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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
12 Months Ended
Dec. 31, 2019
Dec. 31, 2018
Dec. 31, 2017
Cash flows from operating activities      
Net income $ 17,673,317 $ 60,267,491 $ 45,824,328
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 18,753,270 19,303,179 19,075,353
Loss on disposal of property and equipment 0 41,784 0
Impairment of goodwill and intangible assets 1,994,000 3,798,866 2,431,791
Provision for doubtful accounts (1,363,363) 3,887,647 0
Share-based compensation 1,546,861 1,441,089 2,743,116
Gain on loan assumption (2,250,000) 0 0
Unrealized (gain) loss from investment in equity securities (9,119) 25,005 (86,005)
Gain on settlement of preexisting note receivable from ApolloMed 0 0 (921,938)
Gain from investments – fair value adjustments 0 0 (13,697,018)
Change in fair value of derivative instrument 0 0 44,886
Loss from equity method investments 6,900,859 8,125,285 1,112,541
Deferred tax (6,800,919) (8,345,235) (20,675,807)
Changes in operating assets and liabilities, net of acquisition amounts:      
Receivable, net 10,713,803 (263,191) 4,108,970
Receivable, net – related parties (1,435,306) (28,363,108) 6,593,783
Other receivable (15,079,346) 0 0
Prepaid expenses and other current assets (2,755,599) (2,813,564) 1,260,064
Right-of-use assets 2,479,862    
Other assets (572,213) 2,446 (220,925)
Accounts payable and accrued expenses (4,883,243) (22,669,230) (3,687,022)
Fiduciary accounts payable 488,483 0 0
Capitation incentives payable 0 (21,500,000) 1,878,355
Medical liabilities (2,391,459) 4,134,209 5,661,313
Income taxes payable (7,092,994) 8,423,366 388,138
Operating lease liabilities (2,243,511)    
Net cash provided by operating activities 13,673,383 25,496,039 51,833,923
Cash flows from investing activities      
Cash acquired from Merger 0 0 37,112,775
Cash received from consolidation of VIE 0 0 228,287
Purchases of marketable securities (115,402,452) (9,013) (5,283)
Proceeds from loan receivable 0 0 200,000
Advances on loans receivable (11,425,000) (7,500,000) (10,000,000)
Dividends received from equity method investments 240,000 607,411 1,240,000
Proceeds on sale of investments in a privately held entity 0 0 25,000
Payments for business acquisitions, net of cash acquired (49,402,514) 0 0
Purchases of investments in privately held entities (491,000) (405,000) 0
Purchases of investments – equity method (3,108,000) (16,706,152) 0
Purchases of property and equipment (1,041,670) (1,170,064) (2,084,770)
Net cash (used in) provided by investing activities (180,630,636) (25,182,818) 26,716,009
Cash flows from financing activities      
Dividends paid (61,717,367) (17,758,808) (10,447,923)
Change in noncontrolling interest capital 27,500 27,300 0
Borrowings on long-term debt 250,000,000 8,000,000 5,000,000
Borrowings on line of credit 39,600,000 0 0
Advances by NMM to ApolloMed prior to the Merger 0 0 (9,000,000)
Repayments on long-term debt (2,375,000) 0 0
Repayments on bank loan, and lines of credit (52,640,258) (495,134) 0
Payment of capital lease obligations (101,741) (98,735) (102,348)
Proceeds from exercise of stock options included in liabilities 0 0 425,025
Proceeds from exercise of stock options and warrants 3,123,709 3,996,677 164,797
Proceeds from common stock offering 754,998 200,000 2,160,736
Repurchase of common shares (7,569,685) (5,047,643) (3,175,836)
Cost of debt and equity issuances (5,771,444) 0 0
Net cash used in financing activities 163,330,712 (11,176,343) (14,975,549)
Net (decrease) increase in cash, cash equivalents and restricted cash (3,626,541) (10,863,122) 63,574,383
Cash, cash equivalents and restricted cash, beginning of year 107,636,973 118,500,095 54,925,712
Cash, cash equivalents and restricted cash, end of year 104,010,432 107,636,973 118,500,095
Supplemental disclosures of cash flow information      
Cash paid for income taxes 20,200,000 23,642,662 24,362,223
Cash paid for interest 4,257,536 462,336 51,043
Supplemental disclosures of non-cash investing and financing activities      
Cashless exercise of stock options 0 109 0
Deferred tax liability adjusted to goodwill 6,334,368 1,110,456 0
Reclassification of liability for equity shares 1,185,025 0 0
Purchase price adjustment for acceleration of vested stock options 0 868,000 0
Conversion of loan receivable to investment in Accountable Health Care, IPA 0 5,000,000 0
Reclassification of dividends related to share repurchase 0 4,216,202 0
Reclassification of APS noncontrolling interest to equity related to purchase of additional shares 0 2,832,180 0
Distribution of warrants to former NMM shareholders 0 0 5,294,000
Issuance of common stock upon conversion of debt and accrued interest 0 0 5,376,215
Reclassification of liability for unissued common shares payable to equity 0 0 1,237,650
Non-cash purchase consideration for acquisition 0 0 61,092,050
Reconciliation of cash, cash equivalents, and restricted cash      
Cash and cash equivalents 103,189,328 106,891,503 99,749,199
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows 104,010,432 107,636,973 118,500,095
Unvested stock compensation      
Supplemental disclosures of non-cash investing and financing activities      
Non-cash purchase consideration for acquisition 0 0 187,333
NMM      
Supplemental disclosures of non-cash investing and financing activities      
Non-cash purchase consideration for acquisition 0 0 5,129,000
Preferred stock      
Supplemental disclosures of non-cash investing and financing activities      
Non-cash purchase consideration for acquisition 0 0 19,118,000
Affiliated Entity | APC      
Supplemental disclosures of non-cash investing and financing activities      
APC stock issued in exchange for AMG $ 414,250 $ 0 $ 0