10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 10-Q

ý QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended March 31, 2020

¨ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from  ___ to ___.

Commission File No. 001-37392

Apollo Medical Holdings, Inc.

(Exact name of registrant as specified in its charter)

Delaware (State or other jurisdiction of incorporation or organization) 95-4472349 (IRS Employer Identification No.)

1668 S. Garfield Avenue, 2^nd Floor, Alhambra, California 91801

(Address of principal executive offices and zip code)

(626) 282-0288

(Registrant’s telephone number, including area code) 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days:   ý   Yes     ¨    No

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).   ý   Yes     ¨    No

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer ¨	Accelerated filer x
Non-accelerated filer ¨	Smaller reporting company ¨
	Emerging growth company ¨

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ¨

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act):  ¨    Yes     ý    No

Securities registered pursuant to Section 12(b) of the Act:

Title of Each Class	Trading Symbol	Name of Each Exchange on Which Registered
Common Stock, $0.001 par value per share	AMEH	Nasdaq Capital Market

As of May 26, 2020, there were 53,077,073 shares of common stock of the registrant, $0.001 par value per share, issued and outstanding.

APOLLO MEDICAL HOLDINGS, INC.

INDEX TO FORM 10-Q FILING

TABLE OF CONTENTS

		PAGE
	Introductory Note	4
	Note About Forward-Looking Statements	4
	PART I FINANCIAL INFORMATION
Item 1.	Consolidated Financial Statements – Unaudited	4
	Consolidated Balance Sheets as of March 31, 2020 and December 31, 2019	5
	Consolidated Statements of Income for the Three Months Ended March 31, 2020 and 2019	7
	Consolidated Statements of Mezzanine and Stockholders' Equity for the Three Months Ended March 31, 2020 and 2019	8
	Consolidated Statements of Cash Flows for the Three Months Ended March 31, 2020 and 2019	9
	Notes to Consolidated Financial Statements	11
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	46
Item 3.	Quantitative and Qualitative Disclosures about Market Risk	58
Item 4.	Controls and Procedures	58
	PART II OTHER INFORMATION
Item 1.	Legal Proceedings	60
Item 1A.	Risk Factors	60
Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	61
Item 3.	Defaults Upon Senior Securities	61
Item 4.	Mine Safety Disclosures	61
Item 5.	Other Information	61
Item 6.	Exhibits	62

2

Glossary

The following abbreviations or acronyms that may be used in this document shall have the adjacent meanings set forth below:

Accountable Health Care	Accountable Health Care IPA, a Professional Medical Corporation
AHMC	AHMC Healthcare Inc.
AIPBP	All-Inclusive Population-Based Payments
Alpha Care	Alpha Care Medical Group, Inc.
AMG	AMG, a Professional Medical Corporation
AMH	ApolloMed Hospitalists
AMM	Apollo Medical Management, Inc.
AP-AMH	AP-AMH Medical Corporation
APAACO	APA ACO, Inc.
APC	Allied Pacific of California IPA
Apollo Care Connect	Apollo Care Connect, Inc.
BAHA	Bay Area Hospitalist Associates
CDSC	Concourse Diagnostic Surgery Center, LLC
CQMC	Critical Quality Management Corporation
CSI	College Street Investment LP, a California limited partnership
DMHC	California Department of Managed Healthcare
DMG	Diagnostic Medical Group
HSMSO	Health Source MSO Inc., a California corporation
ICC	AHMC International Cancer Center, a Medical Corporation
IPA	independent practice association
LMA	LaSalle Medical Associates
MMG	Maverick Medical Group, Inc.
MPP	Medical Property Partners
NGACO	Next Generation Accountable Care Organization
NMM	Network Medical Management, Inc.
PASC	Pacific Ambulatory Health Care, LLC
PMIOC	Pacific Medical Imaging and Oncology Center, Inc.
SCHC	Southern California Heart Centers
UCAP	Universal Care Acquisition Partners, LLC
UCI	Universal Care, Inc.
VIE	variable interest entity

3

INTRODUCTORY NOTE

Unless the context dictates otherwise, references in this Quarterly Report on Form 10-Q to the “Company,” “we,” “us,” “our,” and similar words are references to Apollo Medical Holdings, Inc., a Delaware corporation, and its consolidated subsidiaries and affiliated entities, as appropriate, including its consolidated variable interest entities (“VIEs”) and "ApolloMed" refers to Apollo Medical Holdings, Inc.

The Centers for Medicare & Medicaid Services (“CMS”) have not reviewed any statements contained in this Quarterly Report on Form 10-Q describing the participation of APA ACO, Inc. (“APAACO”) in the Next Generation Accountable Care Organization (“NGACO”) Model.

Trade names and trademarks of the Company and its subsidiaries referred to herein and their respective logos, are our property. This Quarterly Report on Form 10-Q may contain additional trade names and/or trademarks of other companies, which are the property of their respective owners. We do not intend our use or display of other companies’ trade names and/or trademarks, if any, to imply an endorsement or sponsorship of us by such companies, or any relationship with any of these companies.

NOTE ABOUT FORWARD-LOOKING STATEMENTS

This Quarterly Report on Form 10-Q contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933, as amended (the “Securities Act”), and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). All statements other than statements of historical fact are “forward-looking statements” for purposes of federal and state securities laws, including, but not limited to, statements about the Company's guidance for the year ending December 31, 2020, any statements about our business (including the impact of the COVID-19 pandemic on our business), financial condition, operating results, plans, objectives, expectations and intentions, any guidance on, or projections of, earnings, revenue or other financial items, such as our projected capitation from CMS, for the year ending December 31, 2020 or otherwise, and our future liquidity, including cash flows and any payments under the $545.0 million loan we made to our VIE, AP-AMH; any statements of any plans, strategies and objectives of management for future operations such as the material opportunities that we believe exist for our Company; any statements concerning proposed services, developments, mergers or acquisitions; any statements regarding the outlook on our NGACO Model or strategic transactions; any statements regarding management’s view of future expectations and prospects for us; any statements about prospective adoption of new accounting standards or effects of changes in accounting standards; any statements regarding future economic conditions or performance; any statements of belief; any statements of assumptions underlying any of the foregoing; and other statements that are not historical facts. Forward-looking statements may be identified by the use of forward-looking terms such as “anticipate,” “could,” “can,” “may,” “might,” “potential,” “predict,” “should,” “estimate,” “expect,” “project,” “believe,” “think,” “plan,” “envision,” “intend,” “continue,” “target,” “seek,” “contemplate,” “budgeted,” “will,” “would,” and the negative of such terms, other variations on such terms or other similar or comparable words, phrases or terminology. These forward-looking statements present our estimates and assumptions only as of the date of this Quarterly Report on Form 10-Q and are subject to change.

Forward-looking statements involve risks and uncertainties and are based on the current beliefs, expectations and certain assumptions of management. Some or all of such beliefs, expectations and assumptions may not materialize or may vary significantly from actual results. Such statements are qualified by important economic, competitive, governmental and technological factors that could cause our business, strategy, or actual results or events to differ materially from those in our forward-looking statements. Factors that might cause or contribute to such differences include, but are not limited to, those discussed in our Annual Report on Form 10-K, for the year ended December 31, 2019 filed with the SEC on March 16, 2020, including, the risk factors discussed under the heading “Risk Factors” in Part I, Item IA thereof. Although we believe that the expectations reflected in our forward-looking statements are reasonable, actual results could differ materially from those projected or assumed in any of our forward-looking statements. Our future financial condition and results of operations, as well as any forward-looking statements, are subject to change. Significant risks and uncertainties could cause actual conditions, outcomes and results to differ materially from those indicated by such statements.

PART I FINANCIAL INFORMATION

ITEM 1. CONSOLIDATED FINANCIAL STATEMENTS

4

APOLLO MEDICAL HOLDINGS, INC.

CONSOLIDATED BALANCE SHEETS

(IN THOUSANDS, EXCEPT SHARE AND PER SHARE DATA)

(UNAUDITED)

	March 31, 2020		December 31, 2019
Assets
Current assets
Cash and cash equivalents	$	80,892	$	103,189
Restricted cash	75		75
Investment in marketable securities	117,075		116,539
Receivables, net	18,012		11,004
Receivables, net – related parties	50,911		48,136
Other receivables	16,362		16,885
Prepaid expenses and other current assets	11,811		10,315
Loans receivable	6,425		6,425
Loans receivable – related parties	16,500		16,500
Total current assets	318,063		329,068
Noncurrent assets
Land, property and equipment, net	11,876		12,130
Intangible assets, net	98,840		103,012
Goodwill	238,539		238,505
Investment in other entities – equity method	30,781		28,427
Investments in privately held entities	896		896
Restricted cash	746		746
Operating lease right-of-use assets	18,199		14,248
Other assets	6,475		1,681
Total noncurrent assets	406,352		399,645
Total assets	$	724,415	$	728,713
Liabilities, mezzanine equity and stockholders’ equity
Current liabilities
Accounts payable and accrued expenses	$	20,106	$	27,279
Fiduciary accounts payable	1,709		2,027
Medical liabilities	63,698		58,725
Income taxes payable	8,034		4,529
Dividend payable	337		271
Finance lease liabilities	102		102
Operating lease liabilities	3,119		2,990
Current portion of long-term debt	9,500		9,500
Total current liabilities	106,605		105,423

5

APOLLO MEDICAL HOLDINGS, INC.

CONSOLIDATED BALANCE SHEETS

(IN THOUSANDS, EXCEPT SHARE AND PER SHARE DATA)

(UNAUDITED)

	March 31, 2020		December 31, 2019
Noncurrent liabilities
Deferred tax liability	16,332		18,269
Finance lease liabilities, net of current portion	390		416
Operating lease liabilities, net of current portion	15,583		11,373
Long-term debt, net of current portion and deferred financing costs	230,105		232,172
Total noncurrent liabilities	262,410		262,230
Total liabilities	369,015		367,653
Commitments and contingencies (Note 11)
Mezzanine equity
Noncontrolling interest in Allied Physicians of California, a Professional Medical Corporation	157,439		168,725
Stockholders’ equity
Series A Preferred stock, $0.001 par value per share; 5,000,000 shares authorized (inclusive of all preferred stock, including Series B Preferred stock); 1,111,111 issued and zero outstanding	—		—
Series B Preferred stock, $0.001 par value per share; 5,000,000 shares authorized (inclusive of all preferred stock, including Series A Preferred stock); 555,555 issued and zero outstanding	—		—
Common stock, $0.001 par value per share; 100,000,000 shares authorized, 36,042,761 and 35,908,057 shares outstanding, excluding 17,475,707 and 17,458,810 treasury shares, at March 31, 2020, and December 31, 2019, respectively	36		36
Additional paid-in capital	161,087		159,608
Retained earnings	35,957		31,905
	197,080		191,549
Noncontrolling interest	881		786
Total stockholders’ equity	197,961		192,335
Total liabilities, mezzanine equity and stockholders’ equity	$	724,415	$	728,713

The accompanying notes are an integral part of these unaudited consolidated financial statements.

6

APOLLO MEDICAL HOLDINGS, INC.

CONSOLIDATED STATEMENTS OF INCOME

(IN THOUSANDS, EXCEPT SHARE AND PER SHARE DATA)

(UNAUDITED)

	Three Months Ended March 31,
	2020			2019
Revenue
Capitation, net	$	140,421		$	71,517
Risk pool settlements and incentives	11,236			10,094
Management fee income	8,815			8,997
Fee-for-service, net	3,427			4,081
Other income	1,206			1,069
Total revenue	165,105			95,758
Operating expenses
Cost of services	144,204			83,432
General and administrative expenses	11,834			10,264
Depreciation and amortization	4,702			4,418
Provision for doubtful accounts	—			951
Total expenses	160,740			99,065
Income (loss) from operations	4,365			(3,307		)
Other income (expense)
Income (loss) from equity method investments	2,054			(850		)
Interest expense	(2,868		)	(211		)
Interest income	929			323
Other income	102			187
Total other income (expense), net	217			(551		)
Income (loss) before provision for (benefit from) income taxes	4,582			(3,858		)
Provision for (benefit from) income taxes	1,595			(1,408		)
Net income (loss)	2,987			(2,450		)
Net loss attributable to noncontrolling interests	(1,065		)	(2,590		)
Net income attributable to Apollo Medical Holdings, Inc.	$	4,052		$	140
Earnings per share – basic	$	0.11		$	—
Earnings per share – diluted	$	0.11		$	—
Weighted average shares of common stock outstanding – basic	36,010,268			34,496,622
Weighted average shares of common stock outstanding – diluted	37,439,099			38,074,174

The accompanying notes are an integral part of these unaudited consolidated financial statements.

7

APOLLO MEDICAL HOLDINGS, INC.

CONSOLIDATED STATEMENTS OF MEZZANINE AND STOCKHOLDERS’ EQUITY

(DOLLARS IN THOUSANDS)

(UNAUDITED)

	Mezzanine Equity – Noncontrolling Interest in APC										Retained Earnings
				Common Stock Outstanding				Additional Paid-in Capital					Noncontrolling Interest		Shareholders' Equity
				Shares		Amount
Balance January 1, 2020	$	168,725		35,908,057		$	36	$	159,608		$	31,905	$	786	$	192,335
Net (loss) income	(1,161		)	—		—		—			4,052		95		4,147
Purchase of treasury shares	—			(16,897	)	—		(301		)	—		—		(301		)
Purchase of noncontrolling interest	(125		)	—		—		—			—		—		—
Shares issued for exercise of options and warrants	—			151,601		—		722			—		—		722
Share-based compensation	—			—		—		1,058			—		—		1,058
Dividends	(10,000		)	—		—		—			—		—		—
Balance at March 31, 2020	$	157,439		36,042,761		$	36	$	161,087		$	35,957	$	881	$	197,961

	Mezzanine Equity – Noncontrolling Interest in APC									Retained Earnings
				Common Stock Outstanding				Additional Paid-in Capital				Noncontrolling Interest		Shareholders' Equity
				Shares		Amount
Balance January 1, 2019	$	225,117		34,578,040		$	35	$	162,723	$	17,788	$	998	$	181,544
Net (loss) income	(3,000		)	—		—		—		140		410		550
Purchase of treasury shares	(40		)	(93,451	)	—		—		—		—		—
Shares issued for exercise of options and warrants	155			17,516		—		140		—		—		140
Share-based compensation	202			1,599		—		143		—		—		143
Dividends	(10,000		)	—		—		—		—		—		—
Balance at March 31, 2019	$	212,434		34,503,704		$	35	$	163,006	$	17,928	$	1,408	$	182,377

The accompanying notes are an integral part of these unaudited consolidated financial statements.

8

APOLLO MEDICAL HOLDINGS, INC.

CONSOLIDATED STATEMENTS OF CASH FLOWS

(IN THOUSANDS)

(UNAUDITED)

	Three Months Ended March 31,
	2020			2019
Cash flows from operating activities
Net income (loss)	$	2,987		$	(2,450	)
Adjustments to reconcile net income (loss) to net cash used in operating activities:
Depreciation and amortization	5,010			4,418
Provision for doubtful accounts	—			951
Share-based compensation	1,058			345
Unrealized gain from investment in equity securities	(162		)	(8		)
(Income) loss from equity method investments	(2,054		)	850
Deferred tax	(1,915		)	(2,623		)
Changes in operating assets and liabilities, net of business combinations:
Receivable, net	(7,043		)	487
Receivable, net – related parties	(2,774		)	(7,511		)
Other receivables	521			(11,245		)
Prepaid expenses and other current assets	(1,495		)	(729		)
Right-of-use assets	794			448
Other assets	(4,801		)	(443		)
Accounts payable and accrued expenses	(7,173		)	22,579
Fiduciary accounts payable	(318		)	546
Medical liabilities	4,973			(10,376		)
Income taxes payable	3,505			1,210
Operating lease liabilities	(406		)	(416		)
Net cash used in operating activities	(9,293		)	(3,967		)
Cash flows from investing activities
Purchases of marketable securities	(374		)	(8		)
Purchases of investment – equity method	(300		)	—
Purchases of property and equipment	(269		)	(104		)
Net cash used in investing activities	(943		)	(112		)
Cash flows from financing activities
Repayment of bank loan and lines of credit	—			(40		)
Dividends paid	(9,934		)	(10,000		)
Repayment of term loan	(2,375		)	—
Payment of finance lease obligations	(26		)	(25		)
Proceeds from the exercise of stock options and warrants	700			140
Repurchase of shares	(426		)	(40		)
Proceeds from common stock offering	—			155
Net cash used in financing activities	(12,061		)	(9,810		)
Net decrease in cash, cash equivalents and restricted cash	(22,297		)	(13,889		)

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Cash, cash equivalents and restricted cash, beginning of period	104,010		107,637
Cash, cash equivalents and restricted cash, end of period	$	81,713	$	93,748
Supplementary disclosures of cash flow information:
Cash paid for interest	$	2,619	$	182
Supplemental disclosures of non-cash investing and financing activities
Dividend declared included in dividend payable	$	66	$	—

The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the consolidated balance sheets that sum to the total amounts of cash, cash equivalents and restricted cash shown in the consolidated statements of cash flows (in thousands).

	March 31,
	2020		2019
Cash and cash equivalents	$	80,892	$	93,008
Restricted cash – current	75		—
Restricted cash – non-current	746		740
Total cash, cash equivalents and restricted cash shown in the statement of cash flows	$	81,713	$	93,748

The accompanying notes are an integral part of these unaudited consolidated financial statements.

10

APOLLO MEDICAL HOLDINGS, INC.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

(UNAUDITED)

1. Description of Business

Overview

Apollo Medical Holdings, Inc. (“ApolloMed”), together with its affiliated physician groups and consolidated entities (collectively, the “Company”) is a physician-centric integrated population health management company working to provide coordinated, outcome-based medical care in a cost-effective manner to patients in California, the majority of whom are covered by private or public insurance such as Medicare, Medicaid and health maintenance organization (“HMO”) plans, with a portion of the Company’s revenue coming from non-insured patients. The Company provides care coordination services to each major constituent of the healthcare delivery system, including patients, families, primary care physicians, specialists, acute care hospitals, alternative sites of inpatient care, physician groups and health plans. The Company’s physician network consists of primary care physicians, specialist physicians, and hospitalists. The Company operates primarily through the following subsidiaries of ApolloMed: Network Medical Management, Inc. (“NMM”), Apollo Medical Management, Inc. (“AMM”), APAACO, Apollo Care Connect, Inc. (“Apollo Care Connect”), and their consolidated entities.

NMM was formed in 1994 as a management service organization (“MSO”) for the purposes of providing management services to medical companies and independent practice associations (“IPAs”). The management services primarily include billing, collection, accounting, administration, quality assurance, marketing, compliance, and education. Following a business combination, NMM became a wholly-owned subsidiary of ApolloMed in December 2017.

Allied Physicians of California IPA, a Professional Medical Corporation d.b.a. Allied Pacific of California IPA (“APC”) was incorporated in 1992, for the purpose of arranging healthcare services as an IPA. APC has contracts with various HMOs and other licensed healthcare service plans as defined in the California Knox-Keene Health Care Service Plan Act of 1975. Each HMO negotiates a fixed amount per member per month (“PMPM”) that is to be paid to APC. In return, APC arranges for the delivery of healthcare services by contracting with physicians or professional medical corporations for primary care and specialty care services. APC assumes the financial risk of the cost of delivering healthcare services in excess of the fixed amounts received. Some of the risk is transferred to the contracted physicians or professional corporations. The risk is also minimized by stop-loss provisions in contracts with HMOs.

In July 1999, APC entered into an amended and restated management and administrative services agreement with NMM (the initial management services agreement was entered into in 1997) for an initial fixed term of 30 years. In accordance with relevant accounting guidance, APC is determined to be a VIE of the Company as NMM is the primary beneficiary with the ability to direct the activities (excluding clinical decisions) that most significantly affect APC’s economic performance through its majority representation on the APC Joint Planning Board; therefore APC is consolidated by NMM.

AP-AMH Medical Corporation (“AP-AMH”) was formed in May 2019, as a designated shareholder professional corporation. Dr. Thomas Lam, a shareholder, and the Chief Executive Officer and Chief Financial Officer of APC and Co-Chief Executive Officer of ApolloMed, is the sole shareholder of AP-AMH. ApolloMed makes all the decisions on behalf of AP-AMH and funds and receives all the distributions from its operations. ApolloMed has the rights to receive benefits from the operations of AP-AMH and has the option, but not the obligation, to cover losses. Therefore, AP-AMH is controlled and consolidated by ApolloMed as the primary beneficiary of this VIE.

In September 2019, ApolloMed completed the following series of transactions with its affiliates, AP-AMH and APC;

1. ApolloMed loaned AP-AMH $545.0 million pursuant to a ten-year secured loan agreement (the "AP-AMH Loan"). The loan bears interest at a rate of 10% per annum simple interest, is not prepayable (except in certain limited circumstances), requires quarterly payments of interest only in arrears, and is secured by a first priority security interest in all of AP-AMH's assets, including the shares of APC Series A Preferred Stock to be purchased by AP-AMH. To the extent that AP-AMH is unable to make any interest payment when due because it has received dividends on the APC Series A Preferred Stock insufficient to pay in full such interest payment, then the outstanding principal amount of the loan will be increased by the amount of any such accrued but unpaid interest, and any such increased principal amounts will bear interest at the rate of 10.75% per annum simple interest.

2. AP-AMH purchased 1,000,000 shares of APC Series A Preferred Stock for aggregate consideration of $545.0 million in a private placement. Under the terms of the APC Certificate of Determination of Preferences of Series A Preferred Stock (the "Certificate of Determination"), AP-AMH is entitled to receive preferential, cumulative dividends that accrue on a

11

daily basis and that are equal to the sum of (i) APC's net income from Healthcare Services (as defined in the Certificate of Determination), plus (ii) any dividends received by APC from certain of APC's affiliated entities, less (iii) any Retained Amounts (as defined in the Certificate of Determination).

3. APC purchased 15,015,015 shares of ApolloMed's common stock for total consideration of $300.0 million in private placement. In connection therewith, ApolloMed granted APC certain registration rights with respect to ApolloMed's common stock that APC purchased, and APC agreed that APC votes in excess of 9.99% of ApolloMed's then outstanding shares will be voted by proxy given to the ApolloMed's management, and that those proxy holders will cast the excess votes in the same proportion as all other votes cast on any specific proposal coming before the ApolloMed's stockholders.

4. ApolloMed licensed to AP-AMH the right to use certain tradenames for certain specified purposes for a fee equal to a percentage of the aggregate gross revenues of AP-AMH. The license fee is payable out of any Series A Preferred Stock dividends received by AP-AMH from APC.

5. Through its subsidiary, NMM, the Company agreed to provide certain administrative services to AP-AMH for a fee equal to a percentage of the aggregate gross revenues of AP-AMH. The administrative fee also is payable out of any APC Series A Preferred Stock dividends received by AP-AMH from APC.

APC's ownership in ApolloMed was 32.44% at March 31, 2020 and 32.50% at December 31, 2019.

Concourse Diagnostic Surgery Center, LLC (“CDSC”) was formed in March 2010, in the state of California. CDSC is an ambulatory surgery center in City of Industry, California, is organized by a group of highly qualified physicians, and the surgical center utilizes some of the most advanced equipment in the eastern part of Los Angeles County and the San Gabriel Valley. The facility is Medicare certified and accredited by the Accreditation Association for Ambulatory Healthcare, Inc. As of March 31, 2020, APC's owned 45.01% of CDSC's capital stock. CDSC is determined to be a VIE and APC is determined to be the primary beneficiary. APC has the ability to direct the activities that most significantly affect CDSC's economic performance and receives the most economic benefits; therefore CDSC is consolidated by APC.

APC-LSMA Designated Shareholder Medical Corporation ("APC-LSMA") was formed in October 2012, as a designated shareholder professional corporation. Dr. Thomas Lam, a shareholder and the Chief Executive Officer and Chief Financial Officer of APC and Co-Chief Executive Officer of ApolloMed, is a nominee shareholder of APC. APC makes all investment decisions on behalf of APC-LSMA, funds all investments and receives all distributions from the investments. APC has the obligation to absorb losses and right to receive benefits from all investments made by APC-LSMA. APC-LSMA’s sole function is to act as the nominee shareholder for APC in other California medical professional corporations. Therefore, APC-LSMA is controlled and consolidated by APC as the primary beneficiary of this VIE. The only activity of APC-LSMA is to hold the investments in medical corporations, including the IPA lines of business of LaSalle Medical Associates (“LMA”), Pacific Medical Imaging and Oncology Center, Inc. (“PMIOC”), Diagnostic Medical Group (“DMG”) and AHMC International Cancer Center, a Medical Corporation (“ICC”). APC-LSMA also holds a 100% ownership interest in Maverick Medical Group, Inc. (“MMG”), Alpha Care Medical Group, Inc. (“Alpha Care”), Accountable Health Care IPA, a Professional Medical Corporation (“Accountable Health Care”), and AMG, a Professional Medical Corporation ("AMG").

Alpha Care, an IPA acquired by the Company in May 2019, has been operating in California since 1993 as a risk bearing organization engaged in providing professional services under capitation arrangements with its contracted health plans through a provider network consisting of primary care and specialty care physicians. Alpha Care specializes in delivering high-quality healthcare to over 170,000 enrollees, as of March 31, 2020, and focuses on Medi-Cal/Medicaid, Commercial and Medicare and Dual Eligible members in the Riverside and San Bernardino counties of Southern California.

Accountable Health Care is a California-based IPA that has served the local community in the greater Los Angeles County area through a network of physicians and health care providers for more than 20 years. Accountable Health Care currently has a network of over 300 primary care physicians and 700 specialty care physicians, and four community and regional hospital medical centers that provide quality health care services to more than 80,000 members of three federally qualified health plans and multiple product lines, including Medi-Cal, Commercial, Medicare and the California Healthy Families program. In August 2019, APC and APC-LSMA acquired the remaining outstanding shares of Accountable Health Care's capital stock which they did not already own (comprising 75%) for $7.3 million in cash (see Note 3).

AMG is a network of family practice clinics operating out of three main locations in Southern California. AMG provides professional and post-acute care services to Medicare, Medi-Cal/Medicaid, and Commercial patients through its network of doctors and nurse practitioners. In September 2019, APC-LSMA purchased 100% of the shares of capital stock of AMG for $1.2 million in cash and $0.4 million of APC common stock (see Note 3).

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Universal Care Acquisition Partners, LLC (“UCAP”), a 100% owned subsidiary of APC, was formed in June 2014, for the purpose of holding an investment in Universal Care, Inc. (“UCI”). On April 30, 2020, UCAP completed its disposition of its 48.9% ownership interest in UCI to Bright Health Company of California, Inc. ("Bright") for approximately $69.2 million in cash proceeds (including $16.5 million as repayment of indebtedness owed to APC), plus non-cash consideration consisting of shares of Bright Health, Inc.'s, a Delaware corporation (solely for purposes of section 13.22 thereto) ("Bright Health, Inc.") preferred stock having a stipulated value of approximately $33.3 million. In addition, pursuant to the terms of the stock purchase agreement (the "SPA"), upon release from escrow, APC is entitled to receive all or that portion of the following escrowed amounts that have not been offset or reserved for claims: (i) cash consideration of approximately $15.6 million, plus (ii) non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $5.9 million (see Note 17). As set forth in the Company’s definitive proxy statement filed with the SEC on July 31, 2019 (the “Proxy Statement”), the 48.9% interest in UCI is an “Excluded Asset” that remains solely for the benefit of APC and its shareholders. As such, any proceeds or gain on the sale of APC’s indirect ownership interest in Universal will have no impact on the Series A Dividend payable by APC to AP-AMH Medical Corporation as described in the Proxy Statement and consequently the sale will not affect net income attributable to the Company.

APAACO, jointly owned by NMM and AMM, began participating in the Next Generation Accountable Care Organization Model (“NGACO Model”) of the Centers for Medicare & Medicaid Services ("CMS") in January 2017. The NGACO Model is a new CMS program that allows provider groups to assume higher levels of financial risk and potentially achieve a higher reward from participating in this new attribution-based risk sharing model.

AMM, a wholly-owned subsidiary of ApolloMed, manages affiliated medical groups, which consist of ApolloMed Hospitalists, a Medical Corporation (“AMH”) and Southern California Heart Centers, a Medical Corporation (“SCHC”). AMH provides hospitalist, intensivist, and physician advisory services. SCHC is a specialty clinic that focuses on cardiac care and diagnostic testing.

Apollo Care Connect, Inc., a wholly-owned subsidiary of ApolloMed, provides a cloud and mobile-based population health management platform that includes digital care plans, a case management module, connectivity with multiple healthcare tracking devices and the ability to integrate with multiple electronic health records to capture clinical data.

2. Basis of Presentation and Summary of Significant Accounting Policies

Basis of Presentation

The accompanying consolidated balance sheet at December 31, 2019, has been derived from the Company's audited consolidated financial statements, but does not include all disclosures required by generally accepted accounting principles in the United States of America (“U.S. GAAP”). The accompanying unaudited consolidated financial statements as of March 31, 2020 and for the three months ended March 31, 2020 and 2019, have been prepared in accordance with U.S. GAAP for interim financial information and with the instructions to Form 10-Q and Article 8 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by U.S. GAAP for complete financial statements, and should be read in conjunction with the audited consolidated financial statements and related notes to the financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 as filed with the SEC on March 16, 2020. In the opinion of management, all material adjustments (consisting of normal recurring adjustments) considered necessary for a fair presentation have been made to make the consolidated financial statements not misleading as required by Regulation S-X, Rule 10-01. Operating results for the three months ended March 31, 2020 are not necessarily indicative of the results that may be expected for the year ending December 31, 2020 or any future periods.

Principles of Consolidation

The consolidated balance sheets as of March 31, 2020 and December 31, 2019, and the consolidated statements of income for the three months ended March 31, 2020 and 2019,  include the accounts of ApolloMed, its consolidated subsidiaries NMM, AMM, APAACO, and Apollo Care Connect, including ApolloMed's consolidated VIE, AP-AMH, NMM’s subsidiaries, NMM’s consolidated VIE, APC, APC’s subsidiary, UCAP, and APC’s consolidated VIEs, CDSC, APC-LSMA, ICC, and APC-LSMA's consolidated subsidiaries Alpha Care and Accountable Health Care.

All material intercompany balances and transactions have been eliminated in consolidation.

Use of Estimates

The preparation of the consolidated financial statements and related disclosures in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent

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assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include collectability of receivables, recoverability of long-lived and intangible assets, business combination and goodwill valuation and impairment, accrual of medical liabilities (incurred, but not reported (“IBNR”) claims), determination of full-risk and shared-risk revenue and receivables (including constraints and completion factors, including historical medical loss ratios (“MLR”)), income taxes, valuation of share-based compensation and right-of-use ("ROU") assets and lease liabilities. Management evaluates its estimates and assumptions on an ongoing basis using historical experience and other factors, including the current economic environment, and makes adjustments when facts and circumstances dictate. As future events and their effects cannot be determined with precision, actual results could differ materially from those estimates and assumptions.

Reportable Segments

The Company operates as one reportable segment, the healthcare delivery segment, and implements and operates innovative health care models to create a patient-centered, physician-centric experience. The Company reports its consolidated financial statements in the aggregate, including all activities in one reportable segment.

Reclassifications

Certain amounts disclosed in prior period financial statements have been reclassified to conform to the current period presentation. These reclassifications had no material effect on the Company’s reported revenue, net income, cash flows or total assets.

Cash and Cash Equivalents

The Company’s cash and cash equivalents primarily consist of money market funds and certificates of deposit. The Company considers all highly liquid investments that are both readily convertible into known amounts of cash and mature within ninety days from their date of purchase to be cash equivalents.

The Company maintains its cash in deposit accounts with several banks, which at times may exceed the insured limits of the Federal Deposit Insurance Corporation (“FDIC”). The Company believes it is not exposed to any significant credit risk with respect to its cash, cash equivalents and restricted cash. As of March 31, 2020, the Company’s deposit accounts with banks exceeded the FDIC’s insured limit by approximately $209.3 million, including approximately $117.0 million in certificates of deposit that were recognized as investments in marketable securities. The Company has not experienced any losses to date and performs ongoing evaluations of these financial institutions to limit the Company’s concentration of risk exposure.

Restricted Cash

Restricted cash consists of cash held as collateral to secure standby letters of credits as required by certain contracts.

Investments in Marketable Securities

The appropriate classification of investments is determined at the time of purchase and such designation is reevaluated at each balance sheet date. As of March 31, 2020 and December 31, 2019, short-term marketable securities in the amount of approximately $117.1 million and $116.5 million, respectively, consist of equity securities and certificates of deposit with various financial institutions, reported at par value, plus accrued interest, with maturity dates from 4 months to 24 months (see fair value measurements of financial instruments below). Investments in certificates of deposits are classified as Level 1 investments in the fair value hierarchy.

Receivables and Receivables – Related Parties

The Company’s receivables are comprised of accounts receivable, capitation and claims receivable, risk pool settlements and incentive receivables, management fee income and other receivables. Accounts receivable are recorded and stated at the amount expected to be collected.

The Company’s receivables – related parties are comprised of risk pool settlements, management fee income and incentive receivables, and other receivables. Receivables – related parties are recorded and stated at the amount expected to be collected.

Capitation and claims receivable relate to each health plan’s capitation, is received by the Company in the month following the month of service. Risk pool settlements and incentive receivables mainly consist of the Company’s full risk pool receivable that is recorded quarterly based on reports received from the Company's hospital partners and management’s estimate of the Company’s portion of the estimated risk pool surplus for open performance years. Settlement of risk pool surplus or deficits occurs approximately 18 months after the risk pool performance year is completed. During the three months ended March 31, 2020,

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recoverable claims paid related to the 2019 APAACO performance year to be administered following instructions from CMS, fee-for-services (“FFS”) reimbursement for patient care, certain expense reimbursements, transportation reimbursements from the hospitals, and stop loss insurance premium reimbursements are included in “Other receivables” in the accompanying consolidated balance sheets.

The Company maintains reserves for potential credit losses on accounts receivable. Management reviews the composition of accounts receivable and analyzes historical bad debts, customer concentrations, customer credit worthiness, current economic trends and changes in customer payment patterns to evaluate the adequacy of these reserves. The Company also regularly analyzes the ultimate collectability of accounts receivable after certain stages of the collection cycle using a look-back analysis to determine the amount of receivables subsequently collected and adjustments are recorded when necessary. Reserves are recorded primarily on a specific identification basis.

