Income Taxes (Tables)

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Schedule of Provision for Income Taxes

Provision for income taxes consisted of the following:

	Years ended December 31,
	2019			2018			2017
Current
Federal	$	9,034,736		$	21,058,703		$	19,219,251
State	5,924,933			9,646,172			5,336,885
	14,959,669			30,704,875			24,556,136
Deferred
Federal	(3,508,348		)	(5,954,666		)	(18,718,113		)
State	(3,284,689		)	(2,390,569		)	(1,951,238		)
	(6,793,037		)	(8,345,235		)	(20,669,351		)
Total provision for income taxes	$	8,166,632		$	22,359,640		$	3,886,785

Schedule of Components of Deferred Tax Assets (Liabilities)

Significant components of the Company's deferred tax assets (liabilities) as of December 31, 2019 and December 31, 2018 are shown below. During the year ended December 31, 2019, the Company recorded a non-cash reclassification $0.9 million of deferred tax liabilities to income tax payable related to utilization of NOLs. A valuation allowance of $8.2 million and $3.4 million as of December 31, 2019 and December 31, 2018, respectively, has been established against the Company's deferred tax assets related to loss entities the Company cannot consolidate under the Federal consolidation rules, as realization of these assets is uncertain.

	2019			2018
Deferred tax assets (liabilities)
State taxes	$	1,110,659		$	1,886,010
Stock options	1,293,164			1,660,664
Accrued payroll and related cost	277,682			238,633
Accrued hospital pool deficit	188,075			168,413
Allowance for bad debts	544,028			1,124,917
Investment in other entities	2,977,431			884,922
Net operating loss carryforward	13,849,685			6,414,256
Lease liability	3,567,302			—
Property and equipment	(927,011		)	(1,286,087		)
Acquired intangible assets	(29,195,045		)	(24,084,892		)
Right-of-use assets	(3,544,315		)	—
Risk Pool Receivable	(1,623,049		)	(2,434,573		)
Other	1,403,446			(792,781		)
Net deferred tax liabilities before valuation allowance	(10,077,948		)	(16,220,518		)
Valuation allowance	(8,191,500		)	(3,395,417		)
Net deferred tax liabilities	$	(18,269,448	)	$	(19,615,935	)

	2019		2018
Tax valuation allowance
Beginning balance	$	3,395,417	$	3,224,517
Charged (credited) to tax expense	1,085,842		170,900
Charged to goodwill	3,710,241		—
Ending balance	8,191,500		3,395,417

Schedule of Effective Income Tax Rate Reconciliation for Provision for Income Taxes

The provision for income taxes differs from the amount computed by applying the federal income tax rate as follows for the years ended December 31:

	Years ended December 31,
	2019		2018		2017
Tax provision at U.S. Federal statutory rates	21.0	%	21.0	%	35.0	%
State income taxes net of federal benefit	8.1		6.7		4.4
Non-deductible permanent items	3.3		1.3		(9.7	)
Non-taxable entities	(2.7	)	(0.7	)	(1.9	)
Stock-based compensation	(1.5	)	(1.8	)	0.9
Change in valuation allowance	13.7		—		(2.9	)
Entity Conversion	(10.5	)	0.5		—
Change in rate	—		—		(19.4	)
Other	0.2		0.1		1.4
Effective income tax rate	31.6	%	27.1	%	7.8	%