Related-Party Transactions

3 Months Ended

Mar. 31, 2025

Related Party Transactions [Abstract]

Related-Party Transactions

13.Related-Party Transactions

Equity Method Investments

During the three months ended March 31, 2025 and 2024, the Company paid approximately $0.7 million and $0.8 million, respectively, to Pacific Medical Imaging & 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 the 40% equity ownership interest held (see Note 5 — “Investments in Other Entities – Equity Method”).

During each of the three months ended March 31, 2025, the Company paid approximately $0.2 million and $0.2 million, respectively, for provider services to an equity method investment in which the Company has a 25% equity ownership. (see Note 5 — “Investments in Other Entities – Equity Method”).

During the three months ended March 31, 2025, the Company incurred expenses of approximately $0.7 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 5 — “Investments in Other Entities – Equity Method”).

During the three months ended March 31, 2025, the Company recognized approximately $0.9 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 the equity method (see Note 5 — “Investments in Other Entities – Equity Method”).

Astrana Board Members and Officers

During the three months ended March 31, 2025 and 2024, the Company recognized approximately $0.1 million in expenses and $0.5 million, in revenue, net of expenses, from Arroyo Vista Family Health Center (“Arroyo Vista”), respectively. 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 is a non-profit network of community health centers serving Greater Northeast Los Angeles. Arroyo Vista provides certain primary care services to enrollees of certain healthcare service plans, the providers of which have contracted with our affiliates.

During the three months ended March 31, 2025 and 2024, the Company incurred rent expenses of approximately $1.1 million and $0.9 million, respectively, from certain properties that are managed by Allied Pacific Holdings Investment Management, LLC. As of March 31, 2025, and December 31, 2024, the Company’s operating right-of-use asset balance included $7.3 million and $2.7 million, respectively, and the Company’s operating lease liabilities included $7.5 million and $2.7 million, respectively, for certain properties that are managed by Allied Pacific Holdings Investment Management, LLC. The chief executive officer of Allied Pacific Holdings Investment Management, LLC is a member of the Company’s board of directors.

The Company has a Simple Agreement for Future Equity ("SAFE") with Third Way Health (see Note 5 — “Investments in Other Entities"). As of March 31, 2025 and December 31, 2024 the investment was $6.0 million. During the three months ended March 31, 2025 and 2024, the Company incurred approximately $2.2 million and $0.6 million, respectively, in expenses payable to Third Way Health for call center and credentialing services. One of Astrana’s officers is a board member of Third Way Health.

During the three months ended March 31, 2025 and 2024, the Company paid approximately $0.2 million and $45,000, respectively, to Sunny Village Care Center for services as a provider. 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 months ended March 31, 2025 and 2024, the Company incurred rent expense of approximately $42,000 and $38,000, respectively, to First Commonwealth Property, LLC for an office lease. First Commonwealth Property, LLC shares common ownership with certain board members of APC and AHM. As of March 31, 2025 and December 31, 2024, the Company’s operating right-of-use asset balance included $0.7 million and $0.7 million, respectively, and the Company’s operating lease liabilities included $0.7 million and $0.7 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 the sole owner of Aurion. 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 months ended March 31, 2025 and 2024 (in thousands):

	Three Months Ended March 31, 2025								Three Months Ended March 31, 2024
	AHMC			HSMSO		Aurion			AHMC		HSMSO		Aurion
Revenue	$	6,771		$	105	$	—		$	9,920	$	301	$	—
Expenses		31,680			—		100			7,557		—		50
Net	$	(24,909	)	$	105	$	(100	)	$	2,363	$	301	$	(50	)

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 March 31, 2025 and 2024, the Company had recognized risk pool revenues of $5.0 million and $8.1 million, respectively. As of March 31, 2025 and December 31, 2024, $53.9 million and $47.7 million remained in outstanding risk pool receivables, respectively.

APC Board Members

During the three months ended March 31, 2025 and 2024, the Company paid an aggregate of approximately $6.5 million and $4.7 million, respectively, to board members for provider services and repurchase of APC shares of common stock, which included approximately $1.0 million and $0.8 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 and promissory note payable with related parties, see Note 5 — “Investments in Other Entities — Equity Method” and Note 9 — “Credit Facility, Bank Loans, and Lines of Credit,” respectively.