Receivables are recorded when the Company is able to determine amounts receivable under these contracts and/or agreements based on information provided and collection is reasonably likely to occur. In regards to the credit loss standard, the Company continuously monitors its collections of receivables and our expectation is that the historical credit loss experienced across our receivable portfolio is materially similar to any current expected credit losses that would be estimated under the current expected credit losses (CECL) model. At both March 31, 2020 and December 31, 2019, the Company’s allowance for doubtful accounts was approximately $2.9 million.

Concentrations of Risks

The Company disaggregates revenue from contracts by service type and payor type. This level of detail provides useful information pertaining to how the Company generates revenue by significant revenue stream and by type of direct contracts. The consolidated statements of income present disaggregated revenue by service type. The following table presents disaggregated revenue generated by each payor type for the three months ended March 31, 2020 and 2019 (in thousands):

	For the Three Months Ended March 31,
	2020		2019
Commercial	$	24,710	$	26,761
Medicare	68,641		25,465
Medicaid	62,690		37,232
Other third parties	9,064		6,300
Revenue	$	165,105	$	95,758

The Company had major payors that contributed the following percentages of net revenue:

	For the Three Months Ended March 31,
	2020		2019
Payor A	12.1	%	17.4	%
Payor B	10.3	%	15.3	%
Payor C	*		12.0	%
Payor D	17.6	%	*
Payor E	13.3	%	*

* Less than 10% of total net revenues

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The Company had major payors that contributed to the following percentages of receivables and receivables – related parties before the allowance for doubtful accounts:

	As of March 31, 2020		As of December 31, 2019
Payor D	13.6	%	*
Payor F	33.5	%	30.4	%
Payor G	33.6	%	36.0	%

* Less than 10% of total receivables and receivables — related parties, net

Fair Value Measurements of Financial Instruments

The Company’s financial instruments consist of cash and cash equivalents, fiduciary cash, restricted cash, investment in marketable securities, receivables, loans receivable, accounts payable, certain accrued expenses, finance lease obligations, and long-term debt. The carrying values of the financial instruments classified as current in the accompanying consolidated balance sheets are considered to be at their fair values, due to the short maturity of these instruments. The carrying amounts of the finance lease obligations and long term debt approximate fair value as they bear interest at rates that approximate current market rates for debt with similar maturities and credit quality.

Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) 820, Fair Value Measurement (“ASC 820”), applies to all financial assets and financial liabilities that are measured and reported on a fair value basis and requires disclosure that establishes a framework for measuring fair value and expands disclosure about fair value measurements. ASC 820 establishes a fair value hierarchy for disclosure of the inputs to valuations used to measure fair value.

This hierarchy prioritizes the inputs into three broad levels as follows:

Level 1 —Inputs are unadjusted quoted prices in active markets for identical assets or liabilities that can be accessed at the measurement date.

Level 2 —Inputs include quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets or liabilities in markets that are not active, inputs other than quoted prices that are observable for the asset or liability (i.e., interest rates and yield curves), and inputs that are derived principally from or corroborated by observable market data by correlation or other means (market corroborated inputs).

Level 3 —Unobservable inputs that reflect assumptions about what market participants would use in pricing the asset or liability. These inputs would be based on the best information available, including the Company’s own data.

The carrying amounts and fair values of the Company’s financial instruments as of March 31, 2020 are presented below (in thousands):

	Fair Value Measurements
	Level 1		Level 2		Level 3		Total
Assets
Money market funds*	$	41,675	$	—	$	—	$	41,675
Marketable securities – certificates of deposit	117,036		—		—		117,036
Marketable securities – equity securities	39		—		—		39
Total	$	158,750	$	—	$	—	$	158,750

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The carrying amounts and fair values of the Company’s financial instruments as of December 31, 2019 are presented below (in thousands):

	Fair Value Measurements
	Level 1		Level 2		Level 3		Total
Assets
Money market funds*	$	50,731	$	—	$	—	$	50,731
Marketable securities – certificates of deposit	116,469		—		—		116,469
Marketable securities – equity securities	70		—		—		70
Total	$	167,270	$	—	$	—	$	167,270

*    Included in cash and cash equivalents

There were no Level 2 or Level 3 inputs measured on a recurring basis for the three months ended March 31, 2020.

There have been no changes in Level 1, Level 2, or Level 3 classification and no changes in valuation techniques for these assets for the three months ended March 31, 2020.

Intangible Assets and Long-Lived Assets

Intangible assets with finite lives include network-payor relationships, management contracts and member relationships and are stated at cost, less accumulated amortization and impairment losses. These intangible assets are amortized on the accelerated method using the discounted cash flow rate.

Intangible assets with finite lives also include a patient management platform, as well as trade names and trademarks, whose valuations were determined using the cost to recreate method and the relief from royalty method, respectively. These assets are stated at cost, less accumulated amortization and impairment losses, and are amortized using the straight-line method.

Finite-lived intangibles and long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. If the expected future cash flows from the use of such assets (undiscounted and without interest charges) are less than the carrying value, a write-down would be recorded to reduce the carrying value of the asset to its estimated fair value. Fair value is determined based on appropriate valuation techniques. The Company determined that there was no impairment of its finite-lived intangible or long-lived assets during the three months ended March 31, 2020 and 2019.

Goodwill and Indefinite-Lived Intangible Assets

Under ASC 350, Intangibles – Goodwill and Other, goodwill and indefinite-lived intangible assets are reviewed at least annually for impairment.

At least annually, at the Company’s fiscal year-end, or sooner if events or changes in circumstances indicate that an impairment has occurred, the Company performs a qualitative assessment to determine whether it is more likely than not that the fair value of each reporting unit is less than its carrying amount as a basis for determining whether it is necessary to complete quantitative impairment assessments for each of the Company’s three main reporting units (1) management services, (2) IPAs, and (3) ACOs. The Company is required to perform a quantitative goodwill impairment test only if the conclusion from the qualitative assessment is that it is more likely than not that a reporting unit’s fair value is less than the carrying value of its assets. Should this be the case, a quantitative analysis is performed to identify whether a potential impairment exists by comparing the estimated fair values of the reporting units with their respective carrying values, including goodwill.

An impairment loss is recognized if the implied fair value of the asset being tested is less than its carrying value. In this event, the asset is written down accordingly. The fair values of goodwill are determined using valuation techniques based on estimates, judgments and assumptions management believes are appropriate in the circumstances.

At least annually, indefinite-lived intangible assets are tested for impairment. Impairment for intangible assets with indefinite lives exists if the carrying value of the intangible asset exceeds its fair value. The fair values of indefinite-lived intangible assets are determined using valuation techniques based on estimates, judgments and assumptions management believes are appropriate in the circumstances.

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The Company had no impairment of its goodwill or indefinite-lived intangible assets during the three months ended March 31, 2020 and 2019.

Investments in Other Entities — Equity Method

The Company accounts for certain investments using the equity method of accounting when it is determined that the investment provides the Company with the ability to exercise significant influence, but not control, over the investee. Significant influence is generally deemed to exist if the Company has an ownership interest in the voting stock of the investee of between 20% and 50%, although other factors, such as representation on the investee’s board of directors, are considered in determining whether the equity method of accounting is appropriate. Under the equity method of accounting, the investment, originally recorded at cost, is adjusted to recognize the Company’s share of net earnings or losses of the investee and is recognized in the accompanying consolidated statements of income under “Income (loss) from equity method investments” and also is adjusted by contributions to and distributions from the investee. Equity method investments are subject to impairment evaluation.

Medical Liabilities

APC, Alpha Care, Accountable Health Care, APAACO and MMG are responsible for integrated care that the associated physicians and contracted hospitals provide to their enrollees. APC, Alpha Care, Accountable Health Care, APAACO and MMG, provide integrated care to HMOs, Medicare and Medi-Cal enrollees through a network of contracted providers under sub-capitation and direct patient service arrangements. Medical costs for professional and institutional services rendered by contracted providers are recorded as cost of services expenses in the accompanying consolidated statements of income.

An estimate of amounts due to contracted physicians, hospitals, and other professional providers is included in medical liabilities in the accompanying consolidated balance sheets. Medical liabilities include claims reported as of the balance sheet date and estimates IBNR claims. Such estimates are developed using actuarial methods and are based on numerous variables, including the utilization of health care services, historical payment patterns, cost trends, product mix, seasonality, changes in membership, and other factors. The estimation methods and the resulting reserves are periodically reviewed and updated. Many of the medical contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of various services. Such differing interpretations may not come to light until a substantial period of time has passed following the contract implementation.

Revenue Recognition

The Company receives payments from the following sources for services rendered: (i) commercial insurers; (ii) the federal government under the Medicare program administered by CMS; (iii) state governments under the Medicaid and other programs; (iv) other third party payors (e.g., hospitals and IPAs); and (v) individual patients and clients.

Nature of Services and Revenue Streams

Revenue primarily consists of capitation revenue, risk pool settlements and incentives, NGACO All-Inclusive Population-Based Payments (“AIPBP”), management fee income, and FFS revenue. Revenue is recorded in the period in which services are rendered or the period in which the Company is obligated to provide services. The form of billing and related risk of collection for such services may vary by type of revenue and the customer. The following is a summary of the principal forms of the Company’s billing arrangements and how revenue is recognized for each.

Capitation, Net

Managed care revenues of the Company consist primarily of capitated fees for medical services provided by the Company under a capitated arrangement directly made with various managed care providers including HMOs. Capitation revenue is typically prepaid monthly to the Company based on the number of enrollees selecting the Company as their healthcare provider. Capitation revenue is recognized in the month in which the Company is obligated to provide services to plan enrollees under contracts with various health plans. Minor ongoing adjustments to prior months’ capitation, primarily arising from contracted HMOs finalizing their monthly patient eligibility data for additions or subtractions of enrollees, are recognized in the month they are communicated to the Company. Additionally, Medicare pays capitation using a “Risk Adjustment” model, which compensates managed care organizations and providers based on the health status (acuity) of each individual enrollee. Health plans and providers with higher acuity enrollees will receive more and those with lower acuity enrollees will receive less. Under Risk Adjustment, capitation is determined based on health severity, measured using patient encounter data. Capitation is paid on a monthly basis based on data submitted for the enrollee for the preceding year and is adjusted in subsequent periods after the final data is compiled. Positive or negative capitation adjustments are made for Medicare enrollees with conditions requiring more or less healthcare services than assumed in the interim payments. Since the Company cannot reliably predict these adjustments, periodic changes in capitation

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amounts earned as a result of Risk Adjustment are recognized when those changes are communicated by the health plans to the Company.

PMPM managed care contracts generally have a term of one year or longer. All managed care contracts have a single performance obligation that constitutes a series for the provision of managed healthcare services for a population of enrolled members for the duration of the contract. The transaction price for PMPM contracts is variable as it primarily includes PMPM fees associated with unspecified membership that fluctuates throughout the contract. In certain contracts, PMPM fees also include adjustments for items such as performance incentives, performance guarantees and risk shares. The Company generally estimates the transaction price using the most likely amount methodology and amounts are only included in the net transaction price to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. The majority of the Company’s net PMPM transaction price relates specifically to the Company’s efforts to transfer the service for a distinct increment of the series (e.g., day or month) and is recognized as revenue in the month in which members are entitled to service.

Risk Pool Settlements and Incentives

APC enters into full risk capitation arrangements with certain health plans and local hospitals, which are administered by a third party, where the hospital is responsible for providing, arranging and paying for institutional risk and APC is responsible for providing, arranging and paying for professional risk. Under a full risk pool sharing agreement, APC generally receives a percentage of the net surplus from the affiliated hospital’s risk pools with HMOs after deductions for the affiliated hospitals costs. Advance settlement payments are typically made quarterly in arrears if there is a surplus. The Company's risk pool settlements under arrangements with health plans and hospitals are recognized using the most likely amount methodology and amounts are only included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. The assumptions for historical MLR, IBNR completion factors and constraint percentages were used by management in applying the most likely amount methodology.

Under capitated arrangements with certain HMOs, APC participates in one or more shared risk arrangements relating to the provision of institutional services to enrollees (shared risk arrangements) and thus can earn additional revenue or incur losses based upon the enrollee utilization of institutional services. Shared risk capitation arrangements are entered into with certain health plans, which are administered by the health plan, where APC is responsible for rendering professional services, but the health plan does not enter into a capitation arrangement with a hospital and therefore the health plan retains the institutional risk. Shared risk deficits, if any, are not payable until and unless (and only to the extent of any) risk sharing surpluses are generated. At the termination of the HMO contract, any accumulated deficit will be extinguished.

The Company's risk pool settlements under arrangements with HMOs are recognized, using the most likely methodology, and only included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur. Given the lack of access to the health plans’ data and control over the members assigned to APC, the adjustments and/or the withheld amounts are unpredictable and as such APC’s risk share revenue is deemed to be fully constrained until APC is notified of the amount by the health plan. Risk pools for the prior contract years are generally final settled in the third or fourth quarter of the following year.

In addition to risk-sharing revenues, the Company also receives incentives under “pay-for-performance” programs for quality medical care, based on various criteria. As an incentive to control enrollee utilization and to promote quality care, certain HMOs have designed quality incentive programs and commercial generic pharmacy incentive programs to compensate the Company for its efforts to improve the quality of services and efficient and effective use of pharmacy supplemental benefits provided to HMO members. The incentive programs track specific performance measures and calculate payments to the Company based on the performance measures. The Company's incentives under “pay-for-performance” programs are recognized using the most likely methodology. However, as the Company does not have sufficient insight from the health plans on the amount and timing of the shared risk pool and incentive payments these amounts are considered to be fully constrained and only recorded when such payments are known and/or received.

Generally, for the foregoing arrangements, the final settlement is dependent on each distinct day’s performance within the annual measurement period but cannot be allocated to specific days until the full measurement period has occurred and performance can be assessed. As such, this is a form of variable consideration estimated at contract inception and updated through the measurement period (i.e., the contract year), to the extent the risk of reversal does not exist and the consideration is not constrained.

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NGACO AIPBP Revenue

APAACO and CMS entered into a NGACO Model Participation Agreement (the “Participation Agreement”) with an initial term of two performance years through December 31, 2018, which term was extended for two additional renewal years.

For each performance year, the Company must submit to CMS its selections for risk arrangement; the amount of the profit/loss cap; alternative payment mechanism; benefits enhancements, if any; and its decision regarding voluntary alignment under the NGACO Model. The Company must obtain CMS consent before voluntarily discontinuing any benefit enhancement during a performance year.

Under the NGACO Model, CMS aligns beneficiaries to the Company to manage (direct care and pay providers) based on a budgetary benchmark established with CMS. The Company is responsible for managing medical costs for these beneficiaries. The beneficiaries will receive services from physicians and other medical service providers that are both in-network and out-of-network. The Company receives capitation from CMS on a monthly basis to pay claims from in-network providers. The Company records such capitation received from CMS as revenue as the Company is primarily responsible and liable for managing the patient care and for satisfying provider obligations, is assuming the credit risk for the services provided by in-network providers through its arrangement with CMS, and has control of the funds, the services provided and the process by which the providers are ultimately paid. Claims from out-of-network providers are processed and paid by CMS and the Company’s shared savings or losses in managing the services provided by out-of-network providers are generally determined on an annual basis after reconciliation with CMS. Pursuant to the Company’s risk share agreement with CMS, the Company will be eligible to receive the savings or be liable for the deficit according to the budget established by CMS based on the Company’s efficiency in managing how the beneficiaries aligned to the Company by CMS are served by in-network and out-of-network providers. The Company’s savings or losses on providing such services are both capped by CMS, and are subject to significant estimation risk, whereby payments can vary significantly depending upon certain patient characteristics and other variable factors. Accordingly, the Company recognizes such surplus or deficit upon substantial completion of reconciliation and determination of the amounts. The Company records NGACO capitation revenues monthly. Excess over claims paid, plus an estimate for the related IBNR (see Note 8), monthly capitation received are deferred and recorded as a liability until actual claims are paid or incurred. CMS will determine if there were any excess capitation paid for the performance year and the excess is refunded to CMS.

For each performance year, CMS pays the Company in accordance with the alternative payment mechanism, if any, for which CMS has approved the Company; the risk arrangement for which the Company has been approved by CMS; and as otherwise provided in the Participation Agreement. Following the end of each performance year and at such other times as may be required under the Participation Agreement, CMS will issue a settlement report to the Company setting forth the amount of any shared savings or shared losses and the amount of other monies. If CMS owes the Company shared savings or other monies, CMS shall pay the Company in full within 30 days after the date on which the relevant settlement report is deemed final, except as provided in the Participation Agreement. If the Company owes CMS shared losses or other monies owed as a result of a final settlement, the Company shall pay CMS in full within 30 days after the relevant settlement report is deemed final. If the Company fails to pay the amounts due to CMS in full within 30 days after the date of a demand letter or settlement report, CMS shall assess simple interest on the unpaid balance at the rate applicable to other Medicare debts under current provisions of law and applicable regulations. In addition, CMS and the U.S. Department of the Treasury may use any applicable debt collection tools available to collect any amounts owed by the Company.

The Company participates in the AIPBP track of the NGACO Model. Under the AIPBP track, CMS estimates the total annual expenditures for APAACO’s assigned patients and pays that projected amount to the Company in monthly installments, and the Company is responsible for all Part A and Part B costs for in-network participating providers and preferred providers contracted by the Company to provide services to the assigned patients.

As APAACO does not have sufficient insight into the financial performance of the shared risk pool with CMS because of unknown factors related to IBNR, risk adjustment factors, stop loss provisions, among other factors, an estimate cannot be developed. Due to these limitations, APAACO cannot determine the amount of surplus or deficit that will likely be recognized in the future and therefore this shared risk pool revenue is considered fully constrained.

For performance year 2020, the Company continues to receive monthly AIPBP payments at a rate of approximately $7.5 million per month from CMS, and will need to continue to comply with all terms and conditions in the Participation Agreement and various regulatory requirements to be eligible to participate in the AIPBP mechanism and/or NGACO Model. The Company has received approximately $22.6 million in total AIPBP payments for the three months ended March 31, 2020 of which $21.9 million has been recognized as revenue. The Company also recorded assets of approximately $8.5 million related to IBNR during the three months ended March 31, 2020 and $3.2 million related to final settlement of the 2018 performance year. These balances are included in “Other receivables” in the accompanying consolidated balance sheets.

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Management Fee Income

Management fee income encompasses fees paid for management, physician advisory, healthcare staffing, administrative and other non-medical services provided by the Company to IPAs, hospitals and other healthcare providers. Such fees may be in the form of billings at agreed-upon hourly rates, percentages of revenue or fee collections, or amounts fixed on a monthly, quarterly or annual basis. The revenue may include variable arrangements measuring factors such as hours staffed, patient visits or collections per visit against benchmarks, and, in certain cases, may be subject to achieving quality metrics or fee collections. The Company recognizes such variable supplemental revenues in the period when such amounts are determined to be fixed and therefore contractually obligated as payable by the customer under the terms of the applicable agreement.

The Company provides a significant service of integrating the services selected by the Company’s clients into one overall output for which the client has contracted. Therefore, such management contracts generally contain a single performance obligation. The nature of the Company’s performance obligation is to stand ready to provide services over the contractual period. Also, the Company’s performance obligation forms a series of distinct periods of time over which the Company stands ready to perform. The Company’s performance obligation is satisfied as the Company completes each period’s obligations.

Consideration from management contracts is variable in nature because the majority of the fees are generally based on revenue or collections, which can vary from period to period. The Company has control over pricing. Contractual fees are invoiced to the Company’s clients generally monthly and payment terms are typically due within 30 days. The variable consideration in the Company’s management contracts meets the criteria to be allocated to the distinct period of time to which it relates because (i) it is due to the activities performed to satisfy the performance obligation during that period and (ii) it represents the consideration to which the Company expects to be entitled.

The Company’s management contracts generally have long terms (e.g., 10 years), although they may be terminated earlier under the terms of the applicable contracts. Since the remaining variable consideration will be allocated to a wholly unsatisfied promise that forms part of a single performance obligation recognized under the series guidance, the Company has applied the optional exemption to exclude disclosure of the allocation of the transaction price to remaining performance obligations.

Fee-for-Services Revenue

FFS revenue represents revenue earned under contracts in which the Company bills and collects the professional component of charges for medical services rendered by the Company’s contracted physicians and employed physicians. Under the FFS arrangements, the Company bills the hospitals and third-party payors for the physician staffing and further bills patients or their third-party payors for patient care services provided and receives payment. FFS revenue related to the patient care services is reported net of contractual allowances and policy discounts and are recognized in the period in which the services are rendered to specific patients. All services provided are expected to result in cash flows and are therefore reflected as net revenue in the consolidated financial statements. The recognition of net revenue (gross charges less contractual allowances) from such services is dependent on such factors as proper completion of medical charts following a patient visit, the forwarding of such charts to the Company’s billing center for medical coding and entering into the Company’s billing system and the verification of each patient’s submission or representation at the time services are rendered as to the payor(s) responsible for payment of such services. Revenue is recorded based on the information known at the time of entering of such information into the Company’s billing systems, as well as an estimate of the revenue associated with medical services.

The Company is responsible for confirming member eligibility, performing program utilization review, potentially directing payment to the provider and accepting the financial risk of loss associated with services rendered, as specified within the Company’s client contracts. The Company has the ability to adjust contractual fees with clients and possess the financial risk of loss in certain contractual obligations. These factors indicate the Company is the principal and, as such, the Company records gross fees contracted with clients in revenues.

Consideration from FFS arrangements is variable in nature because fees are based on patient encounters, credits due to clients and reimbursement of provider costs, all of which can vary from period to period. Patient encounters and related episodes of care and procedures qualify as distinct goods and services, provided simultaneously together with other readily available resources, in a single instance of service, and thereby constitute a single performance obligation for each patient encounter and, in most instances, occur at readily determinable transaction prices. As a practical expedient, the Company adopted a portfolio approach for the FFS revenue stream to group together contracts with similar characteristics and analyze historical cash collections trends. The contracts within the portfolio share the characteristics conducive to ensuring that the results do not materially differ under the new standard if it were to be applied to individual patient contracts related to each patient encounter. Accordingly, there was no change in the Company's method to recognize revenue under ASC 606 Revenue from Contracts with Customers (“ASC 606”) from the previous accounting guidance.

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Estimating net FFS revenue is a complex process, largely due to the volume of transactions, the number and complexity of contracts with payors, the limited availability at times of certain patient and payor information at the time services are provided, and the length of time it takes for collections to fully mature. These expected collections are based on fees and negotiated payment rates in the case of third-party payors, the specific benefits provided for under each patient's healthcare plans, mandated payment rates in the case of Medicare and Medicaid programs, and historical cash collections (net of recoveries) in combination with expected collections from third party payors.

The relationship between gross charges and the transaction price recognized is significantly influenced by payor mix, as collections on gross charges may vary significantly, depending on whether and with whom the patients the Company provides services to in the period are insured and the Company's contractual relationships with those payors. Payor mix is subject to change as additional patient and payor information is obtained after the period services are provided. The Company periodically assesses the estimates of unbilled revenue, contractual adjustments and discounts, and payor mix by analyzing actual results, including cash collections, against estimates. Changes in these estimates are charged or credited to the consolidated statements of income in the period that the assessment is made. Significant changes in payor mix, contractual arrangements with payors, specialty mix, acuity, general economic conditions and health care coverage provided by federal or state governments or private insurers may have a significant impact on estimates and significantly affect the results of operations and cash flows.

Contract Assets

Typically, revenues and receivables are recognized once the Company has satisfied its performance obligation. Accordingly, the Company’s contract assets are comprised of receivables and receivables – related parties.

The Company's billing and accounting systems provide historical trends of cash collections and contractual write-offs, accounts receivable agings and established fee adjustments from third-party payors. These estimates are recorded and monitored monthly as revenues are recognized. The principal exposure for uncollectible fee for service visits is from self-pay patients and, to a lesser extent, for co-payments and deductibles from patients with insurance.

Contract Liabilities (Deferred Revenue)

Contract liabilities are recorded when cash payments are received in advance of the Company’s performance, or in the case of the Company’s NGACO, the excess of AIPBP capitation received and the actual claims paid or incurred. The Company’s contract liability balance was $0.7 million and $8.9 million as of March 31, 2020 and December 31, 2019, respectively, and is presented within “Accounts payable and accrued expenses” in the accompanying consolidated balance sheets. During the three months ended March 31, 2020, $0.4 million of the Company’s contract liability accrued in 2019 has been recognized as revenue and $8.5 million was repaid back to CMS for AIPBP capitation received and not earned.

Other Financial Information

In March 2020, the Company made a deposit of $4.0 million for future investment opportunities. The investment was made with cash strictly related to the APC excluded assets that was generated from the series of transactions with AP-AMH. The deposit is included in “Other assets” in the accompanying consolidated balance sheets.

Income Taxes

Federal and state income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a change in judgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reduce deferred tax assets to amounts expected to be realized.

The Company uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to be taken in a tax return in order to be recognized in the consolidated financial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the consolidated financial statements.

Share-Based Compensation

The Company maintains a stock-based compensation program for employees, non-employees, directors and consultants. The value of share-based awards such as options is recognized as compensation expense on a cumulative straight-line basis over the vesting

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period of the awards, adjusted for expected forfeitures. From time to time, the Company issues shares of its common stock to its employees, directors and consultants, which shares may be subject to the Company’s repurchase right (but not obligation) that lapses based on time-based and performance-based vesting schedules.

The Company accounts for share-based awards granted to persons other than employees and directors under ASC 505-50 Equity-Based Payments to Non-Employees. As such the fair value of such shares of stock is periodically remeasured using an appropriate valuation model and income or expense is recognized over the vesting period.

Basic and Diluted Earnings Per Share

Basic earnings per share is computed by dividing net income attributable to holders of the Company’s common stock by the weighted average number of shares of common stock outstanding during the periods presented. Diluted earnings per share is computed using the weighted average number of shares of common stock outstanding, plus the effect of dilutive securities outstanding during the periods presented, using the treasury stock method. Refer to Note 14 for a discussion of shares treated as treasury shares for accounting purposes.

Noncontrolling Interests

The Company consolidates entities in which the Company has a controlling financial interest. The Company consolidates subsidiaries in which the Company holds, directly or indirectly, more than 50% of the voting rights, and VIEs in which the Company is the primary beneficiary. Noncontrolling interests represent third-party equity ownership interests (including certain VIEs) in the Company’s consolidated entities. The amount of net income attributable to noncontrolling interests is disclosed in the consolidated statements of income.

Mezzanine Equity

Pursuant to APC’s shareholder agreements, in the event of a disqualifying event, as defined in the agreements, APC could be required to repurchase the shares from the respective shareholders based on certain triggers outlined in the shareholder agreements. As the redemption feature of the shares is not solely within the control of APC, the equity of APC does not qualify as permanent equity and has been classified as mezzanine or temporary equity. Accordingly, the Company recognizes noncontrolling interests in APC as mezzanine equity in the consolidated financial statements. As of March 31, 2020 and December 31, 2019, APC's shares were not redeemable, nor was it probable the shares would become redeemable.

Recent Accounting Pronouncements

In June 2016, the FASB issued Accounting Standards Update (“ASU”) No. 2016-13, Financial Instruments-Credit Losses (Topic 326)-Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”). The new standard requires entities to measure all expected credit losses for financial assets held at the reporting date based on historical experience, current conditions and reasonable and supportable forecasts. ASU 2016-13 became effective for fiscal years beginning after December 15, 2019, with early adoption permitted. The Company adopted ASU 2016-13 on January 1, 2020. The adoption of ASU 2016-13 did not have a material impact on the consolidated financial statements.

In October 2018, the FASB issued ASU No. 2018-17, Consolidation (Topic 810): Targeted Improvements to Related Party Guidance for Variable Interest Entities (“ASU 2018-17”). This ASU reduces the cost and complexity of financial reporting associated with consolidation of VIEs. A VIE is an organization in which consolidation is not based on a majority of voting rights. The new guidance supersedes the private company alternative for common control leasing arrangements issued in 2014 and expands it to all qualifying common control arrangements. The amendments in this ASU became effective for fiscal years beginning after December 15, 2019, and interim periods within those fiscal years. The Company adopted ASU 2018-17 on January 1, 2020. The adoption of ASU 2018-17 did not have a material impact on the consolidated financial statements.

In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”). This ASU simplifies the accounting for income taxes by eliminating certain exceptions to the guidance in ASC 740 Income Taxes related to the approach for intraperiod tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. The amendments in this ASU are effective for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years. The Company is currently assessing the impact that the adoption of ASU 2019-12 will have on the Company's consolidated financial statements.

In January 2020, the FASB issued ASU No. 2020-01, Investments - Equity Securities (Topic 321), Investments - Equity Method and Joint Ventures (Topic 323), and Derivatives and Hedging (Topic 815) (“ASU 2020-01”). This ASU clarifies the interaction

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between accounting for equity securities, equity method investments and certain derivative instruments. This amendment in this ASU are effective for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years. The Company is currently assessing the impact that the adoption of ASU 2020-01 will have on the Company's consolidation financial statements.

Other than the standards discussed above, there have been no other new accounting pronouncements that have significance, or potential significance, to the Company’s financial position, results of operations and cash flows.

3. Business Combination and Goodwill

Alpha Care Medical Group

On May 31, 2019, APC and APC-LSMA completed their acquisition of 100% of the capital stock of Alpha Care from Dr. Kevin Tyson for an aggregate purchase price of approximately $45.1 million in cash, subject to post-closing adjustments. As part of the transaction the Company deposited $2.0 million into an escrow account for potential post-closing adjustments. As of March 31, 2020 no post-closing adjustment is expected to be paid to Dr. Tyson and the full amount of the escrow account is expected to be returned to the Company. As such, the escrow amount is presented within prepaid expenses and other current assets in the accompanying consolidated balance sheets.

The following table summarizes the estimated fair values of the assets acquired and liabilities assumed, as of the acquisition date (in thousands):

	Balance Sheet
Assets acquired
Cash and cash equivalents	$	3,569
Accounts receivable, net	10,336
Other current assets	4,342
Network relationship intangible assets	22,636
Goodwill	28,585
Accounts payable	(2,758		)
Deferred tax liabilities	(6,334		)
Medical liabilities	(15,320		)
Net assets acquired	$	45,056
Cash paid	$	45,056

Accountable Health Care, IPA

On August 30, 2019, APC and APC-LSMA, acquired the remaining outstanding shares of capital stock (comprising 75%) in Accountable Health Care in exchange for $7.3 million. In addition to the payment of $7.3 million APC assumed all assets and liabilities of Accountable Health Care, including loans payable to NMM and APC of $15.4 million, which have been eliminated upon consolidation and contributed the 25% investment totaling $2.4 million, total purchase price was $25.1 million (see Note 5).

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The following table summarizes the estimated fair values of the assets acquired and liabilities assumed, as of the acquisition date (in thousands):

	Balance Sheet
Assets acquired
Cash and cash equivalents	$	582
Accounts receivable, net	5,150
Other current assets	198
Network relationship intangible assets	11,411
Goodwill	23,052
Accounts payable	(3,245		)
Medical liabilities	(12,154		)
Subordinated loan	(15,327		)
Net asset acquired	$	9,667
Equity investment contributed	$	2,417
Cash paid	$	7,250

The Company acquired AMG in September 2019 for total consideration of $1.6 million, of which $0.4 million was in the form of APC common stock. The business combination did not meet the quantitative thresholds to require separate disclosures based on the Company's consolidated net assets, investments and net income.

The acquisitions were accounted for under the acquisition method of accounting. The fair value of the consideration for the acquired company was allocated to acquired tangible and intangible assets and liabilities based upon their fair values. The excess of the purchase consideration over the fair value of the net tangible and identifiable intangible assets acquired was recorded as goodwill. The determination of the fair value of assets and liabilities acquired requires the Company to make estimates and use valuation techniques when market value is not readily available. The results of operations of the company acquired have been included in the Company's financial statements from the date of acquisition. Transaction costs associated with business acquisitions are expensed as they are incurred.

At the time of acquisition, the Company estimates the amount of the identifiable intangible assets based on a valuation and the facts and circumstances available at the time. The Company determines the final value of the identifiable intangible assets as soon as information is available, but not more than 12 months from the date of acquisition.

Goodwill is not deductible for tax purposes.

The change in the carrying value of goodwill for the three months ended March 31, 2020 was as follows (in thousands);

Balance, January 1, 2020	$	238,505
Adjustments	34
Balance, March 31, 2020	$	238,539

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4. Intangible Assets, Net

At March 31, 2020, the Company’s intangible assets, net, consisted of the following (in thousands):

	Useful Life (Years)	Gross March 31, 2020		Accumulated Amortization			Net March 31, 2020
Amortized intangible assets:
Network relationships	11-15	143,930		(63,831		)	80,099
Management contracts	15	22,832		(10,206		)	12,626
Member relationships	12	6,696		(2,573		)	4,123
Patient management platform	5	2,060		(961		)	1,099
Trade name/trademarks	20	1,011		(118		)	893
		$	176,529	$	(77,689	)	$	98,840

At December 31, 2019, the Company’s intangible assets, net, consisted of the following (in thousands):

	Useful Life (Years)	Gross December 31, 2019		Accumulated Amortization			Net December 31, 2019
Amortized intangible assets:
Network relationships	11-15	143,930		(60,526		)	83,404
Management contracts	15	22,832		(9,676		)	13,156
Member relationships	12	6,696		(2,352		)	4,344
Patient management platform	5	2,060		(858		)	1,202
Trade name/trademarks	20	1,011		(105		)	906
		$	176,529	$	(73,517	)	$	103,012

Amortization expense was $4.2 million and $3.9 million for the three months ended March 31, 2020 and 2019, respectively.

