”).

During the year ended December 31, 2024 and 2023, the Company paid approximately $1.0 million and $1.1 million, respectively, for provider services to an equity method investment in which the Company has a 25% equity ownership (see Note 6—“Investments in Other Entities”).

During the year ended December 31, 2024, the Company recognized approximately $2.2 million in management fees and interest expense to I Health. The Company has a management service agreement and promissory note payable with I Health. I Health is accounted for under the equity method based on the 25% equity ownership interest held (see Note 6—“Investments in Other Entities”).

During the year ended December 31, 2024, the Company recognized approximately $1.0 million in management fee income from equity method investments acquired through the CHS acquisition. The Company owns 50% - 51% equity interest in these investments. These investments are accounted for under equity method (see Note 6—“Investments in Other Entities”).

Astrana Board Members and Officers

During the years ended December 31, 2024, 2023, and 2022, the Company recognized approximately $1.9 million, $2.2 million, and $1.5 million, respectively, in revenue, net of costs, from Arroyo Vista Family Health Center (“Arroyo Vista”). 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. Arroyo Vista’s chief executive officer is a member of the Company’s board of directors.

During the years ended December 31, 2024, 2023, and 2022, the Company incurred rent expenses of approximately $4.0 million, $3.8 million, and $2.2 million, respectively, from certain properties that are managed by Allied Pacific Holdings Investment Management, LLC. As of December 31, 2024 and 2023, the Company’s operating right-of-use asset balance included $2.7 million and $14.1 million, respectively, and the Company’s operating lease liabilities included, $2.7 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 year ended December 31, 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 (see Note 20—“Segments”).

During the years ended December 31, 2024 and 2023, the Company incurred approximately $3.6 million and $1.3 million in expenses, respectively, payable to Third Way Health for call center and credentialing services. One of Astrana’s officers is a board member of Third Way Health. As of December 31, 2024 and 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 consolidated balance sheets.

During the year ended December 31, 2024, the Company incurred approximately $0.2 million in expenses, payable to The Stellar Health Group, Inc. for payment processing services. One of Astrana’s officers is a board member of The Stellar Health Group, Inc.

During the years ended December 31, 2024, 2023, and 2022, the Company paid approximately $0.5 million, $2.6 million, and $1.9 million, respectively, to Sunny Village Care Center for services as a provider. Sunny Village Care Center shares common ownership with certain Astrana board members and officers. The Company has provider contracts with Sunny Village Care Center.

During the years ended December 31, 2024 and 2023, Astrana paid approximately $0.9 million and $9.8 million, respectively, to purchase Astrana’s stock from certain board members. During the year ended December 31, 2022, APC paid approximately $9.3 million to purchase Astrana’s stock from a board member.

During the years ended December 31, 2024 and 2023, the Company incurred rent expenses of approximately $0.2 million and $0.1 million, respectively, from First Commonwealth Property, LLC for office leases. First Commonwealth Property, LLC shares common ownership with certain board members of Astrana. The Company has lease arrangements with First Commonwealth Property, LLC.

As of December 31, 2024 and 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 $0.7 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 and is also the sole owner of Aurion. Revenue with AHMC and HSMSO consists of capitation, risk pool, and other revenues and expenses consisting of claims expenses, management fees, and consulting fees.

The following table sets forth revenue recognized and fees incurred related to AHMC, HSMSO, and Aurion (in thousands):

	Year Ended December 31, 2024							Year Ended December 31, 2023							Year Ended December 31, 2022
	AHMC		HSMSO		AURION			AHMC		HSMSO		AURION			AHMC		HSMSO			AURION
Revenue	$	41,289	$	1,648	$	—		$	49,634	$	1,242	$	—		$	56,397	$	1,089		$	—
Expenses		34,914		—		275			20,000		822		300			21,810		1,554			300
Net	$	6,375	$	1,648	$	(275	)	$	29,634	$	420	$	(300	)	$	34,587	$	(465	)	$	(300	)

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 years ended December 31, 2024, 2023, and 2022, the Company had recognized risk pool revenue of $34.1 million, $43.8 million, and $50.5 million, respectively, of which $47.7 million and $54.0 million, remained outstanding as of December 31, 2024 and 2023, respectively.

APC Board Members

During the years ended December 31, 2024, 2023, and 2022, the Company paid an aggregate of approximately $19.5 million, $23.1 million, and $34.5 million, respectively, to board members for provider services which included approximately $3.1 million, $4.2 million, and $3.7 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 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 and promissory note payable with related parties, see Note 6 — “Investments in Other Entities” and Note 10 — “Credit Facility, Bank Loans, and Lines of Credit,” respectively.