Future amortization expense is estimated to be as follows for the years ending December 31 (in thousands):

	Amount
2020 (excluding the three months ended March 31, 2020)	$	11,856
2021	14,524
2022	12,673
2023	10,842
2024	9,830
Thereafter	39,115
Total	$	98,840

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5. Investments in Other Entities — Equity Method

Rollforward of Equity Method Investment (in thousands)

	December 31, 2019		Allocation of Income (Loss)			Contribution		March 31, 2020
LaSalle Medical Associates – IPA Line of Business	$	6,397	$	(643	)	$	—	$	5,754
Pacific Medical Imaging & Oncology Center, Inc.	1,396		87			—		1,483
Universal Care, Inc.	1,438		2,670			—		4,108
Diagnostic Medical Group	2,334		(5		)	—		2,329
531 W. College, LLC – related party	16,698		(111		)	300		16,887
MWN, LLC – related party	164		56			—		220
	$	28,427	$	2,054		$	300	$	30,781

LaSalle Medical Associates — IPA Line of Business

LMA was founded by Dr. Albert Arteaga in 1996 and currently operates six neighborhood medical centers through its network of more than 2,300 PCP and Specialists providers, treating children, adults and seniors in San Bernardino County, California. LMA’s patients are primarily served by Medi-Cal and they also accept Blue Cross, Blue Shield, Molina, Care 1st, Health Net and Inland Empire Health Plan. LMA is also an IPA of independently contracted doctors, hospitals and clinics, delivering high-quality care to more than 295,000 patients in Fresno, Kings, Los Angeles, Madera, Riverside, San Bernardino and Tulare Counties. During 2012, APC-LSMA and LMA entered into a share purchase agreement whereby APC-LSMA invested $5.0 million for a 25% interest in LMA’s IPA line of business. NMM has a management services agreement with LMA. APC accounts for its investment in LMA under the equity method as APC has the ability to exercise significant influence, but not control over LMA’s operations. For the three months ended March 31, 2020 and 2019, APC recorded losses from this investment of $0.6 million and $1.1 million, respectively, in the accompanying consolidated statements of income. The accompanying consolidated balance sheets include the related investment balance of $5.8 million and $6.4 million at March 31, 2020 and December 31, 2019, respectively.

LMA’s summarized balance sheets at March 31, 2020 and December 31, 2019 and summarized statements of operations for the three months ended March 31, 2020 and 2019 with respect to its IPA line of business are as follows (in thousands):

Balance Sheets

	March 31, 2020			December 31, 2019
Assets
Cash and cash equivalents	$	—		$	6,345
Receivables, net	8,901			5,124
Other current assets	3,380			3,526
Loan receivable	2,250			2,250
Restricted cash	686			683
Total assets	$	15,217		$	17,928
Liabilities and Stockholders’ (Deficit) Equity
Current liabilities	$	23,390		$	23,530
Stockholders’ deficit	(8,173		)	(5,602		)
Total liabilities and stockholders’ deficit	$	15,217		$	17,928

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Statements of Operations

	Three Months Ended March 31,
	2020			2019
Revenues	$	46,304		$	46,406
Expenses	48,730			50,702
Net loss	$	(2,426	)	$	(4,296	)

Pacific Medical Imaging and Oncology Center, Inc.

Incorporated in California in 2004, PMIOC provides comprehensive diagnostic imaging services using state-of-the-art technology. PMIOC offers high-quality diagnostic services, such as MRI/MRA, PET/CT, CT, nuclear medicine, ultrasound, digital x-rays, bone densitometry and digital mammography, at its facilities.

In July 2015, APC-LSMA and PMIOC entered into a share purchase agreement whereby APC-LSMA invested $1.2 million for a 40% ownership interest in PMIOC.

APC and PMIOC have an Ancillary Service Contract together whereby PMIOC provides covered services on behalf of APC to enrollees of the plans of APC. Under the Ancillary Service Contract, APC paid PMIOC fees of approximately $0.6 million and $0.7 million, for the three months ended March 31, 2020 and 2019, respectively. APC accounts for its investment in PMIOC under the equity method of accounting as APC has the ability to exercise significant influence, but not control over PMIOC’s operations. During the three months ended March 31, 2020 and 2019, APC recorded income from this investment of approximately $0.1 million and $0.1 million, respectively, in the accompanying consolidated statements of income and has investment balances of $1.5 million and $1.4 million at March 31, 2020 and December 31, 2019, respectively.

Universal Care, Inc.

UCI is a privately held health plan that has been in operation since 1985. UCI holds a license under the California Knox-Keene Health Care Services Plan Act to operate as a full-service health plan. UCI contracts with CMS under the Medicare Advantage Prescription Drug Program.

On August 10, 2015, UCAP purchased 100,000 shares of UCI class A-2 voting common stock from UCI for $10.0 million, which shares comprise 48.9% of UCI's total outstanding shares and 50% of UCI’s voting common stock. APC accounts for its investment in UCI under the equity method of accounting as APC has the ability to exercise significant influence, but not control over UCI’s operations. During the three months ended March 31, 2020 and 2019, the Company recorded income from this investment of approximately $2.7 million and $1.0 million, respectively, in the accompanying consolidated statements of income and had investment balances of $4.1 million and $1.4 million at March 31, 2020 and December 31, 2019, respectively.

On April 30, 2020, UCAP completed its disposition of its 48.9% ownership interest in UCI to Bright for approximately $69.2 million in cash proceeds (including $16.5 million as repayment of indebtedness owed to APC), plus non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $33.3 million. In addition, pursuant to the terms of the SPA, upon release from escrow, APC is entitled to receive all or that portion of the following escrowed amounts that have not been offset or reserved for claims: (i) cash consideration of approximately $15.6 million, plus (ii) non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $5.9 million (see Note 17).

UCI’s balance sheets at March 31, 2020 and December 31, 2019 and statements of income for the three months ended March 31, 2020 and 2019 are as follows (in thousands):

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Balance Sheets

	March 31, 2020			December 31, 2019
Assets
Cash	$	34,757		$	33,890
Receivables, net	83,454			63,843
Other current assets	43,417			38,280
Other assets	885			882
Property and equipment, net	4,429			4,021
Total assets	$	166,942		$	140,916
Liabilities and Stockholders’ (Deficit) Equity
Current liabilities	$	148,902		$	128,330
Other liabilities	33,126			33,133
Stockholders’ deficit	(15,086		)	(20,547		)
Total liabilities and stockholders’ deficit	$	166,942		$	140,916

Statements of Income

	Three Months Ended March 31,
	2020		2019
Revenues	$	146,481	$	113,319
Expenses	141,771		111,408
Income before benefit from income taxes	4,710		1,911
Benefit from income taxes	—		(211		)
Net income	$	4,710	$	2,122

Diagnostic Medical Group

In May 2016, David C.P. Chen M.D., individually, and APC-LSMA, entered into a share purchase agreement whereby APC-LSMA acquired a 40% ownership interest in DMG.

APC accounts for its investment in DMG under the equity method of accounting as APC has the ability to exercise significant influence, but not control over DMG’s operations. For the three months ended March 31, 2020 and 2019, APC recorded losses and income from this investment of $5,244 and $0.2 million, respectively, in the consolidated statements of income. The accompanying consolidated balance sheets include the related investment balances of $2.3 million as of March 31, 2020 and December 31, 2019, respectively.

531 W. College LLC – Related Party

In June 2018, College Street Investment LP, a California limited partnership (“CSI”), APC and NMM entered into an operating agreement to govern the limited liability company, 531 W. College, LLC and the conduct of its business, and to specify their relative rights and obligations. CSI, APC and NMM, each owns 50%, 25% and 25%, respectively, of member units based on initial capital contributions of $16.7 million, $8.3 million, and $8.3 million, respectively.

On June 29, 2018, 531 W. College, LLC closed its purchase of a non-operational hospital located in Los Angeles from Societe Francaise De Bienfaisance Mutuelle De Los Angeles, a California nonprofit corporation, for a total purchase price of $33.3 million. On April 23, 2019, NMM and APC entered into an agreement whereby NMM assigned and APC assumed NMM's 25% membership

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interest in 531 W. College, LLC for approximately $8.3 million. Subsequently, APC has a 50% ownership in 531 W. College LLC with a total investment balance of approximately $16.9 million.

APC accounts for its investment in 531 W. College, LLC under the equity method of accounting as APC has the ability to exercise significant influence, but not control over the operations of this joint venture. For the three months ended March 31, 2020 and March 31, 2019, APC recorded losses of $0.1 million and $46,968, respectively, in the accompanying consolidated statements of income. During the period ended March 31, 2020, the Company contributed $0.3 million to 531 W. College LLC as part of its 50% interest and had investment balances of $16.9 million and $16.7 million, respectively, at March 31, 2020 and December 31, 2019.

531 W. College LLC’s balance sheets at March 31, 2020 and December 31, 2019 and statements of operations for the three months ended March 31, 2020 and 2019 are as follows (in thousands):

Balance Sheets

	March 31, 2020		December 31, 2019
Assets
Cash	$	48	$	139
Other current assets	124		17
Other assets	70		70
Property and equipment, net	33,697		33,581
Total assets	$	33,939	$	33,807
Liabilities and Members’ Equity
Current liabilities	$	1,114	$	1,062
Stockholders’ equity	32,825		32,745
Total liabilities and members’ equity	$	33,939	$	33,807

Statements of Operation

	Three Months Ended March 31,
	2020			2019
Revenues	—			—
Expenses	338			469
Loss from operations	(338		)	(469		)
Other income	$	21		$	289
Net loss	$	(317	)	$	(180	)

MWN LLC – Related Party

On December 18, 2018, NMM, 6 Founders LLC, a California limited liability company doing business as Pacific6 Enterprises (“Pacific6”), and Health Source MSO Inc., a California corporation (“HSMSO”) entered into an operating agreement to govern MWN Community Hospital, LLC and the conduct of its business and to specify their relative rights and obligations. NMM, Pacific6, and HSMSO each own 33.3% of the membership shares based on each member’s initial capital contributions of $3,000 and working capital contributions of $30,000. NMM invested an additional $0.3 million for working capital purposes in August, 2019. For the three months ended March 31, 2020, NMM recorded income from its investment in MWN LLC of $0.1 million in

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the accompanying consolidated statements of income and had an investment balance of $0.2 million as of March 31, 2020 and December 31, 2019.

Investment in privately held entity that does not report net asset value per share

MediPortal, LLC

In May 2018, APC purchased 270,000 membership interests of MediPortal LLC, a New York limited liability company, for $0.4 million or $1.50 per membership interest, which represented an approximately 2.8% ownership interest. In connection with the initial purchase, APC received a five-year warrant to purchase an additional 270,000 membership interests. Additionally, APC received a five-year option to purchase an additional 380,000 membership interests and a five-year warrant to purchase 480,000 membership interests, which MediPortal LLC will grant APC upon completion of its health portal. As of March 31, 2020, the health portal has not been completed. As APC does not have the ability to exercise significant influence, and lacks control, over the investee, this investment is accounted for using a measurement alternative which allows the investment to be measured at cost, adjusted for observable price changes and impairments, with changes recognized in net income.

AchievaMed

On July 1, 2019, NMM and AchievaMed, Inc., a California corporation ("AchievaMed"), entered into an agreement in which NMM would purchase 50% of the aggregate shares of capital stock of AchievaMed over a period of time not to exceed five years. As a result of this transaction NMM invested $0.5 million for a 10% interest. The related investment balance of $0.5 million is included in "Investment in privately held entities" in the accompanying consolidated balance sheets as of March 31, 2020.

6. Loan Receivable and Loan Receivable – Related Parties

Loan receivable

Dr. Albert Arteaga

On June 28, 2019, APC entered into a convertible secured promissory note with Dr. Albert H. Arteaga, M.D. ("Dr. Arteaga"), Chief Executive Officer of LMA, to loan $6.4 million to Dr. Arteaga. Interest on the loan accrues at a rate that is equal to the prime rate, plus 1% (4.25% as of March 31, 2020) and payable in monthly installments of interest only on the first day of each month until the maturity date of June 28, 2020, at which time, all outstanding principal and accrued interest thereon shall be due and payable in full. The note is secured by certain shares of LMA common stock held by Dr. Arteaga.

At any time on or before June 28, 2020, and upon written notice by APC to Dr. Arteaga, APC has the right, but not the obligation, to convert the entire outstanding principal amount of this note into shares of LMA common stock, which equal 21.25% of the aggregate then-issued and outstanding shares of LMA common stock to be held by APC's designee, which may include APC-LSMA. If converted, APC-LSMA and APC's designee will collectively own 46.25% of the equity of LMA with the remaining 53.75% to be owned by Dr. Arteaga. The entire note receivable has been classified under loans receivable — related parties on the consolidated balance sheets in the amount of $6.4 million as of March 31, 2020.

During the period ended March 31 2020, the Company entered into an agreement to advance Dr. Arteaga $2.2 million related to claims that were overpaid in the ordinary course of business. The advanced amount is repaid as the overpaid claims are recovered. As of March 31, 2020 the outstanding amount due was $1.6 million and included in the "Prepaid expenses and other current assets" in the accompanying consolidated balance sheets.

Loan receivable - related parties

Universal Care, Inc.

In 2015, APC advanced $5.0 million on behalf of UCAP to UCI for working capital purposes. On June 29, 2018, November 28, 2018 and December 13, 2019 APC advanced an additional $2.5 million, $5.0 million and $4.0 million, respectively. The loans accrue interest at the prime rate, plus 1.00%, or 4.25%, as of March 31, 2020 and 5.75% as of December 31, 2019, with interest to be paid monthly. The notes receivable were classified under loans receivable — related parties on the consolidated balance sheets in the amount of $16.5 million as of March 31, 2020 and December 31, 2019, respectively. On April 30, 2020, UCAP completed its disposition of its 48.9% ownership interest in UCI to Bright for approximately $69.2 million in cash proceeds (including $16.5 million as repayment of indebtedness owed to APC), plus non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $33.3 million. In addition, pursuant to the terms of the SPA, upon release from escrow, APC is entitled to receive all or that portion of the following escrowed amounts that have not

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been offset or reserved for claims: (i) cash consideration of approximately $15.6 million, plus (ii) non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $5.9 million (see Note 17).

The Company assessed the loan receivables under the CECL model by assessing the party's ability to pay by reviewing their, interest payment history quarterly, financial history annually and reassessing any insolvency risk that is identified. If a failure to pay occurs, the Company assesses the terms of the notes and estimate an expected credit loss based on the remittance schedule of the note.

7. Accounts Payable and Accrued Expenses

The Company’s accounts payable and accrued expenses consisted of the following (in thousands):

	March 31, 2020		December 31, 2019
Accounts payable	$	7,745	$	6,914
Capitation payable	2,802		2,813
Subcontractor IPA payable	2,886		3,360
Professional fees	1,792		1,837
Due to related parties	55		225
Accrued compensation	4,162		3,238
Contract liabilities	664		8,892
Total accounts payable and accrued expenses	$	20,106	$	27,279

8. Medical Liabilities

The Company’s medical liabilities consisted of the following (in thousands):

	March 31, 2020			March 31, 2019
Medical liabilities, beginning of period	$	58,725		$	33,642
Components of medical care costs related to claims incurred:
Current period	85,928			31,870
Prior periods	(602		)	3,105
Total medical care costs	85,326			34,975
Payments for medical care costs related to claims incurred:
Current period	(37,004		)	(16,587		)
Prior periods	(43,247		)	(28,850		)
Total paid	(80,251		)	(45,437		)
Adjustments	(102		)	86
Medical liabilities, ending balance	$	63,698		$	23,266

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9. Credit Facility, Bank Loan and Lines of Credit

Credit Facility

The Company's credit facility consisted of the following (in thousands):

	March 31, 2020
Term loan A	$	185,250
Revolver loan	60,000
Total debt	245,250
Less: Current portion of debt	(9,500		)
Less: Unamortized financing costs	(5,645		)
Long-term debt	$	230,105

Future maturities of the Company's credit facility is to be as follows for the years ending December 31 (in thousands):

	Amount
2020 (excluding the three months ended March 31, 2020)	$	7,125
2021	10,688
2022	14,250
2023	15,437
2024	197,750
Total	$	245,250

Credit Agreement

In September 2019, the Company entered into a secured credit agreement (the “Credit Agreement,” and the credit facility thereunder, the "Credit Facility") with Truist Financial Corporation (formerly known as SunTrust Bank), in its capacity as administrative agent for the lenders (in such capacity, the “Agent”), as a lender, an issuer of letters of credit and as swingline lender, and Preferred Bank, JPMorgan Chase Bank, N.A., MUFG Union Bank, N.A., Royal Bank of Canada, Fifth Third Bank and City National Bank, as lenders (the “Lenders”). In connection with the closing of the Credit Agreement, the Company, its subsidiary, NMM, and the Agent entered into a Guaranty and Security Agreement (the “Guaranty and Security Agreement”), pursuant to which, among other things, NMM guaranteed the obligations of the Company under the Credit Agreement.

The Credit Agreement provides for a five-year revolving credit facility to the Company of $100.0 million ("Revolver Loan"), which includes a letter of credit subfacility of up to $25.0 million. The Credit Agreement also provides for a term loan of $190.0 million, ("Term Loan A"). The unpaid principal amount of the term loan is payable in quarterly installments on the last day of each fiscal quarter commencing on December 31, 2019. The principal payment for each of the first eight fiscal quarters is $2.4 million, for the following eight fiscal quarters thereafter is $3.6 million and for the following three fiscal quarters thereafter is $4.8 million. The remaining principal payment on the term loan is due on September 11, 2024.

The proceeds of the term loan and up to $60.0 million of the revolving credit facility were used to (i) finance a portion of the AP-AMH Loan, (ii) refinance certain indebtedness of the Company and its subsidiaries and, indirectly, APC, (iii) pay transaction costs and expenses arising in connection with the Credit Agreement, the AP-AMH Loan and certain other related transactions and (iv) provide for working capital, capital expenditures and other general corporate purposes. The remainder of the revolving credit facility will be used to finance future acquisitions and investments and to provide for working capital needs, capital expenditures and other general corporate purposes.

The Company is required to pay an annual facility fee of 0.20% to 0.35% on the available commitments under the Credit Agreement, regardless of usage, with the applicable fee determined on a quarterly basis based on the Company’s leverage ratio. The Company

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is also required to pay customary fees as specified in a separate fee agreement between the Company and SunTrust Robinson Humphrey, Inc., the lead arranger of the Credit Agreement.

Amounts borrowed under the Credit Agreement will bear interest at an annual rate equal to either, at the Company’s option, (a) the rate for Eurocurrency deposits for the corresponding deposits of U.S. dollars appearing on Reuters Screen LIBOR01 Page (“LIBOR”), adjusted for any reserve requirement in effect, plus a spread of between 2.00% and 3.00%, as determined on a quarterly basis based on the Company’s leverage ratio, or (b) a base rate, plus a spread between 1.00% and 2.00%, as determined on a quarterly basis based on the Company’s leverage ratio. As of March 31, 2020, the interest rate on Term Loan A and Revolver Loan was 3.57% and 3.24%, respectively. The base rate is defined in a manner such that it will not be less than LIBOR. The Company will pay fees for standby letters of credit at an annual rate of between 2.00% and 3.00%, as determined on a quarterly basis based on the Company’s leverage ratio, plus facing fees and standard fees payable to the issuing bank on the respective letter of credit. Loans outstanding under the Credit Agreement may be prepaid at any time without penalty, except for LIBOR breakage costs and expenses. If LIBOR ceases to be reported, the Credit Agreement requires the Company and the Agent to endeavor to establish a commercially reasonable alternative rate of interest and until they are able to do so, all borrowings must be at the base rate.

The Credit Agreement requires the Company and its subsidiaries to comply with various affirmative covenants, including, without limitation, furnishing updated financial and other information, preserving existence and entitlements, maintaining properties and insurance, complying with laws, maintaining books and records, requiring any new domestic subsidiary meeting a materiality threshold specified in the Credit Agreement to become a guarantor thereunder and paying obligations. The Credit Agreement requires the Company and its subsidiaries to comply with, and to use commercially reasonable efforts to the extent permitted by law to cause certain material associated practices of the Company, including APC, to comply with, restrictions on liens, indebtedness and investments (including restrictions on acquisitions by the Company), subject to specified exceptions. The Credit Agreement also contains various other negative covenants binding the Company and its subsidiaries, including, without limitation, restrictions on fundamental changes, dividends and distributions, sales and leasebacks, transactions with affiliates, burdensome agreements, use of proceeds, maintenance of business, amendments of organizational documents, accounting changes and prepayments and modifications of subordinated debt.

The Credit Agreement requires the Company to comply with two key financial ratios, each calculated on a consolidated basis. The Company must maintain a maximum consolidated leverage ratio of not greater than 3.75 to 1.00 as of the last day of each fiscal quarter. The maximum consolidated leverage ratio decreases by 0.25 each year, until it is reduced to 3.00 to 1.00 for each fiscal quarter ending after September 30, 2022. The Company must maintain a minimum consolidated interest coverage ratio of not less than 3.25 to 1.00 as of the last day of each fiscal quarter. As of March 31, 2020, the Company was in compliance with the covenants relating to its credit facility.

Pursuant to the Guaranty and Security Agreement, the Company and NMM have granted the Lenders a security interest in all of their assets, including, without limitation, all stock and other equity issued by their subsidiaries (including NMM) and all rights with respect to the AP-AMH Loan. The Guaranty and Security Agreement requires the Company and NMM to comply with various affirmative and negative covenants, including, without limitation, covenants relating to maintaining perfected security interests, providing information and documentation to the Agent, complying with contractual obligations relating to the collateral, restricting the sale and issuance of securities by their respective subsidiaries and providing the Agent access to the collateral.

The Credit Agreement contains events of default, including, without limitation, failure to make a payment when due, default on various covenants in the Credit Agreement, breach of representations or warranties, cross-default on other material indebtedness, bankruptcy or insolvency, occurrence of certain judgments and certain events under the Employee Retirement Income Security Act of 1974 aggregating more than $10.0 million, invalidity of the loan documents, any lien under the Guaranty and Security Agreement ceasing to be valid and perfected, any change in control, as defined in the Credit Agreement, an event of default under the AP-AMH Loan, failure by APC to pay dividends in cash for any period of two consecutive fiscal quarters, failure by AP-AMH to pay cash interest to the Company, or if any modification is made to the Certificate of Determination or the Special Purpose Shareholder Agreement that directly or indirectly restricts, conditions, impairs, reduces or otherwise limits the payment of the Series A Preferred dividend by APC to AP-AMH. In addition, it will constitute an event of default under the Credit Agreement if APC uses all or any portion of the consideration received by APC from AP-AMH on account of AP-AMH’s purchase of Series A Preferred Stock for any purpose other than certain specific approved uses described in the following sentence, unless not less than 50.01% of all holders of common stock of APC at such time approve such use; provided that APC may use up to $50.0 million in the aggregate of such consideration for any purpose without any requirement to obtain such approval of the holders of common stock of APC. The approved uses include (i) any permitted investment, (ii) any dividend or distribution to the holders of the common stock of APC, (iii) any repurchase of common stock of APC, (iv) paying taxes relating to or arising from certain assets and transactions, or (v) funding losses, deficits or working capital support on account of certain non-healthcare assets in an amount not to exceed $125.0 million. If any event of default occurs and is continuing under the Credit Agreement, the Lenders may terminate their commitments, and may require the Company and its guarantors to repay outstanding debt and/or to provide a cash

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deposit as additional security for outstanding letters of credit. In addition, the Agent, on behalf of the Lenders, may pursue remedies under the Guaranty and Security Agreement, including, without limitation, transferring pledged securities of the Company’s subsidiaries in the name of the Agent and exercising all rights with respect thereto (including the right to vote and to receive dividends), collect on pledged accounts, instruments and other receivables (including the AP-AMH Loan), and all other rights provided by law or under the loan documents and the AP-AMH Loan.

In the ordinary course of business, certain of the Lenders under the Credit Agreement and their affiliates have provided to the Company and its subsidiaries and the associated practices, and may in the future provide, (i) investment banking, commercial banking (including pursuant to certain existing business loan and credit agreements being terminated in connection with entering into the Credit Agreement), cash management, foreign exchange or other financial services, and (ii) services as a bond trustee and other trust and fiduciary services, for which they have received compensation and may receive compensation in the future.

Deferred Financing Costs

The Company recorded deferred financing costs of $6.5 million related to the issuance of the Credit Facility. This amount was recorded as a direct reduction of the carrying amount of the related debt liability. The deferred financing costs will be amortized over the life of the Credit Facility using the effective interest rate method.

Effective Interest Rate

The Company’s average effective interest rate on its total debt during the three months ended March 31, 2020 and 2019 was 4.24% and 5.47%, respectively. Interest expense in the consolidated statements of income included amortization of deferred debt issuance costs for the three months ended March 31, 2020 and 2019 of $0.3 million and $0, respectively.

Lines of Credit – Related Party

NMM Business Loan

On June 14, 2018, NMM amended its promissory note agreement with Preferred Bank (“NMM Business Loan Agreement”), which provides for loan availability of up to $20.0 million with a maturity date of June 22, 2020. One of the Company’s board members is the chairman and CEO of Preferred Bank. The NMM Business Loan Agreement was subsequently amended on September 1, 2018 to temporarily increase the loan availability from $20.0 million to $27.0 million for the period from September 1, 2018 through January 31, 2019, further extended to October 31, 2019 to facilitate the issuance of an additional standby letter of credit for the benefit of CMS. The interest rate is based on the Wall Street Journal “prime rate,” plus 0.125%, or 5.625% as of December 31, 2018. The loan was guaranteed by Apollo Medical Holdings, Inc. and is collateralized by substantially all of the assets of NMM. The amounts outstanding as of June 30, 2019 of $5.0 million was fully repaid on September 11, 2019.

On September 5, 2018, NMM entered into a non-revolving line of credit agreement with Preferred Bank, which provides for loan availability of up to $20.0 million with a maturity date of September 5, 2019. This credit facility was subsequently amended on April 17, 2019 and July 29, 2019 to reduce the loan availability from $20.0 million to $16.0 million and from $16.0 million to $2.2 million, respectively. The interest rate is based on the Wall Street Journal “prime rate,” plus 0.125%, or 3.375% as of March 31, 2020 and 4.875% as of December 31, 2019. The line of credit is guaranteed by Apollo Medical Holdings, Inc. and is collateralized by substantially all assets of NMM. NMM obtained this line of credit to finance potential acquisitions. Each drawdown from the line of credit is converted into a five-year term loan with monthly principal payments, plus interest based on a five-year amortization schedule.

On September 11, 2019, the NMM Business Loan Agreement, dated as of June 14, 2018, between NMM and Preferred Bank, as amended, and the Line of Credit Agreement, dated as of September 5, 2018, between NMM and Preferred Bank, as amended, was terminated in connection with the closing of the Credit Facility. Certain letters of credit issued by Preferred Bank under the Line of Credit Agreement was terminated and reissued under the Credit Agreement. These outstanding letters of credit totaled $14.8 million as of March 31, 2020 and the Company has $10.2 million available under the revolving Credit Facility for letter of credit.

APC Business Loan

On June 14, 2018, APC amended its promissory note agreement with Preferred Bank, which provides for loan availability of up to $10.0 million with a maturity date of June 22, 2020. This credit facility was subsequently amended on April 17, 2019 and June 11, 2019 to increase the loan availability from $10.0 million to $40.0 million and extend the maturity date through December 31, 2020. On August 1, 2019 and September 10, 2019, this credit facility was further amended to increase loan availability from $40.0 million to $43.8 million, and decrease loan availability from $43.8 million to $4.1 million, respectively. This decrease further limited the purpose of the indebtedness under APC Business Loan Agreement to the issuance of standby

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letters of credit, and added as a permitted lien the security interest in all of its assets granted by APC in favor of NMM under a Security Agreement dated on or about September 11, 2019 securing APC’s obligations to NMM under, and as required pursuant to, the APC management services agreement dated as of July 1, 1999, as amended. The interest rate is based on the Wall Street Journal “prime rate,” plus 0.125%, or 3.375% and 4.875% as of March 31, 2020 and December 31, 2019, respectively.

As of March 31, 2020 and December 31, 2019, there was no availability under this line of credit.

Standby Letters of Credit

On October 2, 2018, APAACO established a second irrevocable standby letter of credit with Preferred Bank (through the NMM Business Loan Agreement) for $6.6 million for the benefit of CMS. The letter of credit expires on December 31, 2020 and is automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution to terminate prior to 90 days from any expiration date. APAACO may continue to draw from the letter of credit for one year following the bank’s notification of non-renewal. This standby letter of credit was subsequently amended on August 14, 2019 to increase amount from $6.6 million to $14.8 million and extended expiration date on December 31, 2020 with all other terms and conditions remain unchanged. In connection with the closing of the Credit Facility, this letter of credit was terminated and reissued under the Credit Agreement.

APC established irrevocable standby letters of credit with Preferred Bank under the APC Business Loan Agreement for a total of $0.3 million for the benefit of certain health plans. The standby letters of credit are automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution in advance of the expiration date that the letter will be terminated.

Alpha Care established irrevocable standby letters of credit with Preferred Bank under the APC Business Loan Agreement for a total of $3.8 million for the benefit of certain health plans. The standby letters of credit are automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution in advance of the expiration date that the letter will be terminated.

10. Mezzanine and Stockholders’ Equity

Mezzanine

As the redemption feature (see Note 2) of the shares is not solely within the control of APC, the equity of APC does not qualify as permanent equity and has been classified as noncontrolling interest in APC as mezzanine or temporary equity. APC’s shares are not redeemable and it is not probable that the shares will become redeemable as of March 31, 2020 and December 31, 2019.

Stockholders’ Equity

As of March 31, 2020, 302,732 holdback shares have not been issued to certain former NMM shareholders who were NMM shareholders at the time of closing of the merger between NMM and ApolloMed in December 2017 (the "Merger"), as they have yet to submit properly completed letters of transmittal to ApolloMed in order to receive their pro rata portion of ApolloMed common stock and warrants as contemplated under the merger agreement. Pending such receipt, such former NMM shareholders have the right to receive, without interest, their pro rata share of dividends or distributions with a record date after the effectiveness of the Merger. The consolidated financial statements have treated such shares of common stock as outstanding, given the receipt of the letter of transmittal is considered perfunctory and the Company is legally obligated to issue these shares in connection with the Merger.

See options and warrants section below for common stock issued upon exercise of stock options and stock purchase warrants.

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Options

The Company’s outstanding stock options consisted of the following:

	Shares		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)	Aggregate Intrinsic Value (in thousands)
Options outstanding at January 1, 2020	607,346		$	9.22	3.42	$	5,600
Options granted	11,742		18.41		—	—
Options exercised	(100,000	)	2.10		—	1,600
Options forfeited	(12,228	)	17.57		—	—
Options outstanding at March 31, 2020	506,860		$	10.63	3.31	$	2,000
Options exercisable at March 31, 2020	375,960		$	6.25	2.11	$	2,000

During the three months ended March 31, 2020 and 2019, stock options were exercised for 100,000 and 6,000 shares, respectively, of the Company’s common stock, which resulted in proceeds of approximately $0.2 million and $27,000, respectively. The exercise price was $2.10 per share for the exercises during the three months ended March 31, 2020 and was $4.50 per share for the exercises during the three months ended March 31, 2019.

During the three months ended March 31, 2020 and 2019, no stock options were exercised pursuant to the cashless exercise provision.

During the three months ended March 31, 2020, the Company granted 11,742five-year stock options to certain ApolloMed board members with an exercise price of $18.41, which were recognized at fair value, as determined using the Black-Scholes option pricing model and the following assumptions:

March 31, 2020	Board Members
Expected term	3.0 years
Expected volatility	90.01		%
Risk-free interest rate	1.43		%
Market value of common stock	$	10.56
Annual dividend yield	—		%
Forfeiture rate	—		%

Restricted Stock Awards

The Company grants restricted stock awards to employees which are earned based on service conditions. The grant date fair value of the restricted stock awards is that day's closing market price of the Company's common stock. During the three months ended March 31, 2020, the Company granted restricted stock awards totaling 97,447 shares with a weighted average grant date fair value of $17.58. The grant date fair value of the restricted stock was $1.6 million to be recognized on a straight-line basis over the awards' vesting period of three years.

During the three months ended March 31, 2020, the Company recorded approximately $0.9 million of share-based compensation expense associated with the issuance of restricted shares of common stock and vesting of stock options which is included in general and administrative expenses in the accompanying consolidated statements of income, respectively. Unrecognized compensation expense related to total share-based payments outstanding as of March 31, 2020 was $4.6 million.

The aggregate intrinsic value is calculated as the difference between the exercise price and the estimated fair value of common stock as of March 31, 2020.

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Warrants

The Company’s outstanding warrants consisted of the following:

	Shares		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)	Aggregate Intrinsic Value (in thousands)
Warrants outstanding at January 1, 2020	3,154,590		$	9.96	2.01	$	26,700
Warrants granted	—		—		—	—
Warrants exercised	(51,601	)	9.50		—	400
Warrants expired/forfeited	—		—		—	—
Warrants outstanding at March 31, 2020	3,102,989		$	9.97	1.78	$	9,200

Exercise Price Per Share		Warrants Outstanding	Weighted Average Remaining Contractual Life	Warrants Exercisable	Weighted Average Exercise Price Per Share
$	9.00	919,048	0.54	919,048	$	9.00
10.00		1,367,451	2.06	1,367,451	10.00
11.00		816,490	2.69	816,490	11.00
$ 9.00 –11.00		3,102,989	1.78	3,102,989	$	9.97

During the three months ended March 31, 2020 and 2019, common stock warrants were exercised for 51,601 and 11,516 shares, respectively, of the Company’s common stock, which resulted in proceeds of approximately $0.5 million and $0.1 million, respectively. The exercise price ranged from $9.00 to $11.00 per share for the exercises during the three months ended March 31, 2020 and 2019, respectively.

Treasury Stock

APC owned 17,307,214 and 17,290,317 shares of ApolloMed’s common stock as of March 31, 2020 and December 31, 2019, which are legally issued and outstanding but excluded from shares of common stock outstanding in the consolidated financial statements, as such shares are treated as treasury shares for accounting purposes (see Note 1).

During the year ended December 31, 2019, APC established a brokerage account to invest excess capital in the equity market. The brokerage account is managed directly by an independent investment committee of the APC board, of which Dr. Kenneth Sim and Dr. Thomas Lam have been excluded. As of March 31, 2020, the brokerage account only held shares of ApolloMed, as such the brokerage account totaling $7.6 million has been recorded as treasury shares.

Dividends

During the three months ended March 31, 2020 and 2019, APC declared dividends of $10.0 million, respectively.

11. Commitments and Contingencies

Regulatory Matters

Laws and regulations governing the Medicare program and healthcare generally are complex and subject to interpretation. The Company believes that it is in compliance with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of potential wrongdoing. While no regulatory inquiries have been made, compliance with such laws and regulations can be subject to future government review and interpretation, as well as significant regulatory action, including fines, penalties, and exclusion from the Medicare and Medi-Cal programs.

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As risk-bearing organizations, APC, Alpha Care and Accountable Health Care are required to comply with California DMHC regulations, including maintenance of minimum working capital, tangible net equity (“TNE”), cash-to-claims ratio and claims payment requirements prescribed by the California DMHC. TNE is defined as net equity less intangibles, less non-allowable assets (which include unsecured amounts due from affiliates), plus subordinated obligations. At March 31, 2020 and December 31, 2019, APC, Alpha Care and Accountable Health Care were in compliance with these regulations.

Many of the Company’s payor and provider contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of medical services. Such differing interpretations may not come to light until a substantial period of time has passed following contract implementation. Liabilities for claims disputes are recorded when the loss is probable and can be estimated. Any adjustments to reserves are reflected in current operations.

Standby Letters of Credit

As part of the APAACO participation with CMS, the Company must provide a financial guarantee to CMS, the guarantee generally must be in an amount equal to 2% of the Company's benchmark Medicare Part A and Part B expenditures. The Company has established an irrevocable standby letter of credit with Preferred Bank of $8.2 million and $6.6 million for the 2019 and 2018 performance years (see Note 9).

APC established irrevocable standby letters of credit with a financial institution for a total of $0.3 million for the benefit of certain health plans. The standby letters of credit are automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution in advance of the expiration date that the letter will be terminated (see Note 9).

Alpha Care established irrevocable standby letters of credit with a financial institution for a total of $3.8 million for the benefit of certain health plans. The standby letters of credit are automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution in advance of the expiration date that the letter will be terminated.

Litigation

From time to time, the Company is involved in various legal proceedings and other matters arising in the normal course of its business. The resolution of any claim or litigation is subject to inherent uncertainty and could have a material adverse effect on the Company’s financial condition, cash flows or results of operations.

Prospect Medical Systems

On or about March 23, 2018 and April 3, 2018, a Demand for Arbitration and an Amended Demand for Arbitration were filed by Prospect Medical Group, Inc. and Prospect Medical Systems, Inc. (collectively, “Prospect”) against MMG, ApolloMed and AMM with Judicial Arbitration Mediation Services in California, arising out of MMG’s purported business plans, seeking damages in excess of $5.0 million, and alleging breach of contract, violation of unfair competition laws, and tortious interference with Prospect’s current and future economic relationships with its health plans and their members. By stipulation and order dated April 28, 2020, both ApolloMed and Apollo Medical Management, Inc. were dismissed without prejudice from the arbitration for lack of jurisdiction on the basis that neither of them were a party to any arbitration agreement with Prospect, subject, however, to Prospect reserving its rights against Apollo and tolling of applicable statute of limitation. MMG disputes the allegations and intends to vigorously defend against this matter. The resolution of this matter and any potential range of loss in excess of any current accrual cannot be reasonably determined or estimated at this time primarily because the matter has not been fully arbitrated and presents unique regulatory and contractual interpretation issues.

Liability Insurance

The Company believes that its insurance coverage is appropriate based upon the Company’s claims experience and the nature and risks of the Company’s business. In addition to the known incidents that have resulted in the assertion of claims, the Company cannot be certain that its insurance coverage will be adequate to cover liabilities arising out of claims asserted against the Company, the Company’s affiliated professional organizations or the Company’s affiliated hospitalists in the future where the outcomes of such claims are unfavorable. The Company believes that the ultimate resolution of all pending claims, including liabilities in excess of the Company’s insurance coverage, will not have a material adverse effect on the Company’s financial position, results of operations or cash flows; however, there can be no assurance that future claims will not have such a material adverse effect on the Company’s business. Contracted physicians are required to obtain their own insurance coverage.

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Although the Company currently maintains liability insurance policies on a claims-made basis, which are intended to cover malpractice liability and certain other claims, the coverage must be renewed annually, and may not continue to be available to the Company in future years at acceptable costs, and on favorable terms.

12. Related-Party Transactions

On November 16, 2015, UCAP entered into a subordinated note receivable agreement with UCI, a 48.9% owned equity method investee (see Note 5), in the amount of $5.0 million. On June 28, 2018 and November 28, 2018, UCAP entered into two additional subordinated note receivable agreements with UCI in the amount of $2.5 million and $5.0 million, respectively (see Note 6).

During the three months ended March 31, 2020 and 2019, NMM earned approximately $4.2 million and $3.2 million, respectively, in management fees from LMA, which is accounted for under the equity method based on 25% equity ownership interest held by APC in LMA’s IPA line of business (see Note 5).

During the three months ended March 31, 2020 and 2019, APC paid approximately $0.6 million and $0.7 million, respectively, to PMIOC for provider services, which is accounted for under the equity method based on 40% equity ownership interest held by APC (see Note 5).

During the three months ended March 31, 2020 and 2019, APC paid approximately $1.8 million and $2.0 million, respectively, to DMG for provider services, which is accounted for under the equity method based on 40% equity ownership interest held by APC (see Note 5).

During the three months ended March 31, 2020 and 2019, APC paid approximately $39,800 and $92,000, respectively, to Advanced Diagnostic Surgery Center for services as a provider. Advanced Diagnostic Surgery Center shares common ownership with certain board members of APC.

During the three months ended March 31, 2020 and 2019, APC paid an aggregate of approximately $7.3 million and $9.3 million, respectively, to shareholders of APC for provider services, which include approximately $1.7 million and $3.3 million, respectively, to shareholders who are also officers of APC.

During the three months ended March 31, 2020 and 2019, NMM paid approximately $0.3 million, respectively, to Medical Property Partners (“MPP”) for an office lease. MPP shares common ownership with certain board members of NMM.

During the three months ended March 31, 2020, NMM paid approximately $0.4 million, respectively, to One MSO, Inc. ("One MSO") for an office lease. One MSO shares common ownership with certain board members of NMM. As of March 31, 2020, the Company had $10.8 million of ROU assets and lease liabilities, respectively, related to its office lease with One MSO to be amortized over the remaining life of the lease.

During the three months ended March 31, 2020 and 2019, the Company paid approximately $0.1 million, respectively, to Critical Quality Management Corporation (“CQMC”) for an office lease. CQMC shares common ownership with certain board members of APC.

During the three months ended March 31, 2020 and 2019, SCHC paid approximately $0.1 million, respectively, to Numen, LLC (“Numen”) for an office lease. Numen is owned by a shareholder of APC.

The Company has agreements with HSMSO, Aurion Corporation (“Aurion”), and AHMC Healthcare (“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. The following table sets forth fees incurred and income earned related to AHMC, HSMSO and Aurion (in thousands):

	Three Months Ended March 31,
	2020			2019
AHMC – Risk pool and capitation	$	11,999		$	11,600
HSMSO – Management fees, net	(132		)	(650		)
Aurion – Management fees	(75		)	(100		)
Net total	$	11,792		$	10,850

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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. During the three months ended March 31, 2020 and 2019, the Company has recognized risk pool revenue under this agreement of $12.0 million and $10.1 million, respectively, for which $47.2 million and $40.4 million remain outstanding as of March 31, 2020 and December 31, 2019, respectively.

During the quarter ended March 31, 2020, NMM paid approximately $26,600 to an Apollo board member for consulting services.

In addition, affiliates wholly owned by the Company’s officers, including the Company's Co-CEOs, Dr. Sim and Dr. Lam, 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.

For equity method investments, loans receivable and line of credits from related parties, see Notes 5, 6 and 9, respectively.

13. Income Taxes

The Company uses the liability method of accounting for income taxes as set forth in ASC 740. Under the liability method, deferred taxes are determined based on differences between the financial statement and tax bases of assets and liabilities using enacted tax rates.

On an interim basis, the Company estimates what its anticipated annual effective tax rate will be and records a quarterly income tax provision (benefit) in accordance with the estimated annual rate, plus the tax effect of certain discrete items that arise during the quarter. As the fiscal year progresses, the Company refines its estimates based on actual events and financial results during the quarter. This process can result in significant changes to the Company’s estimated effective tax rate. When this occurs, the income tax provision (benefit) is adjusted during the quarter in which the estimates are refined so that the year-to-date provision reflects the estimated annual effective tax rate. These changes, along with adjustments to the Company’s deferred taxes and related valuation allowance, may create fluctuations in the overall effective tax rate from quarter to quarter.

As of March 31, 2020 due to the overall cumulative losses incurred in recent years, the Company maintained a full valuation allowance against its deferred tax assets related to loss entities the Company cannot consolidate under the federal consolidation rules, as realization of these assets is uncertain.

The Company’s effective tax rate for the three months ended March 31, 2020 differed from the U.S. federal statutory rate primarily due to state income taxes, income from flow through entities, nondeductible permanent items, and change in valuation allowance.

As of March 31, 2020, the Company does not have any unrecognized tax benefits related to various federal and state income tax matters. The Company will recognize accrued interest and penalties related to unrecognized tax benefits in income tax expense.

The Company is subject to U.S. federal income tax as well as income tax in California. The Company and its subsidiaries’ state and Federal income tax returns are open to audit under the statute of limitations for the years ended December 31, 2015 through December 31, 2018 and for the years ended December 31, 2016 through December 31, 2018, respectively. The Company does not anticipate material unrecognized tax benefits within the next 12 months.

On March 27, 2020, the Coronavirus Aid, Relief and Economic Security Act ("CARES Act") was signed into law. The CARES Act includes various income and payroll tax provisions that we are in the process of analyzing to determine the tax impacts. However, we do not expect the benefits of the CARES Act to impact the Company’s annual estimated tax rate for the period March 31, 2020.

14. Earnings Per Share

Basic earnings per share is calculated using the weighted average number of shares of the Company’s common stock issued and outstanding during a certain period, and is calculated by dividing net income attributable to Apollo Medical Holdings, Inc. by the weighted average number of shares of the Company’s common stock issued and outstanding during such period. Diluted earnings per share is calculated using the weighted average number of shares of common stock and potentially dilutive shares of common stock outstanding during the period, using the as-if converted method for secured convertible notes, preferred stock, and the treasury stock method for options and common stock warrants.

As of March 31, 2020 and December 31, 2019 APC held 17,307,214 and 17,290,317 shares of ApolloMed’s common stock, respectively, which are treated as treasury shares for accounting purposes and not included in the number of shares of common stock outstanding used to calculate earnings per share.

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Below is a summary of the earnings per share computations:

Three Months Ended March 31,	2020		2019
Earnings per share – basic	$	0.11	$	—
Earnings per share – diluted	$	0.11	$	—
Weighted average shares of common stock outstanding – basic	36,010,268		34,496,622
Weighted average shares of common stock outstanding – diluted	37,439,099		38,074,174

Below is a summary of the shares included in the diluted earnings per share computations:

Three Months Ended March 31,	2020	2019
Weighted average shares of common stock outstanding – basic	36,010,268	34,496,622
10% shares held back pursuant to indemnification clause	—	1,519,805
Stock options	185,830	455,381
Warrants	1,207,445	1,602,366
Restricted stock units	35,556	—
Weighted average shares of common stock outstanding – diluted	37,439,099	38,074,174

15. Variable Interest Entities (VIEs)

A VIE is defined as a legal entity whose equity owners do not have sufficient equity at risk, or, as a group, the holders of the equity investment at risk lack any of the following three characteristics: decision-making rights, the obligation to absorb losses, or the right to receive the expected residual returns of the entity. The primary beneficiary is identified as the variable interest holder that has both the power to direct the activities of the VIE that most significantly affect the entity’s economic performance and the obligation to absorb expected losses or the right to receive benefits from the entity that could potentially be significant to the VIE.

The Company follows guidance on the consolidation of VIEs that requires companies to utilize a qualitative approach to determine whether it is the primary beneficiary of a VIE. See Note 2 – “Basis of Presentation and Summary of Significant Accounting Policies” to the accompanying consolidated financial statements for information on how the Company determines VIEs and its treatment.

The following table includes assets that can only be used to settle the liabilities of APC, including Alpha Care and Accountable Health Care, and the creditors of APC, including Alpha Care and Accountable Health Care, have no recourse to the Company, nor do creditors of the Company have recourse against the assets of APC, including Alpha Care and Accountable Health Care. These assets and liabilities, with the exception of the investment in a privately held entity that does not report net asset value per share and amounts due to affiliates, which are eliminated upon consolidation with NMM, are included in the accompanying consolidated balance sheets (in thousands).

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	March 31, 2020		December 31, 2019
Assets
Current assets
Cash and cash equivalents	$	57,015	$	87,110
Restricted cash	75		75
Investment in marketable securities	117,036		123,948
Receivables, net	16,332		9,300
Receivables, net – related party	49,279		42,976
Other receivables	734		744
Prepaid expenses and other current assets	7,257		7,403
Loan receivable	6,425		6,425
Loan receivable – related parties	16,500		16,500
Total current assets	270,653		294,481
Noncurrent assets
Land, property and equipment, net	9,304		9,547
Intangible assets, net	78,247		81,439
Goodwill	108,946		108,913
Investment in privately held entities	223,796		319,930
Investments in other entities – equity method	30,785		28,427
Restricted cash	746		746
Operating lease right-of-use assets	4,444		4,751
Other assets	5,040		1,057
Total noncurrent assets	461,308		554,810
Total assets	$	731,961	$	849,291
Current liabilities
Accounts payable and accrued expenses	$	11,317	$	11,187
Fiduciary accounts payable	1,709		2,027
Medical liabilities	45,029		49,019
Income taxes payable	8,034		4,530
Amount due to affiliate	23,128		28,058
Dividends payable	337		271
Finance lease liabilities	102		102
Operating lease liabilities	1,217		1,088
Total current liabilities	90,873		96,282
Noncurrent liabilities
Deferred tax liability	12,587		14,059
Finance lease liabilities, net of current portion	390		416
Operating lease liabilities, net of current portion	3,336		3,742
Total noncurrent liabilities	16,313		18,217
Total liabilities	$	107,186	$	114,499

The assets of the Company’s other consolidated VIEs were not considered significant.

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16. Leases

The Company has operating and finance leases for corporate offices, doctors’ offices, and certain equipment. These leases have remaining lease terms of 1 month to 5 years, some of which may include options to extend the leases for up to 10 years, and some of which may include options to terminate the leases within one year. As of March 31, 2020 and December 31, 2019, assets recorded under finance leases were $0.5 million, respectively, and accumulated depreciation associated with finance leases was $0.3 million, respectively.

Also, the Company rents or subleases certain real estate to third parties, which are accounted for as operating leases.

Leases with an initial term of 12 months or less are not recorded on the balance sheet.

The components of lease expense were as follows (in thousands):

	Three Months Ended March 31,
	2020			2019
Operating lease cost	$	1,942		$	1,102
Finance lease cost
Amortization of lease expense	$	26		$	25
Interest on lease liabilities	4			5
Sublease income	$	(134	)	$	(100	)
Total finance lease cost, net	$	1,838		$	1,032

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Other information related to leases was as follows (in thousands):

	Three Months Ended March 31,
	2020			2019
Supplemental Cash Flows Information
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	1,547		$	1,034
Operating cash flows from finance leases	4			5
Financing cash flows from finance leases	26			25
Right-of-use assets obtained in exchange for lease liabilities:
Operating leases	4,745			8,855
	Three Months Ended March 31,
	2020			2019
Weighted Average Remaining Lease Term
Operating leases	7.33 years			4.30 years
Finance leases	4.42 years			5.25 years
Weighted Average Discount Rate
Operating leases	6.10		%	6.13		%
Finance leases	3.00		%	3.00		%

Future minimum lease payments under non-cancellable leases as of March 31, 2020 is as follows (in thousands):

March 31, 2020	Operating Leases		Finance Leases
2020 (excluding the three months ended March 31, 2020)	$	3,227	$	89
2021	3,745		119
2022	2,970		119
2023	2,724		119
2024	2,340		79
Thereafter	8,484		—
Total future minimum lease payments	23,490		525
Less: imputed interest	4,788		33
Total lease liabilities	18,702		492
Less: current portion	3,119		102
Long-term lease liabilities	$	15,583	$	390

As of March 31, 2020, the Company does not have additional operating and finance leases that have not yet commenced.

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17. Subsequent Events

Universal Care Inc.

On December 31, 2019, UCAP, entered into an SPA among UCAP, Bright, Bright Health, Inc., UCI, Howard E. And Elaine H. Davis Family Trust, Howard E. And Elaine H. Davis Grandchildren’s Trust, Jeffrey V. Davis, Jay B. Davis, Laura Davis-Loschiavo, Marc M. Davis, Peter And Helen Lee Family Trust, and, in their respective capacities as seller representatives, Kenneth Sim, M.D., Thomas Lam, M.D., Jay Davis and Jeffrey Davis. Pursuant to the SPA, UCAP and all of the other shareholders of UCI agreed to sell to Bright all of their respective shares of capital stock in UCI.

On April 30, 2020, the Closing Date, and pursuant to the SPA, UCAP and all of the other shareholders of UCI sold to Bright all of their respective shares of capital stock in UCI. In connection with such sale, on the Closing Date, APC received approximately $69.2 million in cash proceeds (including $16.5 million as repayment of indebtedness owed to APC), plus non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $33.3 million. In addition, pursuant to the terms of the SPA, upon release from escrow, APC is entitled to receive all or that portion of the following escrowed amounts that have not been offset or reserved for claims: (i) cash consideration of approximately $15.6 million, plus (ii) non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $5.9 million.

Dividends

On May 4, 2020 APC’s board of directors approved a dividend distribution on a pro rata basis to APC’s shareholders totaling $20.0 million, which was paid on May 6, 2020.

ITEM 2.  MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

The following management’s discussion and analysis should be read in conjunction with the unaudited consolidated financial statements and the notes thereto included in Part I, Item 1, “Financial Statements” of this Quarterly Report on Form 10-Q. In addition, reference is made to our audited consolidated financial statements and notes thereto and related Management’s Discussion and Analysis of Financial Condition and Results of Operations included in our Annual Report on Form 10-K for the year ended December 31, 2019, filed with the SEC on March 16, 2020.

Overview

We, together with our affiliated physician groups and consolidated entities, are a physician-centric integrated population health management company providing coordinated, outcomes-based medical care in a cost-effective manner and serving patients in California, the majority of whom are covered by private or public insurance provided through Medicare, Medicaid and HMOs, with a small portion of our revenues coming from non-insured patients. We provide care coordination services to each major constituent of the healthcare delivery system, including patients, families, primary care physicians, specialists, acute care hospitals, alternative sites of inpatient care, physician groups and health plans. Our physician network consists of primary care physicians, specialist physicians and hospitalists. We operate primarily through ApolloMed and the following subsidiaries: NMM, AMM, APAACO and Apollo Care Connect, and their consolidated entities.

Through our NGACO model and a network of IPAs with more than 7,000 contracted physicians, which physician groups have agreements with various health plans, hospitals and other HMOs, we are currently responsible for coordinating the care for over 1.1 million patients in California as of March 31, 2020. These covered patients are comprised of managed care members whose health coverage is provided through their employers or who have acquired health coverage directly from a health plan or as a result of their eligibility for Medicaid or Medicare benefits. Our managed patients benefit from an integrated approach that places physicians at the center of patient care and utilizes sophisticated risk management techniques and clinical protocols to provide high-quality, cost effective care. To implement a patient-centered, physician-centric experience, we also have other integrated and synergistic operations, including (i) MSOs that provide management and other services to our affiliated IPAs, (ii) outpatient clinics and (iii) hospitalists that coordinate the care of patients in hospitals.

Recent Developments

Auditor Change

On April 24, 2020, following a competitive selection process, the Company's Audit Committee approved the engagement of Ernst & Young LLP (“E&Y”) as the Company’s independent registered public accounting firm for the fiscal year ending December 31,

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2020 and dismissed BDO USA, LLP (“BDO”) from service as the Company’s independent registered public accounting firm, effective immediately. The Company engaged E&Y on April 27, 2020.

Disposition of Investment

On April 30, 2020, Universal Care Acquisition Partners, LLC (“UCAP”), a wholly-owned subsidiary of our consolidated variable interest entity, APC, completed the sale of its 48.9% equity ownership interest (its “Percentage Interest”) in Universal Care, Inc. (“UCI”), a private full service health plan provider doing business as Brand New Day to Bright Health Company of California, Inc. (“Bright”). From the sale, APC received approximately $69.2 million in cash proceeds (including $16.5 million as repayment of indebtedness owed to APC), plus non-cash consideration consisting of shares of Bright Heath, Inc.’s preferred stock having a stipulated value of approximately $33.3 million. In addition, upon release from escrow, APC will be entitled to receive all or that portion of the following escrowed amounts that have not been offset or reserved for claims: (i) cash consideration of approximately $15.6 million, plus (ii) non-cash consideration consisting of shares of Bright Health, Inc.'s preferred stock having a stipulated value of approximately $5.9 million.

As disclosed in the Company’s definitive proxy statement filed with the SEC on July 31, 2019 (the “Proxy Statement”), the Percentage Interest is an “Excluded Asset” that remains solely for the benefit of APC and its shareholders. As such, any proceeds or gain on the sale of APC’s indirect ownership interest in UCI will have no impact on the Series A Dividend payable by APC to AP-AMH as described in the Proxy Statement. Accordingly, the sale will not impact net income attributable to the Company. 

Key Financial Measures and Indicators

Operating Revenues

Our revenue primarily consists of capitation revenue, risk pool settlements and incentives, NGACO AIPBP revenue, management fee income and FFS revenue. The form of billing and related risk of collection for such services may vary by type of revenue and the customer.

Operating Expenses

Our largest expense is the patient care cost paid to contracted physicians, and the cost of providing management and administrative support services to our affiliated physician groups. These services include payroll, benefits, human resource services, physician practice billing, revenue cycle services, physician practice management, administrative oversight, coding services, and other consulting services.

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Results of Operations

Apollo Medical Holdings, Inc.

Consolidated Statements of Income

(In thousands)

(Unaudited)

	For the Three Months Ended
	March 31, 2020			March 31, 2019			$ Change			% Change
Revenue
Capitation, net	$	140,421		$	71,517		$	68,904		96	%
Risk pool settlements and incentives	11,236			10,094			1,142			11	%
Management fee income	8,815			8,997			(182		)	(2	)%
Fee-for-services, net	3,427			4,081			(654		)	(16	)%
Other income	1,206			1,069			137			13	%
Total revenue	165,105			95,758			69,347			72	%
Operating expenses
Cost of services	144,204			83,432			60,772			73	%
General and administrative expenses	11,834			10,264			1,570			15	%
Depreciation and amortization	4,702			4,418			284			6	%
Provision for doubtful accounts	—			951			(951		)	(100	)%
Total expenses	160,740			99,065			61,675			62	%
Income (loss) from operations	4,365			(3,307		)	7,672			(232	)%
Other income (expense)
Income (loss) from equity method investments	2,054			(850		)	2,904			(342	)%
Interest expense	(2,868		)	(211		)	(2,657		)	1259	%
Interest income	929			323			606			188	%
Other income	102			187			(85		)	(45	)%
Total other income (expense), net	217			(551		)	768			(139	)%
Income (loss) before provision for (benefit from) income taxes	4,582			(3,858		)	8,440			(219	)%
Provision for (benefit from) income taxes	1,595			(1,408		)	3,003			(213	)%
Net income (loss)	$	2,987		$	(2,450	)	$	5,437		(222	)%
Net loss attributable to noncontrolling interests	(1,065		)	(2,590		)	1,525			(59	)%
Net income attributable to Apollo Medical Holdings, Inc.	$	4,052		$	140		$	3,912		2794	%

Net Income Attributable to Apollo Medical Holdings, Inc.

Our net income attributable to Apollo Medical Holdings, Inc. for the three months ended March 31, 2020 was $4.1 million, as compared to net income attributable to Apollo Medical Holdings, Inc. of $0.1 million for the same period in 2019, an increase of $4.0 million.

Physician Groups and Patients

As of March 31, 2020 and 2019, we managed a total of 13 and 10 groups of affiliated physicians, respectively, and the total number of patients for whom we managed the delivery of healthcare services was approximately 1.1 million and 0.8 million, respectively. The increase was attributable to a management services agreement entered into in 2020 that contributed 0.1 million new members and increased membership at the physician groups we manage.

Revenue

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Our revenue for the three months ended March 31, 2020 was $165.1 million, as compared to $95.8 million for the three months ended March 31, 2019, an increase of $69.3 million, or 72%. The increase in revenue was primarily attributable to the following;

(i) Capitation revenue increased by approximately $68.9 million primarily due to our acquisition of Alpha Care on May 31, 2019 and Accountable Health Care on August 30, 2019, which contributed revenue of approximately $32.5 million and $12.5 million, respectively for such companies, in addition to organic capitation revenue growth at APC of $2 million, for the three months ended March 31, 2020. Further, the capitation revenue for the three months ended March 31, 2020 included $21.9 million from the APA ACO program as compared with nil from the APA ACO program during the same period in 2019 when the program was temporarily suspended.

(ii) Risk pool revenue increased by $1.1 million due to the refinement of the assumptions used to estimate the amount of net surplus expected to be received from the affiliated hospitals’ risk pools. Our estimated risk pool receivable is calculated based on reports received from our hospital partners and on management’s estimate of the Company’s portion of any estimated risk pool surpluses for which payments have not been received. The actual risk pool surpluses are settled approximately 18 months later.

(iii) Management fee income decreased by $0.2 million mainly due to the acquisition of Accountable Health Care offset with increased fees from a management services agreement entered into beginning January 1, 2020 which contributed approximately $1.7 million.

(iv) Fee-for-service revenue decreased by $0.6 million due to reduced procedures performed at our surgery centers and heart center as a result of the COVID-19 outbreak.

(v) Other income increased by $0.1 million as a result of increased revenue related to maternity supplemental payments.

Cost of Services

Expenses related to cost of services for the three months ended March 31, 2020 were $144.2 million, as compared to $83.4 million for the same period in 2019, an increase of $60.8 million, or 73%. The overall increase was due to a $68.3 million increase in medical claims, capitation and other health services expenses, primarily driven by the Alpha Care and Accountable Health Care acquisitions and APA ACO program, and a $2.5 million increase in payroll cost to support the continued growth of the business, offset by a $10.0 million decrease in provider bonus payments.

General and Administrative Expenses

General and administrative expenses for the three months ended March 31, 2020 were $11.8 million, as compared to $10.3 million for the same period in 2019, an increase of $1.5 million, or 15%. The overall increase is primarily due to increased rent expense to support the continued growth in depth and breadth of our operations and postage expense from additional mailings resulting from increased members under management.

Depreciation and Amortization

Depreciation and amortization expense for the three months ended March 31, 2020 were $4.7 million as compared to $4.4 million for the same period in 2019. This amount includes depreciation of property and equipment and the amortization of intangible assets.

Provision for Doubtful Accounts

For the three months ended March 31, 2019, we released reserves related to certain management fees in the amount of $1.0 million as collectability of the outstanding amount was no longer in doubt. These reserves were related to various pre-acquisition obligations of Accountable Health Care and were no longer necessary as a result of our acquisition of Accountable Health Care. As such our provision for doubtful accounts was nil for the three months ended March 31, 2020.

Income (Loss) from Equity Method Investments

Income from equity method investments for the three months ended March 31, 2020 was $2.1 million, as compared to loss from equity method investments of $0.9 million for the same period in 2019, an increase of $3.0 million, or 342%. The increase was primarily due to equity earnings from our investments in UCI and PMIOC of $2.7 million and $0.1 million, respectively, offset by equity losses from our investments in LMA's IPA line of business and 531 W. College of $0.6 million and $0.1 million, respectively, for the three months ended March 31, 2020, as compared with losses from our investments in LMA’s IPA line of

49

business and Accountable Health Care of $1.1 million and $0.8 million, respectively, and impairment loss of $0.3 million related to our investment in Pacific Ambulatory Surgery Center, LLC, which were offset by earnings from our investments in UCI, DMG, and PMIOC of $1.0 million, $0.2 million, and $0.1 million, respectively for the three months ended March 31, 2019.

Interest Expense

Interest expense for the three months ended March 31, 2020 was $2.9 million, as compared to $0.2 million for the same period in 2019, an increase of $2.7 million, or 1,259%. The increase was primarily due to the new credit facility we secured in September 2019 to fund growth, primarily through acquisitions.

Interest Income

Interest income for the three months ended March 31, 2020 was $0.9 million as compared to $0.3 million for the three months ended March 31, 2019. Interest income reflects interest earned on cash held in money market and certificate of deposit accounts and the interest from notes receivable.

Other Income

Other income for the three months ended March 31, 2020 was $0.1 million as compared to other income of $0.2 million for the same period in 2019.

Provision for (Benefit from) Income Tax

Income tax expense was $1.6 million for the three months ended March 31, 2020, as compared to a tax benefit of $1.4 million for the same period in 2019. The increase in tax expense was due to increased income in the three months ended March 31, 2020 period as compared to the same period in 2019, as described above.

Net Income Attributable to Noncontrolling Interests

Net loss attributable to noncontrolling interests was $1.1 million for the three months ended March 31, 2020 compared to $2.6 million for the same period in 2019, a decrease of $1.5 million, or 59%. The decrease was primarily due to reduced cost of sales at APC mainly attributable to a provider bonus issued in the three months period ended March 31, 2019, which was offset by the completion of a series transactions with APC as further described in Note 1 to our financial statements above, which resulted in preferred, cumulative dividends from APC being allocated to AP-AMH.

2020 Guidance

Our stable, subscription-based revenue model allows us to maintain our previously disclosed 2020 guidance for total revenue and adjusted Earnings Before Interest, Taxes, Depreciation and Amortization (“EBITDA”). We are updating our 2020 guidance for net income and EBITDA to incorporate the impact of the expected gain of approximately $80.0 million related to the sale of UCAP's 48.9% investment in UCI to Bright, which closed on April 30, 2020. As UCI was an excluded asset and remained solely for the benefit of APC and its shareholders, any proceeds or gain on sale will not affect the net income and adjusted EBITDA attributable to ApolloMed.

Our guidance for the year ending December 31, 2020, is as follows:

• Maintaining total revenue of between $665.0 million and $675.0 million,

• Adjusting net income from a range of $20.0 million and $30.0 million (disclosed on March 12, 2020) to a range of $100.0 million and $110.0 million, the increase is primarily driven by the sale of UCI to Bright as disclosed above,

• Adjusting EBITDA from a range of $55.0 million and $67.0 million (disclosed on March 12, 2020) to a range of $155.0 million and $167.0 million, the increase is primarily driven by the sale of UCI to Bright as disclosed above, and

• Maintaining adjusted EBITDA of between $75.0 million and $90.0 million.

Refer to the "Guidance Reconciliation of Net Income to EBITDA and adjusted EBITDA" and "Use of Non-GAAP Financial Measures" for additional information. There can be no assurance that actual amounts will not be materially higher or lower than these expectations. Refer to our discussion of "Forward-Looking Statements" within this Quarterly Report on Form 10-Q.

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Guidance Reconciliation of Net Income to EBITDA and Adjusted EBITDA (in thousands)
	Year Ending
	December 31, 2020
	Low			High
Net income(1)	$	100,000		$	110,000
Depreciation and amortization	18,000			20,000
Provision for income taxes	30,000			31,000
Interest expense	8,000			9,000
Interest income	(1,000		)	(3,000		)
EBITDA(1)	155,000			167,000
Income from equity method investments (2)	(95,000		)	(94,000		)
EBITDA adjustment for recently acquired IPAs	15,000			17,000
Adjusted EBITDA	$75,000			$90,000

⁽¹⁾ Net income and EBITDA includes the expected gain on sale of UCAP's 48.9% investment in UCI to Bright, which closed on April 30, 2020. UCAP is a 100% owned subsidiary of APC and its 48.9% investment in UCI is an excluded asset and as such remained solely for the benefit of APC and its shareholders. As such, any proceeds or gain on sale will not affect the net income and adjusted EBITDA attributable to ApolloMed.

⁽²⁾ Income from equity method investments is mainly attributed to the sale of UCAP's 48.9% investment in UCI to Bright, which closed on April 30, 2020. UCAP is a 100% owned subsidiary of APC and its 48.9% investment in UCI is an excluded asset and as such remained solely for the benefit of APC and its shareholders. As such, any proceeds or gain on sale will not affect the net income and adjusted EBITDA attributable to ApolloMed.

Use of Non-GAAP Financial Measures

This Quarterly Report on Form 10-Q contains the non-GAAP financial measures EBITDA and adjusted EBITDA, of which the most directly comparable financial measure presented in accordance with GAAP is net (loss) income. These measures are not in accordance with, or an alternative to, U.S. generally accepted accounting principles, (“GAAP”), and may be different from other non-GAAP financial measures used by other companies. The Company uses adjusted EBITDA as a supplemental performance measure of our operations, for financial and operational decision-making, and as a supplemental means of evaluating period-to-period comparisons on a consistent basis. Adjusted EBITDA is calculated as earnings before interest, taxes, depreciation, and amortization, excluding losses from equity method investments and other income earned that is not related to the Company's normal operations. Adjusted EBITDA also excludes the effect on EBITDA of certain IPAs we recently acquired.

The Company believes the presentation of these non-GAAP financial measures provides investors with relevant and useful information as it allows investors to evaluate the operating performance of the business activities without having to account for differences recognized because of non-core and non-recurring financial information. When GAAP financial measures are viewed in conjunction with non-GAAP financial measures, investors are provided with a more meaningful understanding of ApolloMed's ongoing operating performance. In addition, these non-GAAP financial measures are among those indicators the Company uses as a basis for evaluating operational performance, allocating resources and planning and forecasting future periods. Non-GAAP financial measures are not intended to be considered in isolation, or as a substitute for, GAAP financial measures. To the extent this release contains historical or future non-GAAP financial measures, the Company has provided corresponding GAAP financial measures for comparative purposes. Reconciliation between certain GAAP and non-GAAP measures is provided above.

Liquidity and Capital Resources

Cash, cash equivalents and investment in marketable securities at March 31, 2020 totaled $198.0 million. Working capital totaled $211.5 million at March 31, 2020, as compared to $223.7 million at December 31, 2019, a decrease of $12.2 million, or 5.5%.

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We have historically financed our operations primarily through internally generated funds. We generate cash primarily from capitations, risk pool settlements and incentives, fees for medical management services provided to our affiliated physician groups, as well as fee-for-service reimbursements. We generally invest cash in money market accounts, which are classified as cash and cash equivalents. We believe we have sufficient liquidity to fund our operations at least through the next 12 months.

Our cash, cash equivalents and restricted cash decreased by $22.3 million from $104.0 million at December 31, 2019 to $81.7 million at March 31, 2020. Cash used in operating activities during the three months ended March 31, 2020 was $9.3 million, as compared to $4.0 million for the three months ended March 31, 2019. The cash used in operations during the three months ended March 31, 2020 is a function of net income of $3.0 million, adjusted for the following non-cash operating items: depreciation and amortization of $5.0 million, share-based compensation of $1.1 million, offset by earnings from equity method investments of approximately $2.1 million, unrealized gain from investment in equity securities of $0.2 million and a change in deferred tax liability of $1.9 million. Our cash provided by operating activities included a net decrease in operating assets and liabilities of $14.2 million.

Cash used in investing activities during the three months ended March 31, 2020 was $0.9 million as compared to $0.1 million for the three months ended March 31, 2019, due primarily to the purchases of marketable securities of $0.4 million, funding for an equity method investment of $0.3 million, and capital expenditures (mainly purchases of property and equipment) of $0.2 million, during the three months ended March 31, 2020.

Cash used in financing activities during the three months ended March 31, 2020 was $12.1 million as compared to $9.8 million for the three months ended March 31, 2019. This change was primarily due to the repayment on our term loan totaling $2.3 million during the three months ended March 31, 2020.

Credit Facilities

Credit Facility

The Company's credit facility consisted of the following (in thousands):

	March 31, 2020
Term loan A	$	185,250
Revolver loan	60,000
Total debt	245,250
Less: Current portion of debt	(9,500		)
Less: Unamortized financing costs	(5,645		)
Long-term debt	$	230,105

The following table presents scheduled maturities of the Company's credit facility as of March 31, 2020 (in thousands):

	Amount
2020 (excluding the three months ended March 31, 2020)	$	7,125
2021	10,688
2022	14,250
2023	15,437
2024	197,750
Total	$	245,250

Credit Agreement

On September 2019, the Company entered into a secured credit agreement (the “Credit Agreement”) with SunTrust Bank, in its capacity as administrative agent for the lenders (in such capacity, the “Agent”), as a lender, an issuer of letters of credit and

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as swingline lender, and Preferred Bank, JPMorgan Chase Bank, N.A., MUFG Union Bank, N.A., Royal Bank of Canada, Fifth Third Bank and City National Bank, as lenders (the “Lenders”). In connection with the closing of the Credit Agreement, the Company, its subsidiary, NMM, and the Agent entered into a Guaranty and Security Agreement (the “Guaranty and Security Agreement”), pursuant to which, among other things, NMM guaranteed the obligations of the Company under the Credit Agreement.

The Credit Agreement provides for a five-year revolving credit facility to the Company of $100.0 million ("Revolver Loan"), which includes a letter of credit subfacility of up to $25.0 million. The Credit Agreement also provides for a term loan of $190.0 million, ("Term Loan A"). The unpaid principal amount of the term loan is payable in quarterly installments on the last day of each fiscal quarter commencing on December 31, 2019. The principal payment for each of the first eight fiscal quarters is $2.4 million, for the following eight fiscal quarters is $3.6 million and for the following three fiscal quarters is $4.8 million. The remaining principal payment on the term loan is due on September 11, 2024.

The proceeds of the term loan and up to $60.0 million of the revolving credit facility may be used to (i) finance a portion of the $545.0 million loan made by the Company to AP-AMH, concurrently with the closing of the Credit Agreement (the “AP-AMH Loan”) as described in the May 13, 2019 Current Report and the August 29, 2019 Current Report, (ii) refinance certain indebtedness of the Company and its subsidiaries and, indirectly, APC, (iii) pay transaction costs and expenses arising in connection with the Credit Agreement, the AP-AMH Loan and certain other related transactions and (iv) provide for working capital, capital expenditures and other general corporate purposes. The remainder of the revolving credit facility will be used to finance future acquisitions and investments and to provide for working capital needs, capital expenditures and other general corporate purposes.

The Company is required to pay an annual facility fee of 0.20% to 0.35% on the available commitments under the Credit Agreement, regardless of usage, with the applicable fee determined on a quarterly basis based on the Company’s leverage ratio. The Company is also required to pay customary fees as specified in a separate fee agreement between the Company and SunTrust Robinson Humphrey, Inc., the lead arranger of the Credit Agreement.

Amounts borrowed under the Credit Agreement will bear interest at an annual rate equal to either, at the Company’s option, (a) the rate for Eurocurrency deposits for the corresponding deposits of U.S. dollars appearing on Reuters LIBOR01screen page (“LIBOR”), adjusted for any reserve requirement in effect, plus a spread of from 2.00% to 3.00%, as determined on a quarterly basis based on the Company’s leverage ratio, or (b) a base rate, plus a spread of 1.00% to 2.00%, as determined on a quarterly basis based on the Company’s leverage ratio. As of March 31, 2020, the interest rate on Term Loan A was 3.57% and Revolver Loan was 3.24%. The base rate is defined in a manner such that it will not be less than LIBOR. The Company will pay fees for standby letters of credit at an annual rate equal to 2.00% to 3.00%, as determined on a quarterly basis based on the Company’s leverage ratio, plus facing fees and standard fees payable to the issuing bank on the respective letter of credit. Loans outstanding under the Credit Agreement may be prepaid at any time without penalty, except for LIBOR breakage costs and expenses. If LIBOR ceases to be reported, the Credit Agreement requires the Company and the Agent to endeavor to establish a commercially reasonable alternative rate of interest and until they are able to do so, all borrowings must be at the base rate.

The Credit Agreement requires the Company and its subsidiaries to comply with various affirmative covenants, including, without limitation, furnishing updated financial and other information, preserving existence and entitlements, maintaining properties and insurance, complying with laws, maintaining books and records, requiring any new domestic subsidiary meeting a materiality threshold specified in the Credit Agreement to become a guarantor thereunder and paying obligations. The Credit Agreement requires the Company and its subsidiaries to comply with, and to use commercially reasonable efforts to the extent permitted by law to cause certain material associated practices of the Company, including APC, to comply with, restrictions on liens, indebtedness and investments (including restrictions on acquisitions by the Company), subject to specified exceptions. The Credit Agreement also contains various other negative covenants binding the Company and its subsidiaries, including, without limitation, restrictions on fundamental changes, dividends and distributions, sales and leasebacks, transactions with affiliates, burdensome agreements, use of proceeds, maintenance of business, amendments of organizational documents, accounting changes and prepayments and modifications of subordinated debt.

The Credit Agreement requires the Company to comply with two key financial ratios, each calculated on a consolidated basis. The Company must maintain a maximum consolidated leverage ratio of not greater than 3.75 to 1.00 as of the last day of each fiscal quarter. The maximum consolidated leverage ratio decreases by 0.25 each year, until it is reduced to 3.00 to 1.00 for each fiscal quarter ending after September 30, 2022. The Company must maintain a minimum consolidated interest coverage ratio of not less than 3.25 to 1.00 as of the last day of each fiscal quarter. As of March 31, 2020, the Company was in compliance with the covenants relating to its credit facility.

Pursuant to the Guaranty and Security Agreement, the Company and NMM have granted the Lenders a security interest in all of their assets, including, without limitation, all stock and other equity issued by their subsidiaries (including NMM) and all rights with respect to the AP-AMH Loan. The Guaranty and Security Agreement requires the Company and NMM to comply with various affirmative and negative covenants, including, without limitation, covenants relating to maintaining perfected security

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interests, providing information and documentation to the Agent, complying with contractual obligations relating to the collateral, restricting the sale and issuance of securities by their respective subsidiaries and providing the Agent access to the collateral.

The Credit Agreement contains events of default, including, without limitation, failure to make a payment when due, default on various covenants in the Credit Agreement, breach of representations or warranties, cross-default on other material indebtedness, bankruptcy or insolvency, occurrence of certain judgments and certain events under the Employee Retirement Income Security Act of 1974 aggregating more than $10.0 million, invalidity of the loan documents, any lien under the Guaranty and Security Agreement ceasing to be valid and perfected, any change in control, as defined in the Credit Agreement, an event of default under the AP-AMH Loan, failure by APC to pay dividends in cash for any period of two consecutive fiscal quarters, failure by AP-AMH to pay cash interest to the Company, or if any modification is made to the Certificate of Determination or the Special Purpose Shareholder Agreement that directly or indirectly restricts, conditions, impairs, reduces or otherwise limits the payment of the Series A Preferred dividend by APC to AP-AMH. In addition, it will constitute an event of default under the Credit Agreement if APC uses all or any portion of the consideration received by APC from AP-AMH on account of AP-AMH’s purchase of Series A Preferred Stock for any purpose other than certain specific approved uses described in the following sentence, unless not less than 50.01% of all holders of common stock of APC at such time approve such use; provided that APC may use up to $50.0 million in the aggregate of such consideration for any purpose without any requirement to obtain such approval of the holders of common stock of APC. The approved uses include (i) any permitted investment, (ii) any dividend or distribution to the holders of the common stock of APC, (iii) any repurchase of common stock of APC, (iv) paying taxes relating to or arising from certain assets and transactions, or (v) funding losses, deficits or working capital support on account of certain non-healthcare assets in an amount not to exceed $125.0 million. If any event of default occurs and is continuing under the Credit Agreement, the Lenders may terminate their commitments, and may require the Company and its guarantors to repay outstanding debt and/or to provide a cash deposit as additional security for outstanding letters of credit. In addition, the Agent, on behalf of the Lenders, may pursue remedies under the Guaranty and Security Agreement, including, without limitation, transferring pledged securities of the Company’s subsidiaries in the name of the Agent and exercising all rights with respect thereto (including the right to vote and to receive dividends), collect on pledged accounts, instruments and other receivables (including the AP-AMH Loan), and all other rights provided by law or under the loan documents and the AP-AMH Loan.

In the ordinary course of business, certain of the Lenders under the Credit Agreement and their affiliates have provided to the Company and its subsidiaries and the associated practices, and may in the future provide, (i) investment banking, commercial banking (including pursuant to certain existing business loan and credit agreements being terminated in connection with entering into the Credit Agreement), cash management, foreign exchange or other financial services, and (ii) services as a bond trustee and other trust and fiduciary services, for which they have received compensation and may receive compensation in the future.

Deferred Financing Costs

The Company recorded deferred financing costs of $6.4 million related to the issuance of the credit facility. This amount was recorded as a direct reduction of the carrying amount of the related debt liability. The deferred financing costs will be amortized over the life of the credit facility using the effective interest rate method.

Effective Interest Rate

The Company’s average effective interest rate on its total debt during the three months ended March 31, 2020 and 2019 was 4.24% and 5.47%, respectively. Interest expense in the consolidated statements of income included amortization of deferred debt issuance costs for the three months ended March 31, 2020 and 2019 of $0.3 million and $0, respectively.

Lines of Credit – Related Party

NMM Business Loan

On June 14, 2018, NMM amended its promissory note agreement with Preferred Bank (“NMM Business Loan Agreement”), which provides for loan availability of up to $20 million with a maturity date of June 22, 2020. One of the Company’s board members is the Chairman and CEO of Preferred Bank. The NMM Business Loan Agreement was subsequently amended on September 1, 2018 to temporarily increase the loan availability from $20 million to $27 million for the period from September 1, 2018 through January 31, 2019, further extended to October 31, 2019 to facilitate the issuance of an additional standby letter of credit for the benefit of CMS. The interest rate is based on the Wall Street Journal “prime rate,” plus 0.125%, or 5.625% as of December 31, 2018. The loan was guaranteed by Apollo Medical Holdings, Inc. and is collateralized by substantially all of the assets of NMM. The amounts outstanding as of June 30, 2019 of $5.0 million was fully repaid on September 11, 2019.

On September 5, 2018, NMM entered into a non-revolving line of credit agreement with Preferred Bank, which provides for loan availability of up to $20.0 million with a maturity date of September 5, 2019. This credit facility was subsequently amended

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on April 17, 2019 and July 29, 2019 to reduce the loan availability from $20.0 million to $16.0 million and from $16.0 million to $2.2 million, respectively. The interest rate is based on the Wall Street Journal “prime rate,” plus 0.125%, or 3.375% as of March 31, 2020 and 4.875% as of December 31, 2019. The line of credit is guaranteed by Apollo Medical Holdings, Inc. and is collateralized by substantially all assets of NMM. NMM obtained this line of credit to finance potential acquisitions. Each drawdown from the line of credit is converted into a five-year term loan with monthly principal payments plus interest based on a five-year amortization schedule.

On September 11, 2019, the Business Loan Agreement, dated as of June 14, 2018, between NMM and Preferred Bank, as amended, and the Line of Credit Agreement, dated as of September 5, 2018, between NMM and Preferred Bank, as amended, was terminated in connection with the closing of the Credit Facility. Certain letters of credit issued by Preferred Bank under the Line of Credit Agreement was terminated and reissued under the Credit Agreement. These outstanding letters of credit totaled $14.8 million as of March 31, 2020. As of March 31, 2020, the Company had $10.2 million available under the Credit Facility to be used for the issuance of letters of credit.

APC Business Loan

On June 14, 2018, APC amended its promissory note agreement with Preferred Bank, which provides for loan availability of up to $10.0 million with a maturity date of June 22, 2020. This credit facility was subsequently amended on April 17, 2019 and June 11, 2019 to increase the loan availability from $10.0 million to $40.0 million and extend the maturity date through December 31, 2020. On August 1, 2019 and September 10, 2019, this credit facility was further amended to increase loan availability from $40.0 million to $43.8 million, and decrease loan availability from $43.8 million to $4.1 million, respectively. This decrease further limited the purpose of the indebtedness under APC Business Loan Agreement to the issuance of standby letters of credit, and added as a permitted lien the security interest in all of its assets granted by APC in favor of NMM under a Security Agreement dated on or about September 11, 2019 securing APC’s obligations to NMM under, and as required pursuant to, the APC management services agreement dated as of July 1, 1999, as amended. The interest rate is based on the Wall Street Journal “prime rate,” plus 0.125%, or 3.375% and 4.875% as of March 31, 2020 and December 31, 2019, respectively.

As of March 31, 2020 and December 31, 2019, there was no availability under this line of credit.

Intercompany Loans

Each of AMH, MMG, BAHA, Apollo Care Connect, AKM Medical Group, Inc. (AKM) and SCHC has entered into an Intercompany Loan Agreement with AMM under which AMM has agreed to provide a revolving loan commitment to each such affiliated entities in an amount set forth in each Intercompany Loan Agreement. Each Intercompany Loan Agreement provides that AMM’s obligation to make any advances automatically terminates concurrently with the termination of the management agreement with the applicable affiliated entity. In addition, each Intercompany Loan Agreement provides that (i) any material breach by the shareholder of record of the applicable Physician Shareholder Agreement or (ii) the termination of the management agreement with the applicable affiliated entity constitutes an event of default under the Intercompany Loan Agreement. All the intercompany loans have been eliminated in consolidation (in thousands).

					Three Months Ended March 31, 2020
Entity	Facility		Interest rate per Annum		Maximum Balance During Period		Ending Balance		Principal Paid During Period		Interest Paid During Period
AMH	$	10,000	10	%	$	5,996	$	5,996	$	—	$	—
Apollo Care Connect	1,000		10	%	1,283		1,283		—		—
MMG	3,000		10	%	3,482		3,482		—		—
AKM	5,000		10	%	—		—		—		—
SCHC	5,000		10	%	4,865		4,865		—		—
BAHA	250		10	%	4,066		4,066		—		—
	$	24,250			$	19,692	$	19,692	$	—	$	—

Critical Accounting Policies and Estimates

The preparation of financial statements and related disclosures in conformity with U.S. GAAP requires our management to make judgments, assumptions and estimates that affect the amounts of revenue, expenses, income, assets and liabilities, reported in our consolidated financial statements and accompanying notes. Actual results and the timing of recognition of such amounts could

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differ from those judgments, assumptions and estimates. In addition, judgments, assumptions and estimates routinely require adjustment based on changing circumstances and the receipt of new or better information. Understanding our accounting policies and the extent to which our management uses judgment, assumptions and estimates in applying these policies, therefore, is integral to understanding our financial statements. Critical accounting policies and estimates are defined as those that are reflective of significant judgments and uncertainties, and potentially result in materially different results under different assumptions and conditions. We summarize our most significant accounting policies in relation to the accompanying consolidated financial statements in Note 2 thereto. Please also refer to the Critical Accounting Policies section of Management’s Discussion and Analysis of Financial Condition and Results of Operations included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2019.

New Accounting Pronouncements

See Note 2 to the accompanying consolidated financial statements for recently issued accounting pronouncements, including information on new accounting standards and the future adoption of such standards.

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Off Balance Sheet Arrangements

As of March 31, 2020, we had no off-balance sheet arrangements that have or are reasonably likely to have a current or future effect on our financial condition, changes in financial condition, revenues or expenses, results of operations, liquidity, capital expenditures or capital resources that are material to investors.

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Inflation

Inflation and changing prices have had no effect on our continuing operations over our two most recent fiscal years.

ITEM 3.  QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

Interest Rate Risk

Borrowings under our Credit Agreement exposed us to interest rate risk. As of March 31, 2020, we had $245.3 million in outstanding borrowings under our Credit Agreement. Amount borrowed under the Credit Agreement bears interest at an annual rate equal to either, at the Company's option, (a) the rate for Eurocurrency deposits for the corresponding deposits of U.S. dollars appearing on LIBOR, adjusted for any reserve requirement in effect, plus a spread of 2.00% to 3.00%, as determined on a quarterly basis based on the Company's leverage ratio, or (b) a base rate, plus a spread of 1.00% to 2.00%, as determined on a quarterly basis based on the Company's leverage ratio. The base rate is defined in a manner such that it will not be less than LIBOR. The Company will pay fees for standby letters of credit at an annual rate equal to 2.00% to 3.00%, as determined on a quarterly basis based on the Company’s leverage ratio, plus facing fees and standard fees payable to the issuing bank on the respective letter of credit. A hypothetical 1% change in our interest rates would have increased or decreased our interest expense for the three months ended March 31, 2020 by $2.5 million.

ITEM 4.  CONTROLS AND PROCEDURES

Evaluation of Disclosure Controls and Procedures

As of March 31, 2020, we carried out an evaluation, under the supervision and with the participation of our management, including our Co-Chief Executive Officers and Chief Financial Officer, of the effectiveness of the design and operation of our disclosure controls and procedures. Based on that evaluation, our management, including Co-Chief Executive Officers and Chief Financial Officer, concluded that our disclosure controls and procedures as defined in Rules 13a-15(e) and 15(d)-15(e) under the Securities Exchange Act of 1934, as amended (Exchange Act), were effective as of March 31, 2020 to ensure that information required to be disclosed by us in this Quarterly Report on Form 10-Q or submitted under the Exchange Act is (i) recorded, processed, summarized and reported within the time periods specified in the Securities and Exchange Commission rules and forms and (ii) accumulated and communicated to our management, including our principal executive officers and principal financial officer, as appropriate, to allow timely decisions regarding required disclosures.

Changes in Internal Control Over Financial Reporting

There were no other changes in our internal control over financial reporting (as defined in Rule 13a-15(f) under the Securities Exchange Act of 1934, as amended) during the period covered by this quarterly report that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

As previously disclosed in the Current Report on Form 8-K filed by Apollo Medical Holdings, Inc. with the Securities and Exchange Commission (the “SEC”) on May 6, 2020, we expected that the filing of this Quarterly Report on Form 10-Q for the three months ended March 31, 2020, originally due on May 11, 2020, would be delayed due to circumstances related to the 2019 Novel Coronavirus (COVID-19) outbreak. In particular, the impact of COVID-19 on the Company and our employees, including our adoption of precautionary measures, such as the work from home policy we implemented to protect our employees, made in conjunction with state and local orders, caused limited employee access to our facilities and disrupted normal interactions amongst our accounting personnel. Further, as disclosed in our Current Report on Form 8-K filed with the SEC on April 28, 2020, following a competitive selection process, our Audit Committee dismissed BDO USA, LLP as our independent registered public accounting firm on April 24, 2020 and engaged Ernst & Young LLP as our independent registered public accounting firm for the fiscal year ending December 31, 2020 on April 27, 2020. The impact of these precautionary measures, including our work from home policy, on our accounting personnel, as well as the sharing of necessary documentation and communications with our new independent registered public accounting firm, which was done remotely, slowed our routine quarterly close process and ability to prepare our unaudited consolidated financial statements as of and for the three months ended March 31, 2020, thus causing a delay in our ability to complete and file this Quarterly Report on Form 10-Q. The Company relied on Release No. 34-88465 issued by the SEC on March 25, 2020, pursuant to Section 36 of the Securities Exchange Act of 1934, as amended, to delay the filing of this Quarterly Report on Form 10-Q. The Company has taken steps, including utilizing additional technology, to reduce the impact of our work from home policy and its impact on our accounting personnel and as such will expect to meet the filing deadline for the Quarterly Report on Form 10-Q for the three months ended June 30, 2020 even if circumstances related to COVID-19 outbreak continue to exist.

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PART II – OTHER INFORMATION

ITEM 1.  LEGAL PROCEEDINGS

In the ordinary course of our business, we from time to time become involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services that are provided by our affiliated hospitalists. Many of the Company’s payor and provider contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of medical services, which may not come to light until a substantial period of time has passed following contract implementation. We may also become subject to other lawsuits which could involve significant claims and/or significant defense costs, but as of the date of this Quarterly Report on Form 10-Q, except as disclosed, we are not a party to any lawsuit or proceeding, which in the opinion of management is expected to individually or in the aggregate have a material adverse effect on us or our business. Nonetheless, the resolution of any claim or litigation is subject to inherent uncertainty and could have a material adverse effect on the Company’s financial condition, cash flows or results of operations.

ITEM 1A. RISK FACTORS

Our business, financial condition and operating results are affected by a number of factors, whether currently known or unknown, including risks specific to us or the healthcare industry, as well as risks that affect businesses in general. In addition to the information and risk factors set forth in this Quarterly Report, you should carefully consider the factors discussed in Part I, Item 1A, “Risk Factors” in our Annual Report on Form 10-K for the year ended December 31, 2019 filed with the SEC on March 16, 2020. The risks disclosed in such Annual Report and in this Quarterly Report could materially adversely affect our business, financial condition, cash flows or results of operations and thus our stock price. We believe there have been no material changes in our risk factors from those disclosed in the Annual Report except as described below. However, additional risks and uncertainties not currently known or we currently deem to be immaterial may also materially adversely affect our business, financial condition or results of operations.

These risk factors may be important to understanding other statements in this Quarterly Report and should be read in conjunction with the consolidated financial statements and related notes in Part I, Item 1, “Financial Statements” and Part I, Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” of this Quarterly Report on Form 10-Q. Because of such risk factors, as well as other factors affecting the Company’s financial condition and operating results, past financial performance should not be considered to be a reliable indicator of future performance, and investors should not use historical trends to anticipate results or trends in future periods.

Our operations and financial results could be adversely effected by a national or localized outbreak of a highly contagious disease or other public health crisis, and a pandemic outside of the United States could also adversely impact our business.

An epidemic outbreak or other public health crisis nationally or in the markets where we operate could adversely affect our operations and financial results.  For example, the recent outbreak of the 2019 Novel Coronavirus (COVID-19), which has been declared a global pandemic, has caused governments and the private sector to take a number of drastic precautionary measures to contain the spread of the coronavirus, including the suspension of classes at various colleges and universities, the cancellation of public events and other nonessential mass gatherings and the implementation of work from home, stay at home and other quarantine mandates.  In order to protect our employees, we have implemented a number of precautionary measures, including a work from home policy, under which the vast majority of our employees currently operate. Such measures may have a substantial impact on employee attendance or productivity, or adversely affect our ability to recruit, attract or retain skilled personnel, which in turn may adversely affect our operations, including our ability to effectively provide management services to our affiliated IPAs and contracted physician groups in compliance with regulatory requirements.  An extended outbreak may also result in disruptions to critical infrastructures and our supply chains and the supply chains of our affiliated IPAs and contracted physician groups, including the supply of pharmaceuticals and medical supplies.  The duration and extent of the impact from the coronavirus outbreak depends on future developments that cannot be accurately predicted at this time, such as the severity and transmission rate of the virus, the extent and effectiveness of containment actions. If we are not able to respond to and manage the impact of such events effectively, our business could be harmed.

This risk factor may be important to understanding other statements in this Quarterly Report and should be read in conjunction with the consolidated financial statements and related notes in Part I, Item 1, “Financial Statements” and Part I, Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” of this Quarterly Report. Because of such risk factors, as well as other factors affecting the Company’s financial condition and operating results, past financial performance should not be considered to be a reliable indicator of future performance, and investors should not use historical trends to anticipate results or trends in future periods.

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ITEM 2.  UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

During the three months ended March 31, 2020, the Company issued an aggregate of 44,356 shares of common stock and received approximately $414,110 from the exercise of certain warrants at exercise prices between $9.00 and $10.00 per share. The foregoing issuances were exempt from the registration provisions of the Securities Act of 1933, as amended, pursuant to Section 4(a)(2) thereof, and/or Regulation D promulgated thereunder.

ITEM 3.  DEFAULTS UPON SENIOR SECURITIES

None

ITEM 4. MINE SAFETY DISCLOSURES

Not applicable.

ITEM 5.  OTHER INFORMATION

None.

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ITEM 6.  EXHIBITS

The following exhibits are either incorporated by reference into or filed or furnished with this Quarterly Report on Form 10-Q, as indicated below.

Exhibit No.	Description
2.1†	Agreement and Plan of Merger, dated December 21, 2016, among Apollo Medical Holdings, Inc., Network Medical Management, Inc., Apollo Acquisition Corp. and Kenneth Sim, M.D. (the “Merger Agreement”) (incorporated herein by reference to Annex A to the joint proxy statement/prospectus filed pursuant to Rule 424(b)(3) on November 15, 2017 that is a part of a Registration Statement on Form S-4).
2.2	Amendment to the Merger Agreement, dated March 30, 2017, among Apollo Medical Holdings, Inc., Network Medical Management, Inc., Apollo Acquisition Corp. and Kenneth Sim, M.D. (incorporated herein by reference to Annex A to the joint proxy statement/prospectus filed pursuant to Rule 424(b)(3) on November 15, 2017 that is a part of a Registration Statement on Form S-4).
2.3	Amendment No. 2 to the Merger Agreement, dated October 17, 2017, among Apollo Medical Holdings, Inc., Network Medical Management, Inc., Apollo Acquisition Corp. and Kenneth Sim, M.D. (incorporated herein by reference to Annex A to the joint proxy statement/prospectus filed pursuant to Rule 424(b)(3) on November 15, 2017 that is a part of a Registration Statement on Form S-4).
2.4†	Stock purchase agreement dated March 15, 2019(incorporated herein by reference to Exhibit 2.4 to the Company’s Quarterly Report on Form 10-Q filed on May 10, 2019).
3.1	Restated Certificate of Incorporation (incorporated herein by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K filed on January 21, 2015).
3.2	Certificate of Amendment of Restated Certificate of Incorporation (incorporated herein by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K filed on April 27, 2015).
3.3	Certificate of Amendment of Restated Certificate of Incorporation (incorporated herein by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K filed on December 13, 2017).
3.4	Certificate of Amendment of Restated Certificate of Incorporation (incorporated herein by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K filed June 21, 2018).
3.5	Restated Bylaws (incorporated herein by reference to Exhibit 3.2 to the Company’s Quarterly Report on Form 10-Q filed on November 16, 2015).
3.6	Amendment to Sections 3.1 and 3.2 of Article III of Bylaws (incorporated herein by reference to Exhibit 3.2 to the Company’s Current Report on Form 8-K filed on December 13, 2017).
3.7	Amendment to Sections 3.1 and 3.2 of Article III of Bylaws (incorporated herein by reference to Exhibit 3.2 to the Company’s Current Report on Form 8-K filed on June 21, 2018).
10.1*†	Stock Purchase Agreement, dated December 31, 2019, by and among Universal Care Acquisition Partners, LLC, Bright Health Company of California, Inc., Bright Health, Inc., Universal Care, Inc., Howard E. And Elaine H. Davis Family Trust, Howard E. And Elaine H. Davis Grandchildren’s Trust, Jeffrey V. Davis, Jay B. Davis, Laura Davis-Loschiavo, Marc M. Davis, Peter And Helen Lee Family Trust, and, in their respective capacities as seller representatives, Kenneth Sim, M.D., Thomas Lam, M.D., Jay Davis and Jeffrey Davis.
31.1*	Certification of Principal Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
31.2*	Certification of Principal Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
31.3*	Certification of Principal Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
32**	Certification of Principal Executive Officers and Principal Financial Officer Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002
101.INS*	XBRL Instance Document
101.SCH*	XBRL Taxonomy Extension Schema Document
101.CAL*	XBRL Taxonomy Extension Calculation Linkbase Document

62

101.DEF*	XBRL Taxonomy Extension Definition Linkbase
101.LAB*	XBRL Taxonomy Extension Label Linkbase Document
101.PRE*	XBRL Taxonomy Extension Presentation Linkbase Document
*	Filed herewith.
**	Furnished herewith
†	The schedules and exhibits thereof have been omitted pursuant to Item 601(b)(2) of Regulation S-K. A copy of any omitted schedule or exhibit will be furnished to the SEC upon request.

63

SIGNATURE

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

	APOLLO MEDICAL HOLDINGS, INC.
Dated: May 29, 2020	By:	/s/ Kenneth Sim
		Kenneth Sim, M.D. Executive Chairman & Co-Chief Executive Officer (Principal Executive Officer)
Dated: May 29, 2020	By:	/s/ Thomas Lam
		Thomas Lam, M.D., M.P.H. Co-Chief Executive Officer & President (Principal Executive Officer)
Dated: May 29, 2020	By:	/s/ Eric Chin
		Eric Chin Chief Financial Officer and Interim Co-Chief Operating Officer (Principal Financial Officer)

64

EX-31.1

EXHIBIT 31.1

CERTIFICATION OF PRINCIPAL EXECUTIVE OFFICER

PURSUANT TO

SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Kenneth Sim, M.D., certify that:

1. I have reviewed this annual report on Form 10-Q of Apollo Medical Holdings, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date:	May 29, 2020	/s/ Kenneth Sim
		Kenneth Sim Executive Chairman and Co-Chief Executive Officer (Principal Executive Officer)

EX-31.2

EXHIBIT 31.2

CERTIFICATION OF PRINCIPAL EXECUTIVE OFFICER

PURSUANT TO

SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Thomas Lam, M.D., certify that:

1. I have reviewed this annual report on Form 10-Q of Apollo Medical Holdings, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date:	May 29, 2020	/s/ Thomas Lam
		Thomas Lam Co-Chief Executive Officer and President (Principal Executive Officer)

EX-31.3

EXHIBIT 31.3

CERTIFICATION OF PRINCIPAL FINANCIAL OFFICER

PURSUANT TO

SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Eric Chin, certify that:

1. I have reviewed this annual report on Form 10-Q of Apollo Medical Holdings, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date:	May 29, 2020	/s/ Eric Chin
		Eric Chin Chief Financial Officer and Interim Co-Chief Operating Officer (Principal Financial Officer)

EX-32

EXHIBIT 32

CERTIFICATION OF PRINCIPAL EXECUTIVE OFFICERS AND PRINCIPAL FINANCIAL OFFICER

PURSUANT TO

18 U.S.C. SECTION 1350.

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

I, Kenneth Sim, M.D., certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that the Quarterly Report on Form 10-Q of Apollo Medical Holdings, Inc. for the quarter ended March 31, 2020, fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, and that the information contained in such report fairly presents, in all material respects, the financial condition and results of operations of Apollo Medical Holdings, Inc.

Date:	May 29, 2020	/s/ Kenneth Sim
		Kenneth Sim Executive Chairman and Co-Chief Executive Officer (Principal Executive Officer)

I, Thomas Lam, M.D., certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that the Quarterly Report on Form 10-Q of Apollo Medical Holdings, Inc. for the quarter ended March 31, 2020, fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, and that the information contained in such report fairly presents, in all material respects, the financial condition and results of operations of Apollo Medical Holdings, Inc.

Date:	May 29, 2020	/s/ Thomas Lam
		Thomas Lam Co-Chief Executive Officer and President (Principal Executive Officer)

I, Eric Chin, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that the Quarterly Report on Form 10-Q of Apollo Medical Holdings, Inc. for the quarter ended March 31, 2020, fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, and that the information contained in such report fairly presents, in all material respects, the financial condition and results of operations of Apollo Medical Holdings, Inc.

Date:	May 29, 2020	/s/ Eric Chin
		Eric Chin Chief Financial Officer and Interim Co-Chief Operating Officer (Principal Financial Officer)

XML

Commitments and Contingencies - Additional Information (Details) - USD ($)		3 Months Ended
	Apr. 03, 2018	Mar. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Commitments And Contingencies [Line Items]
General amount of guarantee (as a percent)		2.00%
Amount outstanding		$ 245,250,000
Damages sought	$ 5,000,000.0
APC | Standby Letters of Credit
Commitments And Contingencies [Line Items]
Term of facility		1 year
Alpha Care Medical Group, Inc. | Standby Letters of Credit
Commitments And Contingencies [Line Items]
Term of facility		1 year
Standby letters of credit assumed		$ 3,800,000
Standby Letters of Credit | APC
Commitments And Contingencies [Line Items]
Amount outstanding		$ 300,000
Preferred Bank
Commitments And Contingencies [Line Items]
Amount outstanding			$ 8,200,000	$ 6,600,000

XML

Earnings Per Share - Earnings Per Share Computations (Details) - $ / shares	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Earnings Per Share [Abstract]
Earnings per share – basic (in dollars per share)	$ 0.11	$ 0.00
Earnings per share – diluted (in dollars per share)	$ 0.11	$ 0.00
Weighted average shares of common stock outstanding – basic (in shares)	36,010,268	34,496,622
Weighted average shares of common stock outstanding – diluted (in shares)	37,439,099	38,074,174

XML

Business Combination and Goodwill - Assumption of Identifiable Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Aug. 30, 2019	May 31, 2019	Mar. 31, 2020	Dec. 31, 2019
Assets acquired
Goodwill			$ 238,539	$ 238,505
Accountable Health Care | Dr. Jay
Assets acquired
Cash and cash equivalents	$ 582
Accounts receivable, net	5,150
Other current assets	198
Network relationship intangible assets	11,411
Goodwill	23,052
Liabilities assumed
Accounts payable	(3,245)
Medical liabilities	(12,154)
Subordinated loan	(15,327)
Net assets acquired	9,667
Equity investment contributed	2,417
Cash paid	$ 7,250
APC and APC-LSMA | Alpha Care Medical Group, Inc.
Assets acquired
Cash and cash equivalents		$ 3,569
Accounts receivable, net		10,336
Other current assets		4,342
Network relationship intangible assets		22,636
Goodwill		28,585
Liabilities assumed
Accounts payable		(2,758)
Deferred tax liabilities		(6,334)
Medical liabilities		(15,320)
Net assets acquired		45,056
Cash paid		$ 45,056

XML

Basis of Presentation and Summary of Significant Accounting Policies - Disaggregation of Revenue by Each Payor Type (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Disaggregation of Revenue [Line Items]
Revenue	$ 165,105	$ 95,758
Commercial
Disaggregation of Revenue [Line Items]
Revenue	24,710	26,761
Medicare
Disaggregation of Revenue [Line Items]
Revenue	68,641	25,465
Medicaid
Disaggregation of Revenue [Line Items]
Revenue	62,690	37,232
Other third parties
Disaggregation of Revenue [Line Items]
Revenue	$ 9,064	$ 6,300

XML

Intangible Assets, Net - Future Amortization Expense (Details) $ in Thousands	Mar. 31, 2020 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2020 (excluding the three months ended March 31, 2020)	$ 11,856
2021	14,524
2022	12,673
2023	10,842
2024	9,830
Thereafter	39,115
Total	$ 98,840

XML

Accounts Payable and Accrued Expenses (Tables)

3 Months Ended

Mar. 31, 2020

Payables and Accruals [Abstract]

Schedule of Accounts Payable and Accrued Expenses

The Company’s accounts payable and accrued expenses consisted of the following (in thousands):

	March 31, 2020		December 31, 2019
Accounts payable	$	7,745	$	6,914
Capitation payable	2,802		2,813
Subcontractor IPA payable	2,886		3,360
Professional fees	1,792		1,837
Due to related parties	55		225
Accrued compensation	4,162		3,238
Contract liabilities	664		8,892
Total accounts payable and accrued expenses	$	20,106	$	27,279

XML

Variable Interest Entities (VIEs)

3 Months Ended

Mar. 31, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Variable Interest Entities (VIEs)

Variable Interest Entities (VIEs)

A VIE is defined as a legal entity whose equity owners do not have sufficient equity at risk, or, as a group, the holders of the equity investment at risk lack any of the following three characteristics: decision-making rights, the obligation to absorb losses, or the right to receive the expected residual returns of the entity. The primary beneficiary is identified as the variable interest holder that has both the power to direct the activities of the VIE that most significantly affect the entity’s economic performance and the obligation to absorb expected losses or the right to receive benefits from the entity that could potentially be significant to the VIE.

The Company follows guidance on the consolidation of VIEs that requires companies to utilize a qualitative approach to determine whether it is the primary beneficiary of a VIE. See Note 2 – “Basis of Presentation and Summary of Significant Accounting Policies” to the accompanying consolidated financial statements for information on how the Company determines VIEs and its treatment.

The following table includes assets that can only be used to settle the liabilities of APC, including Alpha Care and Accountable Health Care, and the creditors of APC, including Alpha Care and Accountable Health Care, have no recourse to the Company, nor do creditors of the Company have recourse against the assets of APC, including Alpha Care and Accountable Health Care. These assets and liabilities, with the exception of the investment in a privately held entity that does not report net asset value per share and amounts due to affiliates, which are eliminated upon consolidation with NMM, are included in the accompanying consolidated balance sheets (in thousands).

	March 31, 2020		December 31, 2019
Assets
Current assets
Cash and cash equivalents	$	57,015	$	87,110
Restricted cash	75		75
Investment in marketable securities	117,036		123,948
Receivables, net	16,332		9,300
Receivables, net – related party	49,279		42,976
Other receivables	734		744
Prepaid expenses and other current assets	7,257		7,403
Loan receivable	6,425		6,425
Loan receivable – related parties	16,500		16,500
Total current assets	270,653		294,481
Noncurrent assets
Land, property and equipment, net	9,304		9,547
Intangible assets, net	78,247		81,439
Goodwill	108,946		108,913
Investment in privately held entities	223,796		319,930
Investments in other entities – equity method	30,785		28,427
Restricted cash	746		746
Operating lease right-of-use assets	4,444		4,751
Other assets	5,040		1,057
Total noncurrent assets	461,308		554,810
Total assets	$	731,961	$	849,291
Current liabilities
Accounts payable and accrued expenses	$	11,317	$	11,187
Fiduciary accounts payable	1,709		2,027
Medical liabilities	45,029		49,019
Income taxes payable	8,034		4,530
Amount due to affiliate	23,128		28,058
Dividends payable	337		271
Finance lease liabilities	102		102
Operating lease liabilities	1,217		1,088
Total current liabilities	90,873		96,282
Noncurrent liabilities
Deferred tax liability	12,587		14,059
Finance lease liabilities, net of current portion	390		416
Operating lease liabilities, net of current portion	3,336		3,742
Total noncurrent liabilities	16,313		18,217
Total liabilities	$	107,186	$	114,499

The assets of the Company’s other consolidated VIEs were not considered significant.

XML

Basis of Presentation and Summary of Significant Accounting Policies (Tables)

3 Months Ended

Mar. 31, 2020

Accounting Policies [Abstract]

Schedule of Disaggregated Revenue by Each Payor Type

The following table presents disaggregated revenue generated by each payor type for the three months ended March 31, 2020 and 2019 (in thousands):

	For the Three Months Ended March 31,
	2020		2019
Commercial	$	24,710	$	26,761
Medicare	68,641		25,465
Medicaid	62,690		37,232
Other third parties	9,064		6,300
Revenue	$	165,105	$	95,758

Schedule of Contributions to Revenue and Receivables by Payor

The Company had major payors that contributed the following percentages of net revenue:

	For the Three Months Ended March 31,
	2020		2019
Payor A	12.1	%	17.4	%
Payor B	10.3	%	15.3	%
Payor C	*		12.0	%
Payor D	17.6	%	*
Payor E	13.3	%	*

* Less than 10% of total net revenues

The Company had major payors that contributed to the following percentages of receivables and receivables – related parties before the allowance for doubtful accounts:

	As of March 31, 2020		As of December 31, 2019
Payor D	13.6	%	*
Payor F	33.5	%	30.4	%
Payor G	33.6	%	36.0	%

* Less than 10% of total receivables and receivables — related parties, net

Schedule of Carrying Amounts and Fair Values of Financial Instruments

The carrying amounts and fair values of the Company’s financial instruments as of March 31, 2020 are presented below (in thousands):

	Fair Value Measurements
	Level 1		Level 2		Level 3		Total
Assets
Money market funds*	$	41,675	$	—	$	—	$	41,675
Marketable securities – certificates of deposit	117,036		—		—		117,036
Marketable securities – equity securities	39		—		—		39
Total	$	158,750	$	—	$	—	$	158,750

The carrying amounts and fair values of the Company’s financial instruments as of December 31, 2019 are presented below (in thousands):

	Fair Value Measurements
	Level 1		Level 2		Level 3		Total
Assets
Money market funds*	$	50,731	$	—	$	—	$	50,731
Marketable securities – certificates of deposit	116,469		—		—		116,469
Marketable securities – equity securities	70		—		—		70
Total	$	167,270	$	—	$	—	$	167,270

*    Included in cash and cash equivalents

XML

Description of Business

3 Months Ended

Mar. 31, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Description of Business

Description of Business

Overview

Apollo Medical Holdings, Inc. (“ApolloMed”), together with its affiliated physician groups and consolidated entities (collectively, the “Company”) is a physician-centric integrated population health management company working to provide coordinated, outcome-based medical care in a cost-effective manner to patients in California, the majority of whom are covered by private or public insurance such as Medicare, Medicaid and health maintenance organization (“HMO”) plans, with a portion of the Company’s revenue coming from non-insured patients. The Company provides care coordination services to each major constituent of the healthcare delivery system, including patients, families, primary care physicians, specialists, acute care hospitals, alternative sites of inpatient care, physician groups and health plans. The Company’s physician network consists of primary care physicians, specialist physicians, and hospitalists. The Company operates primarily through the following subsidiaries of ApolloMed: Network Medical Management, Inc. (“NMM”), Apollo Medical Management, Inc. (“AMM”), APAACO, Apollo Care Connect, Inc. (“Apollo Care Connect”), and their consolidated entities.

NMM was formed in 1994 as a management service organization (“MSO”) for the purposes of providing management services to medical companies and independent practice associations (“IPAs”). The management services primarily include billing, collection, accounting, administration, quality assurance, marketing, compliance, and education. Following a business combination, NMM became a wholly-owned subsidiary of ApolloMed in December 2017.

Allied Physicians of California IPA, a Professional Medical Corporation d.b.a. Allied Pacific of California IPA (“APC”) was incorporated in 1992, for the purpose of arranging healthcare services as an IPA. APC has contracts with various HMOs and other licensed healthcare service plans as defined in the California Knox-Keene Health Care Service Plan Act of 1975. Each HMO negotiates a fixed amount per member per month (“PMPM”) that is to be paid to APC. In return, APC arranges for the delivery of healthcare services by contracting with physicians or professional medical corporations for primary care and specialty care services. APC assumes the financial risk of the cost of delivering healthcare services in excess of the fixed amounts received. Some of the risk is transferred to the contracted physicians or professional corporations. The risk is also minimized by stop-loss provisions in contracts with HMOs.

In July 1999, APC entered into an amended and restated management and administrative services agreement with NMM (the initial management services agreement was entered into in 1997) for an initial fixed term of 30 years. In accordance with relevant accounting guidance, APC is determined to be a VIE of the Company as NMM is the primary beneficiary with the ability to direct the activities (excluding clinical decisions) that most significantly affect APC’s economic performance through its majority representation on the APC Joint Planning Board; therefore APC is consolidated by NMM.

AP-AMH Medical Corporation (“AP-AMH”) was formed in May 2019, as a designated shareholder professional corporation. Dr. Thomas Lam, a shareholder, and the Chief Executive Officer and Chief Financial Officer of APC and Co-Chief Executive Officer of ApolloMed, is the sole shareholder of AP-AMH. ApolloMed makes all the decisions on behalf of AP-AMH and funds and receives all the distributions from its operations. ApolloMed has the rights to receive benefits from the operations of AP-AMH and has the option, but not the obligation, to cover losses. Therefore, AP-AMH is controlled and consolidated by ApolloMed as the primary beneficiary of this VIE.

In September 2019, ApolloMed completed the following series of transactions with its affiliates, AP-AMH and APC;

1. ApolloMed loaned AP-AMH $545.0 million pursuant to a ten-year secured loan agreement (the "AP-AMH Loan"). The loan bears interest at a rate of 10% per annum simple interest, is not prepayable (except in certain limited circumstances), requires quarterly payments of interest only in arrears, and is secured by a first priority security interest in all of AP-AMH's assets, including the shares of APC Series A Preferred Stock to be purchased by AP-AMH. To the extent that AP-AMH is unable to make any interest payment when due because it has received dividends on the APC Series A Preferred Stock insufficient to pay in full such interest payment, then the outstanding principal amount of the loan will be increased by the amount of any such accrued but unpaid interest, and any such increased principal amounts will bear interest at the rate of 10.75% per annum simple interest.

2. AP-AMH purchased 1,000,000 shares of APC Series A Preferred Stock for aggregate consideration of $545.0 million in a private placement. Under the terms of the APC Certificate of Determination of Preferences of Series A Preferred Stock (the "Certificate of Determination"), AP-AMH is entitled to receive preferential, cumulative dividends that accrue on a daily basis and that are equal to the sum of (i) APC's net income from Healthcare Services (as defined in the Certificate of Determination), plus (ii) any dividends received by APC from certain of APC's affiliated entities, less (iii) any Retained Amounts (as defined in the Certificate of Determination).

3. APC purchased 15,015,015 shares of ApolloMed's common stock for total consideration of $300.0 million in private placement. In connection therewith, ApolloMed granted APC certain registration rights with respect to ApolloMed's common stock that APC purchased, and APC agreed that APC votes in excess of 9.99% of ApolloMed's then outstanding shares will be voted by proxy given to the ApolloMed's management, and that those proxy holders will cast the excess votes in the same proportion as all other votes cast on any specific proposal coming before the ApolloMed's stockholders.

4. ApolloMed licensed to AP-AMH the right to use certain tradenames for certain specified purposes for a fee equal to a percentage of the aggregate gross revenues of AP-AMH. The license fee is payable out of any Series A Preferred Stock dividends received by AP-AMH from APC.

5. Through its subsidiary, NMM, the Company agreed to provide certain administrative services to AP-AMH for a fee equal to a percentage of the aggregate gross revenues of AP-AMH. The administrative fee also is payable out of any APC Series A Preferred Stock dividends received by AP-AMH from APC.

APC's ownership in ApolloMed was 32.44% at March 31, 2020 and 32.50% at December 31, 2019.

Concourse Diagnostic Surgery Center, LLC (“CDSC”) was formed in March 2010, in the state of California. CDSC is an ambulatory surgery center in City of Industry, California, is organized by a group of highly qualified physicians, and the surgical center utilizes some of the most advanced equipment in the eastern part of Los Angeles County and the San Gabriel Valley. The facility is Medicare certified and accredited by the Accreditation Association for Ambulatory Healthcare, Inc. As of March 31, 2020, APC's owned 45.01% of CDSC's capital stock. CDSC is determined to be a VIE and APC is determined to be the primary beneficiary. APC has the ability to direct the activities that most significantly affect CDSC's economic performance and receives the most economic benefits; therefore CDSC is consolidated by APC.

APC-LSMA Designated Shareholder Medical Corporation ("APC-LSMA") was formed in October 2012, as a designated shareholder professional corporation. Dr. Thomas Lam, a shareholder and the Chief Executive Officer and Chief Financial Officer of APC and Co-Chief Executive Officer of ApolloMed, is a nominee shareholder of APC. APC makes all investment decisions on behalf of APC-LSMA, funds all investments and receives all distributions from the investments. APC has the obligation to absorb losses and right to receive benefits from all investments made by APC-LSMA. APC-LSMA’s sole function is to act as the nominee shareholder for APC in other California medical professional corporations. Therefore, APC-LSMA is controlled and consolidated by APC as the primary beneficiary of this VIE. The only activity of APC-LSMA is to hold the investments in medical corporations, including the IPA lines of business of LaSalle Medical Associates (“LMA”), Pacific Medical Imaging and Oncology Center, Inc. (“PMIOC”), Diagnostic Medical Group (“DMG”) and AHMC International Cancer Center, a Medical Corporation (“ICC”). APC-LSMA also holds a 100% ownership interest in Maverick Medical Group, Inc. (“MMG”), Alpha Care Medical Group, Inc. (“Alpha Care”), Accountable Health Care IPA, a Professional Medical Corporation (“Accountable Health Care”), and AMG, a Professional Medical Corporation ("AMG").

Alpha Care, an IPA acquired by the Company in May 2019, has been operating in California since 1993 as a risk bearing organization engaged in providing professional services under capitation arrangements with its contracted health plans through a provider network consisting of primary care and specialty care physicians. Alpha Care specializes in delivering high-quality healthcare to over 170,000 enrollees, as of March 31, 2020, and focuses on Medi-Cal/Medicaid, Commercial and Medicare and Dual Eligible members in the Riverside and San Bernardino counties of Southern California.

Accountable Health Care is a California-based IPA that has served the local community in the greater Los Angeles County area through a network of physicians and health care providers for more than 20 years. Accountable Health Care currently has a network of over 300 primary care physicians and 700 specialty care physicians, and four community and regional hospital medical centers that provide quality health care services to more than 80,000 members of three federally qualified health plans and multiple product lines, including Medi-Cal, Commercial, Medicare and the California Healthy Families program. In August 2019, APC and APC-LSMA acquired the remaining outstanding shares of Accountable Health Care's capital stock which they did not already own (comprising 75%) for $7.3 million in cash (see Note 3).

AMG is a network of family practice clinics operating out of three main locations in Southern California. AMG provides professional and post-acute care services to Medicare, Medi-Cal/Medicaid, and Commercial patients through its network of doctors and nurse practitioners. In September 2019, APC-LSMA purchased 100% of the shares of capital stock of AMG for $1.2 million in cash and $0.4 million of APC common stock (see Note 3).

Universal Care Acquisition Partners, LLC (“UCAP”), a 100% owned subsidiary of APC, was formed in June 2014, for the purpose of holding an investment in Universal Care, Inc. (“UCI”). On April 30, 2020, UCAP completed its disposition of its 48.9% ownership interest in UCI to Bright Health Company of California, Inc. ("Bright") for approximately $69.2 million in cash proceeds (including $16.5 million as repayment of indebtedness owed to APC), plus non-cash consideration consisting of shares of Bright Health, Inc.'s, a Delaware corporation (solely for purposes of section 13.22 thereto) ("Bright Health, Inc.") preferred stock having a stipulated value of approximately $33.3 million. In addition, pursuant to the terms of the stock purchase agreement (the "SPA"), upon release from escrow, APC is entitled to receive all or that portion of the following escrowed amounts that have not been offset or reserved for claims: (i) cash consideration of approximately $15.6 million, plus (ii) non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $5.9 million (see Note 17). As set forth in the Company’s definitive proxy statement filed with the SEC on July 31, 2019 (the “Proxy Statement”), the 48.9% interest in UCI is an “Excluded Asset” that remains solely for the benefit of APC and its shareholders. As such, any proceeds or gain on the sale of APC’s indirect ownership interest in Universal will have no impact on the Series A Dividend payable by APC to AP-AMH Medical Corporation as described in the Proxy Statement and consequently the sale will not affect net income attributable to the Company.

APAACO, jointly owned by NMM and AMM, began participating in the Next Generation Accountable Care Organization Model (“NGACO Model”) of the Centers for Medicare & Medicaid Services ("CMS") in January 2017. The NGACO Model is a new CMS program that allows provider groups to assume higher levels of financial risk and potentially achieve a higher reward from participating in this new attribution-based risk sharing model.

AMM, a wholly-owned subsidiary of ApolloMed, manages affiliated medical groups, which consist of ApolloMed Hospitalists, a Medical Corporation (“AMH”) and Southern California Heart Centers, a Medical Corporation (“SCHC”). AMH provides hospitalist, intensivist, and physician advisory services. SCHC is a specialty clinic that focuses on cardiac care and diagnostic testing.

Apollo Care Connect, Inc., a wholly-owned subsidiary of ApolloMed, provides a cloud and mobile-based population health management platform that includes digital care plans, a case management module, connectivity with multiple healthcare tracking devices and the ability to integrate with multiple electronic health records to capture clinical data.

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CONSOLIDATED BALANCE SHEETS (UNAUDITED) (Parenthetical) - $ / shares	Mar. 31, 2020	Dec. 31, 2019
Common Stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares outstanding (in shares)	36,042,761	35,908,057
Treasury shares (in shares)	17,475,707	17,458,810
Series A Preferred Stock
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, shares issued (in shares)	1,111,111	1,111,111
Preferred stock, shares outstanding (in shares)	0	0
Series B Preferred Stock
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, shares issued (in shares)	555,555	555,555
Preferred stock, shares outstanding (in shares)	0	0

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Earnings Per Share (Tables)

3 Months Ended

Mar. 31, 2020

Earnings Per Share [Abstract]

Schedule of Earnings Per Share Computations

Below is a summary of the earnings per share computations:

Three Months Ended March 31,	2020		2019
Earnings per share – basic	$	0.11	$	—
Earnings per share – diluted	$	0.11	$	—
Weighted average shares of common stock outstanding – basic	36,010,268		34,496,622
Weighted average shares of common stock outstanding – diluted	37,439,099		38,074,174

Schedule of Shares Included in the Diluted Earnings Per Share Computations

Below is a summary of the shares included in the diluted earnings per share computations:

Three Months Ended March 31,	2020	2019
Weighted average shares of common stock outstanding – basic	36,010,268	34,496,622
10% shares held back pursuant to indemnification clause	—	1,519,805
Stock options	185,830	455,381
Warrants	1,207,445	1,602,366
Restricted stock units	35,556	—
Weighted average shares of common stock outstanding – diluted	37,439,099	38,074,174

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Medical Liabilities (Tables)

3 Months Ended

Mar. 31, 2020

Liability for Unpaid Claims and Claims Adjustment Expense, Activity in Liability [Abstract]

Schedule of Medical Liabilities

The Company’s medical liabilities consisted of the following (in thousands):

	March 31, 2020			March 31, 2019
Medical liabilities, beginning of period	$	58,725		$	33,642
Components of medical care costs related to claims incurred:
Current period	85,928			31,870
Prior periods	(602		)	3,105
Total medical care costs	85,326			34,975
Payments for medical care costs related to claims incurred:
Current period	(37,004		)	(16,587		)
Prior periods	(43,247		)	(28,850		)
Total paid	(80,251		)	(45,437		)
Adjustments	(102		)	86
Medical liabilities, ending balance	$	63,698		$	23,266

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Basis of Presentation and Summary of Significant Accounting Policies - Additional Information (Details)	3 Months Ended
	Mar. 31, 2020 USD ($) segment unit	Mar. 31, 2019 USD ($)	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Number of operating segments | segment	1
Number of reportable segments | segment	1
Amount deposit accounts exceeded FDIC insured limit	$ 209,300,000
Amount of short-term marketable securities	$ 117,075,000		$ 116,539,000
Risk pool surplus or deficits, settlement period after risk pool performance year	18 months
Allowance for doubtful accounts	$ 2,900,000		2,900,000
Impairment of finite-lived intangible assets	0	$ 0
Impairment of long-lived assets	$ 0	0
Number of main reporting units | unit	3
Impairment of goodwill	$ 0	0
Impairment of indefinite-lived intangible assets	0	$ 0
Contract liabilities	664,000		$ 8,892,000
Payments received	7,500,000
Accrued contract liability recognized	21,900,000
Investment deposit	$ 4,000,000
Voting rights held (more than)	50.00%
Other Receivables, Final Settlement 2017 Performance Year
Summary Of Significant Accounting Policies [Line Items]
Recoverable claims paid				$ 3,200,000
Accounts Payable and Accrued Expenses
Summary Of Significant Accounting Policies [Line Items]
Payments received	$ 22,600,000
Accrued contract liability recognized	400,000
Contract liability repaid, capitation received and not earned	8,500,000
Other Receivables
Summary Of Significant Accounting Policies [Line Items]
Recoverable claims paid	$ 8,500,000
CMS
Summary Of Significant Accounting Policies [Line Items]
Expected period of payment upon termination of agreement	30 days
PMPM Managed Care Contract
Summary Of Significant Accounting Policies [Line Items]
Contract term	P1Y
Management Fee Income Contract
Summary Of Significant Accounting Policies [Line Items]
Contract term	P10Y
Minimum
Summary Of Significant Accounting Policies [Line Items]
Marketable Securities, Current, Maturity Period	4 months
Maximum
Summary Of Significant Accounting Policies [Line Items]
Marketable Securities, Current, Maturity Period	24 months
Certificates of Deposit
Summary Of Significant Accounting Policies [Line Items]
Amount of short-term marketable securities	$ 117,000,000

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Accounts Payable and Accrued Expenses

3 Months Ended

Mar. 31, 2020

Payables and Accruals [Abstract]

Accounts Payable and Accrued Expenses

Accounts Payable and Accrued Expenses

The Company’s accounts payable and accrued expenses consisted of the following (in thousands):

	March 31, 2020		December 31, 2019
Accounts payable	$	7,745	$	6,914
Capitation payable	2,802		2,813
Subcontractor IPA payable	2,886		3,360
Professional fees	1,792		1,837
Due to related parties	55		225
Accrued compensation	4,162		3,238
Contract liabilities	664		8,892
Total accounts payable and accrued expenses	$	20,106	$	27,279

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Commitments and Contingencies

3 Months Ended

Mar. 31, 2020

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

Commitments and Contingencies

Regulatory Matters

Laws and regulations governing the Medicare program and healthcare generally are complex and subject to interpretation. The Company believes that it is in compliance with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of potential wrongdoing. While no regulatory inquiries have been made, compliance with such laws and regulations can be subject to future government review and interpretation, as well as significant regulatory action, including fines, penalties, and exclusion from the Medicare and Medi-Cal programs.

As risk-bearing organizations, APC, Alpha Care and Accountable Health Care are required to comply with California DMHC regulations, including maintenance of minimum working capital, tangible net equity (“TNE”), cash-to-claims ratio and claims payment requirements prescribed by the California DMHC. TNE is defined as net equity less intangibles, less non-allowable assets (which include unsecured amounts due from affiliates), plus subordinated obligations. At March 31, 2020 and December 31, 2019, APC, Alpha Care and Accountable Health Care were in compliance with these regulations.

Many of the Company’s payor and provider contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of medical services. Such differing interpretations may not come to light until a substantial period of time has passed following contract implementation. Liabilities for claims disputes are recorded when the loss is probable and can be estimated. Any adjustments to reserves are reflected in current operations.

Standby Letters of Credit

As part of the APAACO participation with CMS, the Company must provide a financial guarantee to CMS, the guarantee generally must be in an amount equal to 2% of the Company's benchmark Medicare Part A and Part B expenditures. The Company has established an irrevocable standby letter of credit with Preferred Bank of $8.2 million and $6.6 million for the 2019 and 2018 performance years (see Note 9).

APC established irrevocable standby letters of credit with a financial institution for a total of $0.3 million for the benefit of certain health plans. The standby letters of credit are automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution in advance of the expiration date that the letter will be terminated (see Note 9).

Alpha Care established irrevocable standby letters of credit with a financial institution for a total of $3.8 million for the benefit of certain health plans. The standby letters of credit are automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution in advance of the expiration date that the letter will be terminated.

Litigation

From time to time, the Company is involved in various legal proceedings and other matters arising in the normal course of its business. The resolution of any claim or litigation is subject to inherent uncertainty and could have a material adverse effect on the Company’s financial condition, cash flows or results of operations.

Prospect Medical Systems

On or about March 23, 2018 and April 3, 2018, a Demand for Arbitration and an Amended Demand for Arbitration were filed by Prospect Medical Group, Inc. and Prospect Medical Systems, Inc. (collectively, “Prospect”) against MMG, ApolloMed and AMM with Judicial Arbitration Mediation Services in California, arising out of MMG’s purported business plans, seeking damages in excess of $5.0 million, and alleging breach of contract, violation of unfair competition laws, and tortious interference with Prospect’s current and future economic relationships with its health plans and their members. By stipulation and order dated April 28, 2020, both ApolloMed and Apollo Medical Management, Inc. were dismissed without prejudice from the arbitration for lack of jurisdiction on the basis that neither of them were a party to any arbitration agreement with Prospect, subject, however, to Prospect reserving its rights against Apollo and tolling of applicable statute of limitation. MMG disputes the allegations and intends to vigorously defend against this matter. The resolution of this matter and any potential range of loss in excess of any current accrual cannot be reasonably determined or estimated at this time primarily because the matter has not been fully arbitrated and presents unique regulatory and contractual interpretation issues.

Liability Insurance

The Company believes that its insurance coverage is appropriate based upon the Company’s claims experience and the nature and risks of the Company’s business. In addition to the known incidents that have resulted in the assertion of claims, the Company cannot be certain that its insurance coverage will be adequate to cover liabilities arising out of claims asserted against the Company, the Company’s affiliated professional organizations or the Company’s affiliated hospitalists in the future where the outcomes of such claims are unfavorable. The Company believes that the ultimate resolution of all pending claims, including liabilities in excess of the Company’s insurance coverage, will not have a material adverse effect on the Company’s financial position, results of operations or cash flows; however, there can be no assurance that future claims will not have such a material adverse effect on the Company’s business. Contracted physicians are required to obtain their own insurance coverage.

Although the Company currently maintains liability insurance policies on a claims-made basis, which are intended to cover malpractice liability and certain other claims, the coverage must be renewed annually, and may not continue to be available to the Company in future years at acceptable costs, and on favorable terms.

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Leases - Other Information Related to Leases (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 1,547	$ 1,034
Operating cash flows from finance leases	4	5
Financing cash flows from finance leases	26	25
Right-of-use assets obtained in exchange for lease liabilities:
Operating leases	$ 4,745	$ 8,855
Weighted Average Remaining Lease Term
Operating leases	7 years 3 months 29 days	4 years 3 months 18 days
Finance leases	4 years 5 months 1 day	5 years 3 months 1 day
Weighted Average Discount Rate
Operating leases	6.10%	6.13%
Finance leases	3.00%	3.00%

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Mezzanine and Stockholders' Equity - Schedule of Stock Options Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Shares
Options outstanding, beginning balance (in shares)	607,346
Options granted (in shares)	11,742
Options exercised (in shares)	(100,000)	(6,000)
Options forfeited (in shares)	(12,228)
Options outstanding, ending balance (in shares)	506,860		607,346
Options exercisable (in shares)	375,960
Weighted Average Exercise Price
Options outstanding, beginning balance (in dollars per share)	$ 9.22
Options granted (in dollars per share)	18.41
Options exercised (in dollars per share)	2.10
Options forfeited (in dollars per share)	17.57
Options outstanding, ending balance (in dollars per share)	10.63		$ 9.22
Options exercisable (in dollars per share)	$ 6.25
Weighted Average Remaining Contractual Term (Years)
Options outstanding	3 years 3 months 22 days		3 years 5 months 1 day
Options exercisable	2 years 1 month 10 days
Aggregate Intrinsic Value (in thousands)
Beginning balance	$ 5,600
Options exercised	1,600
Ending balance	2,000		$ 5,600
Options exercisable	$ 2,000

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Investments in Other Entities - Equity Method - Summarized Balance Sheets and Statements of Income (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
LaSalle Medical Associates
Assets
Cash and cash equivalents	$ 0		$ 6,345
Receivables, net	8,901		5,124
Other current assets	3,380		3,526
Loan receivable	2,250		2,250
Restricted cash	686		683
Total assets	15,217		17,928
Liabilities and Stockholders’ (Deficit) Equity
Current liabilities	23,390		23,530
Stockholders’ deficit	(8,173)		(5,602)
Total liabilities and stockholders’ deficit	15,217		17,928
Statements of Operations
Revenues	46,304	$ 46,406
Expenses	48,730	50,702
Net income (loss)	(2,426)	(4,296)
Universal Care, Inc.
Assets
Cash and cash equivalents	34,757		33,890
Receivables, net	83,454		63,843
Other current assets	43,417		38,280
Other assets	885		882
Property and equipment, net	4,429		4,021
Total assets	166,942		140,916
Liabilities and Stockholders’ (Deficit) Equity
Current liabilities	148,902		128,330
Other liabilities	33,126		33,133
Stockholders’ deficit	(15,086)		(20,547)
Total liabilities and stockholders’ deficit	166,942		140,916
Statements of Operations
Revenues	146,481	113,319
Expenses	141,771	111,408
Income before benefit from income taxes	4,710	1,911
Benefit from income taxes	0	(211)
Net income (loss)	4,710	2,122
513 W. College LLC
Assets
Cash and cash equivalents	48		139
Other current assets	124		17
Other assets	70		70
Property and equipment, net	33,697		33,581
Total assets	33,939		33,807
Liabilities and Stockholders’ (Deficit) Equity
Current liabilities	1,114		1,062
Stockholders’ deficit	32,825		32,745
Total liabilities and stockholders’ deficit	33,939		$ 33,807
Statements of Operations
Revenues	0	0
Expenses	338	469
Loss from operations	(338)	(469)
Other income	21	289
Net income (loss)	$ (317)	$ (180)

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Credit Facility, Bank Loan and Lines of Credit - Credit Facility (Details) $ in Thousands	Mar. 31, 2020 USD ($)
Line of Credit Facility [Line Items]
Total debt	$ 245,250
Less: Current portion of debt	(9,500)
Less: Unamortized financing costs	(5,645)
Total	230,105
Term loan A
Line of Credit Facility [Line Items]
Total debt	185,250
Revolver loan
Line of Credit Facility [Line Items]
Total debt	$ 60,000

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Basis of Presentation and Summary of Significant Accounting Policies - Additional Information, Performance Obligation (Details) - Next Generation ACO Model Participation Agreement	Mar. 31, 2020	Dec. 31, 2019
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2017-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Period		2 years
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2019-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Period	2 years

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Variable Interest Entities (VIEs) (Tables)

3 Months Ended

Mar. 31, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Variable Interest Entities

The following table includes assets that can only be used to settle the liabilities of APC, including Alpha Care and Accountable Health Care, and the creditors of APC, including Alpha Care and Accountable Health Care, have no recourse to the Company, nor do creditors of the Company have recourse against the assets of APC, including Alpha Care and Accountable Health Care. These assets and liabilities, with the exception of the investment in a privately held entity that does not report net asset value per share and amounts due to affiliates, which are eliminated upon consolidation with NMM, are included in the accompanying consolidated balance sheets (in thousands).

	March 31, 2020		December 31, 2019
Assets
Current assets
Cash and cash equivalents	$	57,015	$	87,110
Restricted cash	75		75
Investment in marketable securities	117,036		123,948
Receivables, net	16,332		9,300
Receivables, net – related party	49,279		42,976
Other receivables	734		744
Prepaid expenses and other current assets	7,257		7,403
Loan receivable	6,425		6,425
Loan receivable – related parties	16,500		16,500
Total current assets	270,653		294,481
Noncurrent assets
Land, property and equipment, net	9,304		9,547
Intangible assets, net	78,247		81,439
Goodwill	108,946		108,913
Investment in privately held entities	223,796		319,930
Investments in other entities – equity method	30,785		28,427
Restricted cash	746		746
Operating lease right-of-use assets	4,444		4,751
Other assets	5,040		1,057
Total noncurrent assets	461,308		554,810
Total assets	$	731,961	$	849,291
Current liabilities
Accounts payable and accrued expenses	$	11,317	$	11,187
Fiduciary accounts payable	1,709		2,027
Medical liabilities	45,029		49,019
Income taxes payable	8,034		4,530
Amount due to affiliate	23,128		28,058
Dividends payable	337		271
Finance lease liabilities	102		102
Operating lease liabilities	1,217		1,088
Total current liabilities	90,873		96,282
Noncurrent liabilities
Deferred tax liability	12,587		14,059
Finance lease liabilities, net of current portion	390		416
Operating lease liabilities, net of current portion	3,336		3,742
Total noncurrent liabilities	16,313		18,217
Total liabilities	$	107,186	$	114,499

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Credit Facility, Bank Loan and Lines of Credit (Tables)

3 Months Ended

Mar. 31, 2020

Debt Disclosure [Abstract]

Schedule of Line of Credit Facilities

The Company's credit facility consisted of the following (in thousands):

	March 31, 2020
Term loan A	$	185,250
Revolver loan	60,000
Total debt	245,250
Less: Current portion of debt	(9,500		)
Less: Unamortized financing costs	(5,645		)
Long-term debt	$	230,105

Schedule of Future Maturities of Credit Facility

Future maturities of the Company's credit facility is to be as follows for the years ending December 31 (in thousands):

	Amount
2020 (excluding the three months ended March 31, 2020)	$	7,125
2021	10,688
2022	14,250
2023	15,437
2024	197,750
Total	$	245,250

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Loan Receivable and Loan Receivable - Related Parties

3 Months Ended

Mar. 31, 2020

Receivables [Abstract]

Loan Receivable and Loan Receivable - Related Parties

Loan Receivable and Loan Receivable – Related Parties

Loan receivable

Dr. Albert Arteaga

On June 28, 2019, APC entered into a convertible secured promissory note with Dr. Albert H. Arteaga, M.D. ("Dr. Arteaga"), Chief Executive Officer of LMA, to loan $6.4 million to Dr. Arteaga. Interest on the loan accrues at a rate that is equal to the prime rate, plus 1% (4.25% as of March 31, 2020) and payable in monthly installments of interest only on the first day of each month until the maturity date of June 28, 2020, at which time, all outstanding principal and accrued interest thereon shall be due and payable in full. The note is secured by certain shares of LMA common stock held by Dr. Arteaga.

At any time on or before June 28, 2020, and upon written notice by APC to Dr. Arteaga, APC has the right, but not the obligation, to convert the entire outstanding principal amount of this note into shares of LMA common stock, which equal 21.25% of the aggregate then-issued and outstanding shares of LMA common stock to be held by APC's designee, which may include APC-LSMA. If converted, APC-LSMA and APC's designee will collectively own 46.25% of the equity of LMA with the remaining 53.75% to be owned by Dr. Arteaga. The entire note receivable has been classified under loans receivable — related parties on the consolidated balance sheets in the amount of $6.4 million as of March 31, 2020.

During the period ended March 31 2020, the Company entered into an agreement to advance Dr. Arteaga $2.2 million related to claims that were overpaid in the ordinary course of business. The advanced amount is repaid as the overpaid claims are recovered. As of March 31, 2020 the outstanding amount due was $1.6 million and included in the "Prepaid expenses and other current assets" in the accompanying consolidated balance sheets.

Loan receivable - related parties

Universal Care, Inc.

In 2015, APC advanced $5.0 million on behalf of UCAP to UCI for working capital purposes. On June 29, 2018, November 28, 2018 and December 13, 2019 APC advanced an additional $2.5 million, $5.0 million and $4.0 million, respectively. The loans accrue interest at the prime rate, plus 1.00%, or 4.25%, as of March 31, 2020 and 5.75% as of December 31, 2019, with interest to be paid monthly. The notes receivable were classified under loans receivable — related parties on the consolidated balance sheets in the amount of $16.5 million as of March 31, 2020 and December 31, 2019, respectively. On April 30, 2020, UCAP completed its disposition of its 48.9% ownership interest in UCI to Bright for approximately $69.2 million in cash proceeds (including $16.5 million as repayment of indebtedness owed to APC), plus non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $33.3 million. In addition, pursuant to the terms of the SPA, upon release from escrow, APC is entitled to receive all or that portion of the following escrowed amounts that have not been offset or reserved for claims: (i) cash consideration of approximately $15.6 million, plus (ii) non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $5.9 million (see Note 17).

The Company assessed the loan receivables under the CECL model by assessing the party's ability to pay by reviewing their, interest payment history quarterly, financial history annually and reassessing any insolvency risk that is identified. If a failure to pay occurs, the Company assesses the terms of the notes and estimate an expected credit loss based on the remittance schedule of the note.

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Mezzanine and Stockholders' Equity

3 Months Ended

Mar. 31, 2020

Stockholders' Equity Note [Abstract]

Mezzanine and Stockholders' Equity

Mezzanine and Stockholders’ Equity

Mezzanine

As the redemption feature (see Note 2) of the shares is not solely within the control of APC, the equity of APC does not qualify as permanent equity and has been classified as noncontrolling interest in APC as mezzanine or temporary equity. APC’s shares are not redeemable and it is not probable that the shares will become redeemable as of March 31, 2020 and December 31, 2019.

Stockholders’ Equity

As of March 31, 2020, 302,732 holdback shares have not been issued to certain former NMM shareholders who were NMM shareholders at the time of closing of the merger between NMM and ApolloMed in December 2017 (the "Merger"), as they have yet to submit properly completed letters of transmittal to ApolloMed in order to receive their pro rata portion of ApolloMed common stock and warrants as contemplated under the merger agreement. Pending such receipt, such former NMM shareholders have the right to receive, without interest, their pro rata share of dividends or distributions with a record date after the effectiveness of the Merger. The consolidated financial statements have treated such shares of common stock as outstanding, given the receipt of the letter of transmittal is considered perfunctory and the Company is legally obligated to issue these shares in connection with the Merger.

See options and warrants section below for common stock issued upon exercise of stock options and stock purchase warrants.

Options

The Company’s outstanding stock options consisted of the following:

	Shares		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)	Aggregate Intrinsic Value (in thousands)
Options outstanding at January 1, 2020	607,346		$	9.22	3.42	$	5,600
Options granted	11,742		18.41		—	—
Options exercised	(100,000	)	2.10		—	1,600
Options forfeited	(12,228	)	17.57		—	—
Options outstanding at March 31, 2020	506,860		$	10.63	3.31	$	2,000
Options exercisable at March 31, 2020	375,960		$	6.25	2.11	$	2,000

During the three months ended March 31, 2020 and 2019, stock options were exercised for 100,000 and 6,000 shares, respectively, of the Company’s common stock, which resulted in proceeds of approximately $0.2 million and $27,000, respectively. The exercise price was $2.10 per share for the exercises during the three months ended March 31, 2020 and was $4.50 per share for the exercises during the three months ended March 31, 2019.

During the three months ended March 31, 2020 and 2019, no stock options were exercised pursuant to the cashless exercise provision.

During the three months ended March 31, 2020, the Company granted 11,742five-year stock options to certain ApolloMed board members with an exercise price of $18.41, which were recognized at fair value, as determined using the Black-Scholes option pricing model and the following assumptions:

March 31, 2020	Board Members
Expected term	3.0 years
Expected volatility	90.01		%
Risk-free interest rate	1.43		%
Market value of common stock	$	10.56
Annual dividend yield	—		%
Forfeiture rate	—		%

Restricted Stock Awards

The Company grants restricted stock awards to employees which are earned based on service conditions. The grant date fair value of the restricted stock awards is that day's closing market price of the Company's common stock. During the three months ended March 31, 2020, the Company granted restricted stock awards totaling 97,447 shares with a weighted average grant date fair value of $17.58. The grant date fair value of the restricted stock was $1.6 million to be recognized on a straight-line basis over the awards' vesting period of three years.

During the three months ended March 31, 2020, the Company recorded approximately $0.9 million of share-based compensation expense associated with the issuance of restricted shares of common stock and vesting of stock options which is included in general and administrative expenses in the accompanying consolidated statements of income, respectively. Unrecognized compensation expense related to total share-based payments outstanding as of March 31, 2020 was $4.6 million.

The aggregate intrinsic value is calculated as the difference between the exercise price and the estimated fair value of common stock as of March 31, 2020.

Warrants

The Company’s outstanding warrants consisted of the following:

	Shares		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)	Aggregate Intrinsic Value (in thousands)
Warrants outstanding at January 1, 2020	3,154,590		$	9.96	2.01	$	26,700
Warrants granted	—		—		—	—
Warrants exercised	(51,601	)	9.50		—	400
Warrants expired/forfeited	—		—		—	—
Warrants outstanding at March 31, 2020	3,102,989		$	9.97	1.78	$	9,200

Exercise Price Per Share		Warrants Outstanding	Weighted Average Remaining Contractual Life	Warrants Exercisable	Weighted Average Exercise Price Per Share
$	9.00	919,048	0.54	919,048	$	9.00
10.00		1,367,451	2.06	1,367,451	10.00
11.00		816,490	2.69	816,490	11.00
$ 9.00 –11.00		3,102,989	1.78	3,102,989	$	9.97

During the three months ended March 31, 2020 and 2019, common stock warrants were exercised for 51,601 and 11,516 shares, respectively, of the Company’s common stock, which resulted in proceeds of approximately $0.5 million and $0.1 million, respectively. The exercise price ranged from $9.00 to $11.00 per share for the exercises during the three months ended March 31, 2020 and 2019, respectively.

Treasury Stock

APC owned 17,307,214 and 17,290,317 shares of ApolloMed’s common stock as of March 31, 2020 and December 31, 2019, which are legally issued and outstanding but excluded from shares of common stock outstanding in the consolidated financial statements, as such shares are treated as treasury shares for accounting purposes (see Note 1).

During the year ended December 31, 2019, APC established a brokerage account to invest excess capital in the equity market. The brokerage account is managed directly by an independent investment committee of the APC board, of which Dr. Kenneth Sim and Dr. Thomas Lam have been excluded. As of March 31, 2020, the brokerage account only held shares of ApolloMed, as such the brokerage account totaling $7.6 million has been recorded as treasury shares.

Dividends

During the three months ended March 31, 2020 and 2019, APC declared dividends of $10.0 million, respectively.

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Leases - Future Minimum Payments Under Non-cancelable Leases (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Operating Leases
2020 (excluding the three months ended March 31, 2020)	$ 3,227
2021	3,745
2022	2,970
2023	2,724
2024	2,340
Thereafter	8,484
Total future minimum lease payments	23,490
Less: imputed interest	4,788
Total lease liabilities	18,702
Less: current portion	3,119	$ 2,990
Long-term lease liabilities	15,583	11,373
Finance Leases
2020 (excluding the three months ended March 31, 2020)	89
2021	119
2022	119
2023	119
2024	79
Thereafter	0
Total future minimum lease payments	525
Less: imputed interest	33
Total lease liabilities	492
Less: current portion	102	102
Long-term lease liabilities	$ 390	$ 416

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Investments in Other Entities - Equity Method - Additional Information (Details)					1 Months Ended	3 Months Ended
	Apr. 30, 2020 USD ($)	Jul. 01, 2019 USD ($)	Jun. 29, 2018 USD ($)	Aug. 10, 2015 USD ($) shares	May 31, 2018 USD ($) shares	Mar. 31, 2020 USD ($) provider	Mar. 31, 2019 USD ($)	Mar. 31, 2020 medical_center	Mar. 31, 2020 patient	Mar. 31, 2020	Mar. 31, 2020 USD ($)	Mar. 31, 2020 plan	Mar. 31, 2020 specialty_care_physician	Mar. 31, 2020 primary_care_physician	Mar. 31, 2020 member	Dec. 31, 2019 USD ($)	Aug. 31, 2019 USD ($)	Apr. 23, 2019 USD ($)	Dec. 18, 2018 USD ($)	Jun. 30, 2018 USD ($)	May 14, 2016	Jul. 31, 2015 USD ($)	Dec. 31, 2012 USD ($)
Schedule of Equity Method Investments [Line Items]
Income (loss) from equity method investments						$ 2,054,000	$ (850,000)
Investments in other entities – equity method											$ 30,781,000					$ 28,427,000
Cash consideration paid for ownership interest						300,000	0
Contribution						$ 300,000
APC | MediPortal LLC
Schedule of Equity Method Investments [Line Items]
Membership interests purchased (in shares) | shares					270,000
Payments to purchase membership interests					$ 400,000
Membership interests acquired (in dollars per share) | shares					1.50
Ownership percentage					2.80%
Term of warrant					5 years
Number of warrants received (in shares) | shares					270,000
Term of option					5 years
Options to purchase additional membership interests (in shares) | shares					380,000
Number of warrants available to purchase, contingent upon the portal completion date (in shares) | shares					480,000
Accountable Health Care
Schedule of Equity Method Investments [Line Items]
Number of medical centers | medical_center								4
Number of employees (more than)													700	300
Number of members of federally qualified health plans (more than) | member															80,000
Number federally qualified health plans | plan												3
Network Medical Management, Inc. | AchievaMed, Inc.
Schedule of Equity Method Investments [Line Items]
Ownership percentage		10.00%
Percentage of voting common stock, within five years		50.00%
Duration of investment		5 years
Investment amount		$ 500,000
Related investment balance											500,000
Pacific6 Enterprises
Schedule of Equity Method Investments [Line Items]
Ownership interest																			33.30%
Health Source MSO Inc.
Schedule of Equity Method Investments [Line Items]
Ownership interest																			33.30%
LaSalle Medical Associates
Schedule of Equity Method Investments [Line Items]
Number of medical centers | medical_center								6
Number of employees (more than) | provider						2,300
Number of patients (more than) | patient									295,000
Income (loss) from equity method investments						$ (643,000)
Investments in other entities – equity method											5,754,000					6,397,000
Contribution						0
LaSalle Medical Associates | APC LSMA
Schedule of Equity Method Investments [Line Items]
Amount invested for interest																							$ 5,000,000
Ownership interest																							25.00%
LaSalle Medical Associates | APC
Schedule of Equity Method Investments [Line Items]
Income (loss) from equity method investments						(600,000)	(1,100,000)
Pacific Medical Imaging & Oncology Center, Inc.
Schedule of Equity Method Investments [Line Items]
Income (loss) from equity method investments						87,000
Investments in other entities – equity method											1,483,000					1,396,000
Contribution						0
Pacific Medical Imaging & Oncology Center, Inc. | APC LSMA
Schedule of Equity Method Investments [Line Items]
Amount invested for interest																						$ 1,200,000
Ownership interest																						40.00%
Pacific Medical Imaging & Oncology Center, Inc. | APC
Schedule of Equity Method Investments [Line Items]
Income (loss) from equity method investments						100,000	100,000
Investments in other entities – equity method											1,500,000					1,400,000
Pacific Medical Imaging & Oncology Center, Inc. | APC | Ancillary Service Contract
Schedule of Equity Method Investments [Line Items]
Fees paid						600,000	700,000
Universal Care, Inc.
Schedule of Equity Method Investments [Line Items]
Income (loss) from equity method investments						2,670,000	1,000,000
Investments in other entities – equity method											4,108,000					1,438,000
Contribution						0
Universal Care, Inc. | APC | Subsequent Event
Schedule of Equity Method Investments [Line Items]
Ownership interest disposed	48.90%
Cash consideration received, sale of equity method investment	$ 69,200,000
Repayment of indebtedness received	16,500,000
Additional cash consideration entitled to be received	15,600,000
Universal Care, Inc. | APC | Preferred Stock | Subsequent Event | Bright
Schedule of Equity Method Investments [Line Items]
Value of non-cash consideration received	33,300,000
Value of additional non-cash consideration to be received	$ 5,900,000
Universal Care, Inc. | Universal Care Acquisition Partners, LLC | Subsequent Event | APC
Schedule of Equity Method Investments [Line Items]
Ownership interest	48.90%
Universal Care, Inc. | Universal Care Acquisition Partners, LLC | Voting Common Stock A Two
Schedule of Equity Method Investments [Line Items]
Shares purchased (in shares) | shares				100,000
Cash consideration paid for ownership interest				$ 10,000,000
Percentage of voting common stock				50.00%
Universal Care, Inc. | Universal Care Acquisition Partners, LLC | Ancillary Service Contract | Voting Common Stock A Two
Schedule of Equity Method Investments [Line Items]
Ownership interest				48.90%
Diagnostic Medical Group
Schedule of Equity Method Investments [Line Items]
Income (loss) from equity method investments						(5,000)
Investments in other entities – equity method											2,329,000					2,334,000
Contribution						0
Diagnostic Medical Group | APC
Schedule of Equity Method Investments [Line Items]
Ownership interest																					40.00%
Income (loss) from equity method investments						(5,244)	200,000
Investments in other entities – equity method											2,300,000					2,300,000
513 W. College LLC
Schedule of Equity Method Investments [Line Items]
Income (loss) from equity method investments						(111,000)
Investments in other entities – equity method											16,887,000					16,698,000
Purchase price of real estate			$ 33,300,000
Contribution						300,000
513 W. College LLC | APC
Schedule of Equity Method Investments [Line Items]
Ownership interest										50.00%										25.00%
Income (loss) from equity method investments						(100,000)	$ (46,968)
Investments in other entities – equity method											16,900,000					16,700,000
Initial capital contributions																				$ 8,300,000
Contribution						300,000
513 W. College LLC | College Street Investment LP
Schedule of Equity Method Investments [Line Items]
Ownership interest																				50.00%
Initial capital contributions																				$ 16,700,000
513 W. College LLC | Network Medical Management, Inc.
Schedule of Equity Method Investments [Line Items]
Amount invested for interest																		$ 8,300,000
Ownership interest																		25.00%		25.00%
Initial capital contributions																				$ 8,300,000
MWN, LLC – related party
Schedule of Equity Method Investments [Line Items]
Income (loss) from equity method investments						56,000
Investments in other entities – equity method											220,000					164,000
Contribution						0
MWN, LLC – related party | Network Medical Management, Inc.
Schedule of Equity Method Investments [Line Items]
Ownership interest																			33.30%
Income (loss) from equity method investments						$ 100,000
Investments in other entities – equity method											$ 200,000					$ 200,000
Initial capital contributions																			$ 3,000
Working capital contribution																	$ 300,000		30,000
MWN, LLC – related party | Pacific6 Enterprises
Schedule of Equity Method Investments [Line Items]
Initial capital contributions																			3,000
Working capital contribution																			30,000
MWN, LLC – related party | Health Source MSO Inc.
Schedule of Equity Method Investments [Line Items]
Initial capital contributions																			3,000
Working capital contribution																			$ 30,000

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Medical Liabilities - Schedule of Medical Liabilities (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Medical Liabilities [Roll Forward]
Medical liabilities, beginning of period	$ 58,725	$ 33,642
Components of medical care costs related to claims incurred:
Current period	85,928	31,870
Prior periods	(602)	3,105
Total medical care costs	85,326	34,975
Payments for medical care costs related to claims incurred:
Current period	(37,004)	(16,587)
Prior periods	(43,247)	(28,850)
Total paid	(80,251)	(45,437)
Adjustments	(102)	86
Medical liabilities, ending balance	$ 63,698	$ 23,266

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Mezzanine and Stockholders' Equity - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Class of Stock [Line Items]
Holdback shares not issued to former shareholders (in shares)	302,732
Stock options exercised (in shares)	100,000	6,000
Exercise price of exercises during period (in dollars per share)	$ 2.10	$ 4.50
Options exercised (in shares)	0	0
Options outstanding term	3 years 3 months 22 days		3 years 5 months 1 day
Options outstanding exercise price (in dollars per share)	$ 10.63		$ 9.22
Share-based compensation	$ 1,058	$ 345
Warrants exercised (in shares)	51,601	11,516
Proceeds from warrants exercised	$ 500	$ 100
Treasury shares (in shares)	17,475,707		17,458,810
Allied Pacific of California Brokerage Account
Class of Stock [Line Items]
Treasury stock, value	$ 7,600
APC
Class of Stock [Line Items]
Treasury shares (in shares)	17,307,214		17,290,317
Dividends declared	$ 10,000	$ 10,000
Restricted Stock Units (RSUs)
Class of Stock [Line Items]
Share-based compensation	900
Unrecognized compensation expense	$ 4,600
Restricted Stock Awards
Class of Stock [Line Items]
Restricted stock awards granted (in shares)	97,447
Weighted average grant date fair value (in dollars per share)	$ 17.58
Grant date fair value of restricted stock to be recognized straight-line	$ 1,600
Award vesting period	3 years
Minimum
Class of Stock [Line Items]
Exercise price of warrants exercised (in dollars per share)	$ 9.00	$ 9.00
Maximum
Class of Stock [Line Items]
Exercise price of warrants exercised (in dollars per share)	$ 11.00	$ 11.00
APC Stock Option
Class of Stock [Line Items]
Proceeds of options exercised	$ 200	$ 27
Board Members
Class of Stock [Line Items]
Options granted (in shares)	11,742
Options outstanding term	5 years
Options outstanding exercise price (in dollars per share)	$ 18.41

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Mezzanine and Stockholders' Equity - Warrants (Details) - $ / shares	3 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Class of Warrant or Right [Line Items]
Weighted Average Exercise Price Per Share (in dollars per share)	$ 9.97	$ 9.96
Warrant Exercise Price Range One
Class of Warrant or Right [Line Items]
Exercise Price Per Share (in dollars per share)	$ 9
Warrants Outstanding (in shares)	919,048
Weighted Average Remaining Contractual Life	6 months 15 days
Warrants Exercisable (in shares)	919,048
Weighted Average Exercise Price Per Share (in dollars per share)	$ 9.00
Warrant Exercise Price Range Two
Class of Warrant or Right [Line Items]
Exercise Price Per Share (in dollars per share)	$ 10
Warrants Outstanding (in shares)	1,367,451
Weighted Average Remaining Contractual Life	2 years 22 days
Warrants Exercisable (in shares)	1,367,451
Weighted Average Exercise Price Per Share (in dollars per share)	$ 10.00
Warrant Exercise Price Range Three
Class of Warrant or Right [Line Items]
Exercise Price Per Share (in dollars per share)	$ 11
Warrants Outstanding (in shares)	816,490
Weighted Average Remaining Contractual Life	2 years 8 months 9 days
Warrants Exercisable (in shares)	816,490
Weighted Average Exercise Price Per Share (in dollars per share)	$ 11.00
Warrant Exercise Price Range Four
Class of Warrant or Right [Line Items]
Warrants Outstanding (in shares)	3,102,989
Weighted Average Remaining Contractual Life	1 year 9 months 11 days
Warrants Exercisable (in shares)	3,102,989
Weighted Average Exercise Price Per Share (in dollars per share)	$ 9.97
Warrant Exercise Price Range Four | Minimum
Class of Warrant or Right [Line Items]
Exercise Price Per Share (in dollars per share)	9.00
Warrant Exercise Price Range Four | Maximum
Class of Warrant or Right [Line Items]
Exercise Price Per Share (in dollars per share)	$ 11.00

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Earnings Per Share - Additional Information (Details) - shares	3 Months Ended	12 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
APC
Earnings Per Share [Line Items]
Treasury shares not included in the calculation of earnings per share (in shares)	17,307,214	17,290,317

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Investments in Other Entities - Equity Method - Equity Method Investments (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Equity Method Investments [Roll Forward]
Beginning Balance	$ 28,427
Allocation of Income (Loss)	2,054	$ (850)
Contribution	300
Ending Balance	30,781
LaSalle Medical Associates – IPA Line of Business
Equity Method Investments [Roll Forward]
Beginning Balance	6,397
Allocation of Income (Loss)	(643)
Contribution	0
Ending Balance	5,754
Pacific Medical Imaging & Oncology Center, Inc.
Equity Method Investments [Roll Forward]
Beginning Balance	1,396
Allocation of Income (Loss)	87
Contribution	0
Ending Balance	1,483
Universal Care, Inc.
Equity Method Investments [Roll Forward]
Beginning Balance	1,438
Allocation of Income (Loss)	2,670	$ 1,000
Contribution	0
Ending Balance	4,108
Diagnostic Medical Group
Equity Method Investments [Roll Forward]
Beginning Balance	2,334
Allocation of Income (Loss)	(5)
Contribution	0
Ending Balance	2,329
531 W. College, LLC – related party
Equity Method Investments [Roll Forward]
Beginning Balance	16,698
Allocation of Income (Loss)	(111)
Contribution	300
Ending Balance	16,887
MWN, LLC – related party
Equity Method Investments [Roll Forward]
Beginning Balance	164
Allocation of Income (Loss)	56
Contribution	0
Ending Balance	$ 220

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Business Combination and Goodwill - Summary of Goodwill (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2020 USD ($)
Goodwill [Roll Forward]
Balance	$ 238,505
Adjustments	34
Balance	$ 238,539

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Basis of Presentation and Summary of Significant Accounting Policies - Contributions to Revenue and Receivables by Payor (Details)	3 Months Ended		12 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Net Revenue | Payor A
Accounts Receivable And Net Revenue [Line Items]
Concentration risk	12.10%	17.40%
Net Revenue | Payor B
Accounts Receivable And Net Revenue [Line Items]
Concentration risk	10.30%	15.30%
Net Revenue | Payor C
Accounts Receivable And Net Revenue [Line Items]
Concentration risk		12.00%
Net Revenue | Payor D
Accounts Receivable And Net Revenue [Line Items]
Concentration risk	17.60%
Net Revenue | Payor E
Accounts Receivable And Net Revenue [Line Items]
Concentration risk	13.30%
Accounts Receivable | Payor D
Accounts Receivable And Net Revenue [Line Items]
Concentration risk	13.60%
Accounts Receivable | Payor F
Accounts Receivable And Net Revenue [Line Items]
Concentration risk	33.50%		30.40%
Accounts Receivable | Payor G
Accounts Receivable And Net Revenue [Line Items]
Concentration risk	33.60%		36.00%

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Earnings Per Share

3 Months Ended

Mar. 31, 2020

Earnings Per Share [Abstract]

Earnings Per Share

Earnings Per Share

Basic earnings per share is calculated using the weighted average number of shares of the Company’s common stock issued and outstanding during a certain period, and is calculated by dividing net income attributable to Apollo Medical Holdings, Inc. by the weighted average number of shares of the Company’s common stock issued and outstanding during such period. Diluted earnings per share is calculated using the weighted average number of shares of common stock and potentially dilutive shares of common stock outstanding during the period, using the as-if converted method for secured convertible notes, preferred stock, and the treasury stock method for options and common stock warrants.

As of March 31, 2020 and December 31, 2019 APC held 17,307,214 and 17,290,317 shares of ApolloMed’s common stock, respectively, which are treated as treasury shares for accounting purposes and not included in the number of shares of common stock outstanding used to calculate earnings per share.

Below is a summary of the earnings per share computations:

Three Months Ended March 31,	2020		2019
Earnings per share – basic	$	0.11	$	—
Earnings per share – diluted	$	0.11	$	—
Weighted average shares of common stock outstanding – basic	36,010,268		34,496,622
Weighted average shares of common stock outstanding – diluted	37,439,099		38,074,174

Below is a summary of the shares included in the diluted earnings per share computations:

Three Months Ended March 31,	2020	2019
Weighted average shares of common stock outstanding – basic	36,010,268	34,496,622
10% shares held back pursuant to indemnification clause	—	1,519,805
Stock options	185,830	455,381
Warrants	1,207,445	1,602,366
Restricted stock units	35,556	—
Weighted average shares of common stock outstanding – diluted	37,439,099	38,074,174

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Basis of Presentation and Summary of Significant Accounting Policies (Policies)

3 Months Ended

Mar. 31, 2020

Accounting Policies [Abstract]

Basis of Presentation

Basis of Presentation

The accompanying consolidated balance sheet at December 31, 2019, has been derived from the Company's audited consolidated financial statements, but does not include all disclosures required by generally accepted accounting principles in the United States of America (“U.S. GAAP”). The accompanying unaudited consolidated financial statements as of March 31, 2020 and for the three months ended March 31, 2020 and 2019, have been prepared in accordance with U.S. GAAP for interim financial information and with the instructions to Form 10-Q and Article 8 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by U.S. GAAP for complete financial statements, and should be read in conjunction with the audited consolidated financial statements and related notes to the financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 as filed with the SEC on March 16, 2020. In the opinion of management, all material adjustments (consisting of normal recurring adjustments) considered necessary for a fair presentation have been made to make the consolidated financial statements not misleading as required by Regulation S-X, Rule 10-01.

Principles of Consolidation

Principles of Consolidation

The consolidated balance sheets as of March 31, 2020 and December 31, 2019, and the consolidated statements of income for the three months ended March 31, 2020 and 2019,  include the accounts of ApolloMed, its consolidated subsidiaries NMM, AMM, APAACO, and Apollo Care Connect, including ApolloMed's consolidated VIE, AP-AMH, NMM’s subsidiaries, NMM’s consolidated VIE, APC, APC’s subsidiary, UCAP, and APC’s consolidated VIEs, CDSC, APC-LSMA, ICC, and APC-LSMA's consolidated subsidiaries Alpha Care and Accountable Health Care.

All material intercompany balances and transactions have been eliminated in consolidation.

Use of Estimates

Use of Estimates

The preparation of the consolidated financial statements and related disclosures in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include collectability of receivables, recoverability of long-lived and intangible assets, business combination and goodwill valuation and impairment, accrual of medical liabilities (incurred, but not reported (“IBNR”) claims), determination of full-risk and shared-risk revenue and receivables (including constraints and completion factors, including historical medical loss ratios (“MLR”)), income taxes, valuation of share-based compensation and right-of-use ("ROU") assets and lease liabilities. Management evaluates its estimates and assumptions on an ongoing basis using historical experience and other factors, including the current economic environment, and makes adjustments when facts and circumstances dictate. As future events and their effects cannot be determined with precision, actual results could differ materially from those estimates and assumptions.

Reportable Segments

Reportable Segments

The Company operates as one reportable segment, the healthcare delivery segment, and implements and operates innovative health care models to create a patient-centered, physician-centric experience. The Company reports its consolidated financial statements in the aggregate, including all activities in one reportable segment.

Reclassifications

Reclassifications

Certain amounts disclosed in prior period financial statements have been reclassified to conform to the current period presentation. These reclassifications had no material effect on the Company’s reported revenue, net income, cash flows or total assets.

Cash and Cash Equivalents

Cash and Cash Equivalents

The Company’s cash and cash equivalents primarily consist of money market funds and certificates of deposit. The Company considers all highly liquid investments that are both readily convertible into known amounts of cash and mature within ninety days from their date of purchase to be cash equivalents.

The Company maintains its cash in deposit accounts with several banks, which at times may exceed the insured limits of the Federal Deposit Insurance Corporation (“FDIC”). The Company believes it is not exposed to any significant credit risk with respect to its cash, cash equivalents and restricted cash.

Restricted Cash

Restricted Cash

Restricted cash consists of cash held as collateral to secure standby letters of credits as required by certain contracts.

Investments in Marketable Securities

Investments in Marketable Securities

The appropriate classification of investments is determined at the time of purchase and such designation is reevaluated at each balance sheet date. As of March 31, 2020 and December 31, 2019, short-term marketable securities in the amount of approximately $117.1 million and $116.5 million, respectively, consist of equity securities and certificates of deposit with various financial institutions, reported at par value, plus accrued interest, with maturity dates from 4 months to 24 months (see fair value measurements of financial instruments below). Investments in certificates of deposits are classified as Level 1 investments in the fair value hierarchy.

Receivables and Receivables – Related Parties

Receivables and Receivables – Related Parties

The Company’s receivables are comprised of accounts receivable, capitation and claims receivable, risk pool settlements and incentive receivables, management fee income and other receivables. Accounts receivable are recorded and stated at the amount expected to be collected.

The Company’s receivables – related parties are comprised of risk pool settlements, management fee income and incentive receivables, and other receivables. Receivables – related parties are recorded and stated at the amount expected to be collected.

Capitation and claims receivable relate to each health plan’s capitation, is received by the Company in the month following the month of service. Risk pool settlements and incentive receivables mainly consist of the Company’s full risk pool receivable that is recorded quarterly based on reports received from the Company's hospital partners and management’s estimate of the Company’s portion of the estimated risk pool surplus for open performance years. Settlement of risk pool surplus or deficits occurs approximately 18 months after the risk pool performance year is completed. During the three months ended March 31, 2020, recoverable claims paid related to the 2019 APAACO performance year to be administered following instructions from CMS, fee-for-services (“FFS”) reimbursement for patient care, certain expense reimbursements, transportation reimbursements from the hospitals, and stop loss insurance premium reimbursements are included in “Other receivables” in the accompanying consolidated balance sheets.

The Company maintains reserves for potential credit losses on accounts receivable. Management reviews the composition of accounts receivable and analyzes historical bad debts, customer concentrations, customer credit worthiness, current economic trends and changes in customer payment patterns to evaluate the adequacy of these reserves. The Company also regularly analyzes the ultimate collectability of accounts receivable after certain stages of the collection cycle using a look-back analysis to determine the amount of receivables subsequently collected and adjustments are recorded when necessary. Reserves are recorded primarily on a specific identification basis.

Receivables are recorded when the Company is able to determine amounts receivable under these contracts and/or agreements based on information provided and collection is reasonably likely to occur. In regards to the credit loss standard, the Company continuously monitors its collections of receivables and our expectation is that the historical credit loss experienced across our receivable portfolio is materially similar to any current expected credit losses that would be estimated under the current expected credit losses (CECL) model.

Concentrations of Risks

Concentrations of Risks

The Company disaggregates revenue from contracts by service type and payor type. This level of detail provides useful information pertaining to how the Company generates revenue by significant revenue stream and by type of direct contracts. The consolidated statements of income present disaggregated revenue by service type.

Fair Value Measurements of Financial Instruments

Fair Value Measurements of Financial Instruments

The Company’s financial instruments consist of cash and cash equivalents, fiduciary cash, restricted cash, investment in marketable securities, receivables, loans receivable, accounts payable, certain accrued expenses, finance lease obligations, and long-term debt. The carrying values of the financial instruments classified as current in the accompanying consolidated balance sheets are considered to be at their fair values, due to the short maturity of these instruments. The carrying amounts of the finance lease obligations and long term debt approximate fair value as they bear interest at rates that approximate current market rates for debt with similar maturities and credit quality.

Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) 820, Fair Value Measurement (“ASC 820”), applies to all financial assets and financial liabilities that are measured and reported on a fair value basis and requires disclosure that establishes a framework for measuring fair value and expands disclosure about fair value measurements. ASC 820 establishes a fair value hierarchy for disclosure of the inputs to valuations used to measure fair value.

This hierarchy prioritizes the inputs into three broad levels as follows:

Level 1 —Inputs are unadjusted quoted prices in active markets for identical assets or liabilities that can be accessed at the measurement date.

Level 2 —Inputs include quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets or liabilities in markets that are not active, inputs other than quoted prices that are observable for the asset or liability (i.e., interest rates and yield curves), and inputs that are derived principally from or corroborated by observable market data by correlation or other means (market corroborated inputs).

Level 3 —Unobservable inputs that reflect assumptions about what market participants would use in pricing the asset or liability. These inputs would be based on the best information available, including the Company’s own data.

Intangible Assets and Long-Lived Assets

Intangible Assets and Long-Lived Assets

Intangible assets with finite lives include network-payor relationships, management contracts and member relationships and are stated at cost, less accumulated amortization and impairment losses. These intangible assets are amortized on the accelerated method using the discounted cash flow rate.

Intangible assets with finite lives also include a patient management platform, as well as trade names and trademarks, whose valuations were determined using the cost to recreate method and the relief from royalty method, respectively. These assets are stated at cost, less accumulated amortization and impairment losses, and are amortized using the straight-line method.

Finite-lived intangibles and long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. If the expected future cash flows from the use of such assets (undiscounted and without interest charges) are less than the carrying value, a write-down would be recorded to reduce the carrying value of the asset to its estimated fair value. Fair value is determined based on appropriate valuation techniques.

Goodwill and Indefinite-Lived Intangible Assets

Goodwill and Indefinite-Lived Intangible Assets

Under ASC 350, Intangibles – Goodwill and Other, goodwill and indefinite-lived intangible assets are reviewed at least annually for impairment.

At least annually, at the Company’s fiscal year-end, or sooner if events or changes in circumstances indicate that an impairment has occurred, the Company performs a qualitative assessment to determine whether it is more likely than not that the fair value of each reporting unit is less than its carrying amount as a basis for determining whether it is necessary to complete quantitative impairment assessments for each of the Company’s three main reporting units (1) management services, (2) IPAs, and (3) ACOs. The Company is required to perform a quantitative goodwill impairment test only if the conclusion from the qualitative assessment is that it is more likely than not that a reporting unit’s fair value is less than the carrying value of its assets. Should this be the case, a quantitative analysis is performed to identify whether a potential impairment exists by comparing the estimated fair values of the reporting units with their respective carrying values, including goodwill.

An impairment loss is recognized if the implied fair value of the asset being tested is less than its carrying value. In this event, the asset is written down accordingly. The fair values of goodwill are determined using valuation techniques based on estimates, judgments and assumptions management believes are appropriate in the circumstances.

At least annually, indefinite-lived intangible assets are tested for impairment. Impairment for intangible assets with indefinite lives exists if the carrying value of the intangible asset exceeds its fair value. The fair values of indefinite-lived intangible assets are determined using valuation techniques based on estimates, judgments and assumptions management believes are appropriate in the circumstances.

Investments in Other Entities - Equity Method

Investments in Other Entities — Equity Method

The Company accounts for certain investments using the equity method of accounting when it is determined that the investment provides the Company with the ability to exercise significant influence, but not control, over the investee. Significant influence is generally deemed to exist if the Company has an ownership interest in the voting stock of the investee of between 20% and 50%, although other factors, such as representation on the investee’s board of directors, are considered in determining whether the equity method of accounting is appropriate. Under the equity method of accounting, the investment, originally recorded at cost, is adjusted to recognize the Company’s share of net earnings or losses of the investee and is recognized in the accompanying consolidated statements of income under “Income (loss) from equity method investments” and also is adjusted by contributions to and distributions from the investee. Equity method investments are subject to impairment evaluation.

Medical Liabilities

Medical Liabilities

APC, Alpha Care, Accountable Health Care, APAACO and MMG are responsible for integrated care that the associated physicians and contracted hospitals provide to their enrollees. APC, Alpha Care, Accountable Health Care, APAACO and MMG, provide integrated care to HMOs, Medicare and Medi-Cal enrollees through a network of contracted providers under sub-capitation and direct patient service arrangements. Medical costs for professional and institutional services rendered by contracted providers are recorded as cost of services expenses in the accompanying consolidated statements of income.

An estimate of amounts due to contracted physicians, hospitals, and other professional providers is included in medical liabilities in the accompanying consolidated balance sheets. Medical liabilities include claims reported as of the balance sheet date and estimates IBNR claims. Such estimates are developed using actuarial methods and are based on numerous variables, including the utilization of health care services, historical payment patterns, cost trends, product mix, seasonality, changes in membership, and other factors. The estimation methods and the resulting reserves are periodically reviewed and updated. Many of the medical contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of various services. Such differing interpretations may not come to light until a substantial period of time has passed following the contract implementation.

Revenue Recognition

Revenue Recognition

The Company receives payments from the following sources for services rendered: (i) commercial insurers; (ii) the federal government under the Medicare program administered by CMS; (iii) state governments under the Medicaid and other programs; (iv) other third party payors (e.g., hospitals and IPAs); and (v) individual patients and clients.

Nature of Services and Revenue Streams

Revenue primarily consists of capitation revenue, risk pool settlements and incentives, NGACO All-Inclusive Population-Based Payments (“AIPBP”), management fee income, and FFS revenue. Revenue is recorded in the period in which services are rendered or the period in which the Company is obligated to provide services. The form of billing and related risk of collection for such services may vary by type of revenue and the customer. The following is a summary of the principal forms of the Company’s billing arrangements and how revenue is recognized for each.

Capitation, Net

Managed care revenues of the Company consist primarily of capitated fees for medical services provided by the Company under a capitated arrangement directly made with various managed care providers including HMOs. Capitation revenue is typically prepaid monthly to the Company based on the number of enrollees selecting the Company as their healthcare provider. Capitation revenue is recognized in the month in which the Company is obligated to provide services to plan enrollees under contracts with various health plans. Minor ongoing adjustments to prior months’ capitation, primarily arising from contracted HMOs finalizing their monthly patient eligibility data for additions or subtractions of enrollees, are recognized in the month they are communicated to the Company. Additionally, Medicare pays capitation using a “Risk Adjustment” model, which compensates managed care organizations and providers based on the health status (acuity) of each individual enrollee. Health plans and providers with higher acuity enrollees will receive more and those with lower acuity enrollees will receive less. Under Risk Adjustment, capitation is determined based on health severity, measured using patient encounter data. Capitation is paid on a monthly basis based on data submitted for the enrollee for the preceding year and is adjusted in subsequent periods after the final data is compiled. Positive or negative capitation adjustments are made for Medicare enrollees with conditions requiring more or less healthcare services than assumed in the interim payments. Since the Company cannot reliably predict these adjustments, periodic changes in capitation amounts earned as a result of Risk Adjustment are recognized when those changes are communicated by the health plans to the Company.

PMPM managed care contracts generally have a term of one year or longer. All managed care contracts have a single performance obligation that constitutes a series for the provision of managed healthcare services for a population of enrolled members for the duration of the contract. The transaction price for PMPM contracts is variable as it primarily includes PMPM fees associated with unspecified membership that fluctuates throughout the contract. In certain contracts, PMPM fees also include adjustments for items such as performance incentives, performance guarantees and risk shares. The Company generally estimates the transaction price using the most likely amount methodology and amounts are only included in the net transaction price to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. The majority of the Company’s net PMPM transaction price relates specifically to the Company’s efforts to transfer the service for a distinct increment of the series (e.g., day or month) and is recognized as revenue in the month in which members are entitled to service.

Risk Pool Settlements and Incentives

APC enters into full risk capitation arrangements with certain health plans and local hospitals, which are administered by a third party, where the hospital is responsible for providing, arranging and paying for institutional risk and APC is responsible for providing, arranging and paying for professional risk. Under a full risk pool sharing agreement, APC generally receives a percentage of the net surplus from the affiliated hospital’s risk pools with HMOs after deductions for the affiliated hospitals costs. Advance settlement payments are typically made quarterly in arrears if there is a surplus. The Company's risk pool settlements under arrangements with health plans and hospitals are recognized using the most likely amount methodology and amounts are only included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. The assumptions for historical MLR, IBNR completion factors and constraint percentages were used by management in applying the most likely amount methodology.

Under capitated arrangements with certain HMOs, APC participates in one or more shared risk arrangements relating to the provision of institutional services to enrollees (shared risk arrangements) and thus can earn additional revenue or incur losses based upon the enrollee utilization of institutional services. Shared risk capitation arrangements are entered into with certain health plans, which are administered by the health plan, where APC is responsible for rendering professional services, but the health plan does not enter into a capitation arrangement with a hospital and therefore the health plan retains the institutional risk. Shared risk deficits, if any, are not payable until and unless (and only to the extent of any) risk sharing surpluses are generated. At the termination of the HMO contract, any accumulated deficit will be extinguished.

The Company's risk pool settlements under arrangements with HMOs are recognized, using the most likely methodology, and only included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur. Given the lack of access to the health plans’ data and control over the members assigned to APC, the adjustments and/or the withheld amounts are unpredictable and as such APC’s risk share revenue is deemed to be fully constrained until APC is notified of the amount by the health plan. Risk pools for the prior contract years are generally final settled in the third or fourth quarter of the following year.

In addition to risk-sharing revenues, the Company also receives incentives under “pay-for-performance” programs for quality medical care, based on various criteria. As an incentive to control enrollee utilization and to promote quality care, certain HMOs have designed quality incentive programs and commercial generic pharmacy incentive programs to compensate the Company for its efforts to improve the quality of services and efficient and effective use of pharmacy supplemental benefits provided to HMO members. The incentive programs track specific performance measures and calculate payments to the Company based on the performance measures. The Company's incentives under “pay-for-performance” programs are recognized using the most likely methodology. However, as the Company does not have sufficient insight from the health plans on the amount and timing of the shared risk pool and incentive payments these amounts are considered to be fully constrained and only recorded when such payments are known and/or received.

Generally, for the foregoing arrangements, the final settlement is dependent on each distinct day’s performance within the annual measurement period but cannot be allocated to specific days until the full measurement period has occurred and performance can be assessed. As such, this is a form of variable consideration estimated at contract inception and updated through the measurement period (i.e., the contract year), to the extent the risk of reversal does not exist and the consideration is not constrained.

NGACO AIPBP Revenue

APAACO and CMS entered into a NGACO Model Participation Agreement (the “Participation Agreement”) with an initial term of two performance years through December 31, 2018, which term was extended for two additional renewal years.

For each performance year, the Company must submit to CMS its selections for risk arrangement; the amount of the profit/loss cap; alternative payment mechanism; benefits enhancements, if any; and its decision regarding voluntary alignment under the NGACO Model. The Company must obtain CMS consent before voluntarily discontinuing any benefit enhancement during a performance year.

Under the NGACO Model, CMS aligns beneficiaries to the Company to manage (direct care and pay providers) based on a budgetary benchmark established with CMS. The Company is responsible for managing medical costs for these beneficiaries. The beneficiaries will receive services from physicians and other medical service providers that are both in-network and out-of-network. The Company receives capitation from CMS on a monthly basis to pay claims from in-network providers. The Company records such capitation received from CMS as revenue as the Company is primarily responsible and liable for managing the patient care and for satisfying provider obligations, is assuming the credit risk for the services provided by in-network providers through its arrangement with CMS, and has control of the funds, the services provided and the process by which the providers are ultimately paid. Claims from out-of-network providers are processed and paid by CMS and the Company’s shared savings or losses in managing the services provided by out-of-network providers are generally determined on an annual basis after reconciliation with CMS. Pursuant to the Company’s risk share agreement with CMS, the Company will be eligible to receive the savings or be liable for the deficit according to the budget established by CMS based on the Company’s efficiency in managing how the beneficiaries aligned to the Company by CMS are served by in-network and out-of-network providers. The Company’s savings or losses on providing such services are both capped by CMS, and are subject to significant estimation risk, whereby payments can vary significantly depending upon certain patient characteristics and other variable factors. Accordingly, the Company recognizes such surplus or deficit upon substantial completion of reconciliation and determination of the amounts. The Company records NGACO capitation revenues monthly. Excess over claims paid, plus an estimate for the related IBNR (see Note 8), monthly capitation received are deferred and recorded as a liability until actual claims are paid or incurred. CMS will determine if there were any excess capitation paid for the performance year and the excess is refunded to CMS.

For each performance year, CMS pays the Company in accordance with the alternative payment mechanism, if any, for which CMS has approved the Company; the risk arrangement for which the Company has been approved by CMS; and as otherwise provided in the Participation Agreement. Following the end of each performance year and at such other times as may be required under the Participation Agreement, CMS will issue a settlement report to the Company setting forth the amount of any shared savings or shared losses and the amount of other monies. If CMS owes the Company shared savings or other monies, CMS shall pay the Company in full within 30 days after the date on which the relevant settlement report is deemed final, except as provided in the Participation Agreement. If the Company owes CMS shared losses or other monies owed as a result of a final settlement, the Company shall pay CMS in full within 30 days after the relevant settlement report is deemed final. If the Company fails to pay the amounts due to CMS in full within 30 days after the date of a demand letter or settlement report, CMS shall assess simple interest on the unpaid balance at the rate applicable to other Medicare debts under current provisions of law and applicable regulations. In addition, CMS and the U.S. Department of the Treasury may use any applicable debt collection tools available to collect any amounts owed by the Company.

The Company participates in the AIPBP track of the NGACO Model. Under the AIPBP track, CMS estimates the total annual expenditures for APAACO’s assigned patients and pays that projected amount to the Company in monthly installments, and the Company is responsible for all Part A and Part B costs for in-network participating providers and preferred providers contracted by the Company to provide services to the assigned patients.

As APAACO does not have sufficient insight into the financial performance of the shared risk pool with CMS because of unknown factors related to IBNR, risk adjustment factors, stop loss provisions, among other factors, an estimate cannot be developed. Due to these limitations, APAACO cannot determine the amount of surplus or deficit that will likely be recognized in the future and therefore this shared risk pool revenue is considered fully constrained.

For performance year 2020, the Company continues to receive monthly AIPBP payments at a rate of approximately $7.5 million per month from CMS, and will need to continue to comply with all terms and conditions in the Participation Agreement and various regulatory requirements to be eligible to participate in the AIPBP mechanism and/or NGACO Model. The Company has received approximately $22.6 million in total AIPBP payments for the three months ended March 31, 2020 of which $21.9 million has been recognized as revenue. The Company also recorded assets of approximately $8.5 million related to IBNR during the three months ended March 31, 2020 and $3.2 million related to final settlement of the 2018 performance year. These balances are included in “Other receivables” in the accompanying consolidated balance sheets.

Management Fee Income

Management fee income encompasses fees paid for management, physician advisory, healthcare staffing, administrative and other non-medical services provided by the Company to IPAs, hospitals and other healthcare providers. Such fees may be in the form of billings at agreed-upon hourly rates, percentages of revenue or fee collections, or amounts fixed on a monthly, quarterly or annual basis. The revenue may include variable arrangements measuring factors such as hours staffed, patient visits or collections per visit against benchmarks, and, in certain cases, may be subject to achieving quality metrics or fee collections. The Company recognizes such variable supplemental revenues in the period when such amounts are determined to be fixed and therefore contractually obligated as payable by the customer under the terms of the applicable agreement.

The Company provides a significant service of integrating the services selected by the Company’s clients into one overall output for which the client has contracted. Therefore, such management contracts generally contain a single performance obligation. The nature of the Company’s performance obligation is to stand ready to provide services over the contractual period. Also, the Company’s performance obligation forms a series of distinct periods of time over which the Company stands ready to perform. The Company’s performance obligation is satisfied as the Company completes each period’s obligations.

Consideration from management contracts is variable in nature because the majority of the fees are generally based on revenue or collections, which can vary from period to period. The Company has control over pricing. Contractual fees are invoiced to the Company’s clients generally monthly and payment terms are typically due within 30 days. The variable consideration in the Company’s management contracts meets the criteria to be allocated to the distinct period of time to which it relates because (i) it is due to the activities performed to satisfy the performance obligation during that period and (ii) it represents the consideration to which the Company expects to be entitled.

The Company’s management contracts generally have long terms (e.g., 10 years), although they may be terminated earlier under the terms of the applicable contracts. Since the remaining variable consideration will be allocated to a wholly unsatisfied promise that forms part of a single performance obligation recognized under the series guidance, the Company has applied the optional exemption to exclude disclosure of the allocation of the transaction price to remaining performance obligations.

Fee-for-Services Revenue

FFS revenue represents revenue earned under contracts in which the Company bills and collects the professional component of charges for medical services rendered by the Company’s contracted physicians and employed physicians. Under the FFS arrangements, the Company bills the hospitals and third-party payors for the physician staffing and further bills patients or their third-party payors for patient care services provided and receives payment. FFS revenue related to the patient care services is reported net of contractual allowances and policy discounts and are recognized in the period in which the services are rendered to specific patients. All services provided are expected to result in cash flows and are therefore reflected as net revenue in the consolidated financial statements. The recognition of net revenue (gross charges less contractual allowances) from such services is dependent on such factors as proper completion of medical charts following a patient visit, the forwarding of such charts to the Company’s billing center for medical coding and entering into the Company’s billing system and the verification of each patient’s submission or representation at the time services are rendered as to the payor(s) responsible for payment of such services. Revenue is recorded based on the information known at the time of entering of such information into the Company’s billing systems, as well as an estimate of the revenue associated with medical services.

The Company is responsible for confirming member eligibility, performing program utilization review, potentially directing payment to the provider and accepting the financial risk of loss associated with services rendered, as specified within the Company’s client contracts. The Company has the ability to adjust contractual fees with clients and possess the financial risk of loss in certain contractual obligations. These factors indicate the Company is the principal and, as such, the Company records gross fees contracted with clients in revenues.

Consideration from FFS arrangements is variable in nature because fees are based on patient encounters, credits due to clients and reimbursement of provider costs, all of which can vary from period to period. Patient encounters and related episodes of care and procedures qualify as distinct goods and services, provided simultaneously together with other readily available resources, in a single instance of service, and thereby constitute a single performance obligation for each patient encounter and, in most instances, occur at readily determinable transaction prices. As a practical expedient, the Company adopted a portfolio approach for the FFS revenue stream to group together contracts with similar characteristics and analyze historical cash collections trends. The contracts within the portfolio share the characteristics conducive to ensuring that the results do not materially differ under the new standard if it were to be applied to individual patient contracts related to each patient encounter. Accordingly, there was no change in the Company's method to recognize revenue under ASC 606 Revenue from Contracts with Customers (“ASC 606”) from the previous accounting guidance.

Estimating net FFS revenue is a complex process, largely due to the volume of transactions, the number and complexity of contracts with payors, the limited availability at times of certain patient and payor information at the time services are provided, and the length of time it takes for collections to fully mature. These expected collections are based on fees and negotiated payment rates in the case of third-party payors, the specific benefits provided for under each patient's healthcare plans, mandated payment rates in the case of Medicare and Medicaid programs, and historical cash collections (net of recoveries) in combination with expected collections from third party payors.

The relationship between gross charges and the transaction price recognized is significantly influenced by payor mix, as collections on gross charges may vary significantly, depending on whether and with whom the patients the Company provides services to in the period are insured and the Company's contractual relationships with those payors. Payor mix is subject to change as additional patient and payor information is obtained after the period services are provided. The Company periodically assesses the estimates of unbilled revenue, contractual adjustments and discounts, and payor mix by analyzing actual results, including cash collections, against estimates. Changes in these estimates are charged or credited to the consolidated statements of income in the period that the assessment is made. Significant changes in payor mix, contractual arrangements with payors, specialty mix, acuity, general economic conditions and health care coverage provided by federal or state governments or private insurers may have a significant impact on estimates and significantly affect the results of operations and cash flows.

Contract Assets

Typically, revenues and receivables are recognized once the Company has satisfied its performance obligation. Accordingly, the Company’s contract assets are comprised of receivables and receivables – related parties.

The Company's billing and accounting systems provide historical trends of cash collections and contractual write-offs, accounts receivable agings and established fee adjustments from third-party payors. These estimates are recorded and monitored monthly as revenues are recognized. The principal exposure for uncollectible fee for service visits is from self-pay patients and, to a lesser extent, for co-payments and deductibles from patients with insurance.

Contract Liabilities (Deferred Revenue)

Contract liabilities are recorded when cash payments are received in advance of the Company’s performance, or in the case of the Company’s NGACO, the excess of AIPBP capitation received and the actual claims paid or incurred.

Income Taxes

Income Taxes

Federal and state income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a change in judgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reduce deferred tax assets to amounts expected to be realized.

The Company uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to be taken in a tax return in order to be recognized in the consolidated financial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the consolidated financial statements.

Share-Based Compensation

Share-Based Compensation

The Company maintains a stock-based compensation program for employees, non-employees, directors and consultants. The value of share-based awards such as options is recognized as compensation expense on a cumulative straight-line basis over the vesting period of the awards, adjusted for expected forfeitures. From time to time, the Company issues shares of its common stock to its employees, directors and consultants, which shares may be subject to the Company’s repurchase right (but not obligation) that lapses based on time-based and performance-based vesting schedules.

The Company accounts for share-based awards granted to persons other than employees and directors under ASC 505-50 Equity-Based Payments to Non-Employees. As such the fair value of such shares of stock is periodically remeasured using an appropriate valuation model and income or expense is recognized over the vesting period.

Basic and Diluted Earnings Per Share

Basic and Diluted Earnings Per Share

Basic earnings per share is computed by dividing net income attributable to holders of the Company’s common stock by the weighted average number of shares of common stock outstanding during the periods presented. Diluted earnings per share is computed using the weighted average number of shares of common stock outstanding, plus the effect of dilutive securities outstanding during the periods presented, using the treasury stock method. Refer to Note 14 for a discussion of shares treated as treasury shares for accounting purposes.

Noncontrolling Interests

Noncontrolling Interests

The Company consolidates entities in which the Company has a controlling financial interest. The Company consolidates subsidiaries in which the Company holds, directly or indirectly, more than 50% of the voting rights, and VIEs in which the Company is the primary beneficiary. Noncontrolling interests represent third-party equity ownership interests (including certain VIEs) in the Company’s consolidated entities. The amount of net income attributable to noncontrolling interests is disclosed in the consolidated statements of income.

Mezzanine Equity

Mezzanine Equity

Pursuant to APC’s shareholder agreements, in the event of a disqualifying event, as defined in the agreements, APC could be required to repurchase the shares from the respective shareholders based on certain triggers outlined in the shareholder agreements. As the redemption feature of the shares is not solely within the control of APC, the equity of APC does not qualify as permanent equity and has been classified as mezzanine or temporary equity. Accordingly, the Company recognizes noncontrolling interests in APC as mezzanine equity in the consolidated financial statements.

Recent Accounting Pronouncements

Recent Accounting Pronouncements

In June 2016, the FASB issued Accounting Standards Update (“ASU”) No. 2016-13, Financial Instruments-Credit Losses (Topic 326)-Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”). The new standard requires entities to measure all expected credit losses for financial assets held at the reporting date based on historical experience, current conditions and reasonable and supportable forecasts. ASU 2016-13 became effective for fiscal years beginning after December 15, 2019, with early adoption permitted. The Company adopted ASU 2016-13 on January 1, 2020. The adoption of ASU 2016-13 did not have a material impact on the consolidated financial statements.

In October 2018, the FASB issued ASU No. 2018-17, Consolidation (Topic 810): Targeted Improvements to Related Party Guidance for Variable Interest Entities (“ASU 2018-17”). This ASU reduces the cost and complexity of financial reporting associated with consolidation of VIEs. A VIE is an organization in which consolidation is not based on a majority of voting rights. The new guidance supersedes the private company alternative for common control leasing arrangements issued in 2014 and expands it to all qualifying common control arrangements. The amendments in this ASU became effective for fiscal years beginning after December 15, 2019, and interim periods within those fiscal years. The Company adopted ASU 2018-17 on January 1, 2020. The adoption of ASU 2018-17 did not have a material impact on the consolidated financial statements.

In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”). This ASU simplifies the accounting for income taxes by eliminating certain exceptions to the guidance in ASC 740 Income Taxes related to the approach for intraperiod tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. The amendments in this ASU are effective for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years. The Company is currently assessing the impact that the adoption of ASU 2019-12 will have on the Company's consolidated financial statements.

In January 2020, the FASB issued ASU No. 2020-01, Investments - Equity Securities (Topic 321), Investments - Equity Method and Joint Ventures (Topic 323), and Derivatives and Hedging (Topic 815) (“ASU 2020-01”). This ASU clarifies the interaction between accounting for equity securities, equity method investments and certain derivative instruments. This amendment in this ASU are effective for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years. The Company is currently assessing the impact that the adoption of ASU 2020-01 will have on the Company's consolidation financial statements.

Other than the standards discussed above, there have been no other new accounting pronouncements that have significance, or potential significance, to the Company’s financial position, results of operations and cash flows.

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Investments in Other Entities - Equity Method (Tables)

3 Months Ended

Mar. 31, 2020

Equity Method Investments and Joint Ventures [Abstract]

Equity Method Investments

UCI’s balance sheets at March 31, 2020 and December 31, 2019 and statements of income for the three months ended March 31, 2020 and 2019 are as follows (in thousands):

Balance Sheets

	March 31, 2020			December 31, 2019
Assets
Cash	$	34,757		$	33,890
Receivables, net	83,454			63,843
Other current assets	43,417			38,280
Other assets	885			882
Property and equipment, net	4,429			4,021
Total assets	$	166,942		$	140,916
Liabilities and Stockholders’ (Deficit) Equity
Current liabilities	$	148,902		$	128,330
Other liabilities	33,126			33,133
Stockholders’ deficit	(15,086		)	(20,547		)
Total liabilities and stockholders’ deficit	$	166,942		$	140,916

Statements of Income

	Three Months Ended March 31,
	2020		2019
Revenues	$	146,481	$	113,319
Expenses	141,771		111,408
Income before benefit from income taxes	4,710		1,911
Benefit from income taxes	—		(211		)
Net income	$	4,710	$	2,122

531 W. College LLC’s balance sheets at March 31, 2020 and December 31, 2019 and statements of operations for the three months ended March 31, 2020 and 2019 are as follows (in thousands):

Balance Sheets

	March 31, 2020		December 31, 2019
Assets
Cash	$	48	$	139
Other current assets	124		17
Other assets	70		70
Property and equipment, net	33,697		33,581
Total assets	$	33,939	$	33,807
Liabilities and Members’ Equity
Current liabilities	$	1,114	$	1,062
Stockholders’ equity	32,825		32,745
Total liabilities and members’ equity	$	33,939	$	33,807

Statements of Operation

	Three Months Ended March 31,
	2020			2019
Revenues	—			—
Expenses	338			469
Loss from operations	(338		)	(469		)
Other income	$	21		$	289
Net loss	$	(317	)	$	(180	)

LMA’s summarized balance sheets at March 31, 2020 and December 31, 2019 and summarized statements of operations for the three months ended March 31, 2020 and 2019 with respect to its IPA line of business are as follows (in thousands):

Balance Sheets

	March 31, 2020			December 31, 2019
Assets
Cash and cash equivalents	$	—		$	6,345
Receivables, net	8,901			5,124
Other current assets	3,380			3,526
Loan receivable	2,250			2,250
Restricted cash	686			683
Total assets	$	15,217		$	17,928
Liabilities and Stockholders’ (Deficit) Equity
Current liabilities	$	23,390		$	23,530
Stockholders’ deficit	(8,173		)	(5,602		)
Total liabilities and stockholders’ deficit	$	15,217		$	17,928

Statements of Operations

	Three Months Ended March 31,
	2020			2019
Revenues	$	46,304		$	46,406
Expenses	48,730			50,702
Net loss	$	(2,426	)	$	(4,296	)

Rollforward of Equity Method Investment (in thousands)

	December 31, 2019		Allocation of Income (Loss)			Contribution		March 31, 2020
LaSalle Medical Associates – IPA Line of Business	$	6,397	$	(643	)	$	—	$	5,754
Pacific Medical Imaging & Oncology Center, Inc.	1,396		87			—		1,483
Universal Care, Inc.	1,438		2,670			—		4,108
Diagnostic Medical Group	2,334		(5		)	—		2,329
531 W. College, LLC – related party	16,698		(111		)	300		16,887
MWN, LLC – related party	164		56			—		220
	$	28,427	$	2,054		$	300	$	30,781

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CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Cash flows from operating activities
Net income (loss)	$ 2,987	$ (2,450)
Adjustments to reconcile net income (loss) to net cash used in operating activities:
Depreciation and amortization	5,010	4,418
Provision for doubtful accounts	0	951
Share-based compensation	1,058	345
Unrealized gain from investment in equity securities	(162)	(8)
(Income) loss from equity method investments	(2,054)	850
Deferred tax	(1,915)	(2,623)
Changes in operating assets and liabilities, net of business combinations:
Receivable, net	(7,043)	487
Receivable, net – related parties	(2,774)	(7,511)
Other receivables	521	(11,245)
Prepaid expenses and other current assets	(1,495)	(729)
Right-of-use assets	794	448
Other assets	(4,801)	(443)
Accounts payable and accrued expenses	(7,173)	22,579
Fiduciary accounts payable	(318)	546
Medical liabilities	4,973	(10,376)
Income taxes payable	3,505	1,210
Operating lease liabilities	(406)	(416)
Net cash used in operating activities	(9,293)	(3,967)
Cash flows from investing activities
Purchases of marketable securities	(374)	(8)
Purchases of investment – equity method	(300)	0
Purchases of property and equipment	(269)	(104)
Net cash used in investing activities	(943)	(112)
Cash flows from financing activities
Repayment of bank loan and lines of credit	0	(40)
Dividends paid	(9,934)	(10,000)
Repayment of term loan	(2,375)	0
Payment of finance lease obligations	(26)	(25)
Proceeds from the exercise of stock options and warrants	700	140
Repurchase of shares	(426)	(40)
Proceeds from common stock offering	0	155
Net cash used in financing activities	(12,061)	(9,810)
Net decrease in cash, cash equivalents and restricted cash	(22,297)	(13,889)
Cash, cash equivalents and restricted cash, beginning of period	104,010	107,637
Cash, cash equivalents and restricted cash, end of period	81,713	93,748
Supplementary disclosures of cash flow information:
Cash paid for interest	2,619	182
Reconciliation of cash, cash equivalents, and restricted cash
Cash and cash equivalents	80,892	93,008
Restricted cash – current	75	0
Restricted cash – non-current	746	740
Total cash, cash equivalents and restricted cash shown in the statement of cash flows	$ 81,713	$ 93,748

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CONSOLIDATED BALANCE SHEETS (UNAUDITED) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current assets
Cash and cash equivalents	$ 80,892	$ 103,189
Restricted cash	75	75
Investment in marketable securities	117,075	116,539
Receivables, net	18,012	11,004
Receivables, net – related parties	50,911	48,136
Other receivables	16,362	16,885
Prepaid expenses and other current assets	11,811	10,315
Loans receivable	6,425	6,425
Loans receivable – related parties	16,500	16,500
Total current assets	318,063	329,068
Noncurrent assets
Land, property and equipment, net	11,876	12,130
Intangible assets, net	98,840	103,012
Goodwill	238,539	238,505
Investment in other entities – equity method	30,781	28,427
Investments in privately held entities	896	896
Restricted cash	746	746
Operating lease right-of-use assets	18,199	14,248
Other assets	6,475	1,681
Total noncurrent assets	406,352	399,645
Total assets	724,415	728,713
Current liabilities
Accounts payable and accrued expenses	20,106	27,279
Fiduciary accounts payable	1,709	2,027
Medical liabilities	63,698	58,725
Income taxes payable	8,034	4,529
Dividend payable	337	271
Finance lease liabilities	102	102
Operating lease liabilities	3,119	2,990
Current portion of long-term debt	9,500	9,500
Total current liabilities	106,605	105,423
Noncurrent liabilities
Deferred tax liability	16,332	18,269
Finance lease liabilities, net of current portion	390	416
Operating lease liabilities, net of current portion	15,583	11,373
Long-term debt, net of current portion and deferred financing costs	230,105	232,172
Total noncurrent liabilities	262,410	262,230
Total liabilities	369,015	367,653
Commitments and contingencies (Note 11)
Mezzanine equity
Noncontrolling interest in Allied Physicians of California, a Professional Medical Corporation	157,439	168,725
Stockholders’ equity
Common stock, $0.001 par value per share; 100,000,000 shares authorized, 36,042,761 and 35,908,057 shares outstanding, excluding 17,475,707 and 17,458,810 treasury shares, at March 31, 2020, and December 31, 2019, respectively	36	36
Additional paid-in capital	161,087	159,608
Retained earnings	35,957	31,905
Retained earnings	197,080	191,549
Noncontrolling interest	881	786
Total stockholders’ equity	197,961	192,335
Total liabilities, mezzanine equity and stockholders’ equity	724,415	728,713
Series A Preferred stock, $0.001 par value per share; 5,000,000 shares authorized (inclusive of all preferred stock, including Series B Preferred stock); 1,111,111 issued and zero outstanding
Stockholders’ equity
Preferred stock	0	0
Series B Preferred stock, $0.001 par value per share; 5,000,000 shares authorized (inclusive of all preferred stock, including Series A Preferred stock); 555,555 issued and zero outstanding
Stockholders’ equity
Preferred stock	$ 0	$ 0

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Related-Party Transactions

3 Months Ended

Mar. 31, 2020

Related Party Transactions [Abstract]

Related-Party Transactions

Related-Party Transactions

On November 16, 2015, UCAP entered into a subordinated note receivable agreement with UCI, a 48.9% owned equity method investee (see Note 5), in the amount of $5.0 million. On June 28, 2018 and November 28, 2018, UCAP entered into two additional subordinated note receivable agreements with UCI in the amount of $2.5 million and $5.0 million, respectively (see Note 6).

During the three months ended March 31, 2020 and 2019, NMM earned approximately $4.2 million and $3.2 million, respectively, in management fees from LMA, which is accounted for under the equity method based on 25% equity ownership interest held by APC in LMA’s IPA line of business (see Note 5).

During the three months ended March 31, 2020 and 2019, APC paid approximately $0.6 million and $0.7 million, respectively, to PMIOC for provider services, which is accounted for under the equity method based on 40% equity ownership interest held by APC (see Note 5).

During the three months ended March 31, 2020 and 2019, APC paid approximately $1.8 million and $2.0 million, respectively, to DMG for provider services, which is accounted for under the equity method based on 40% equity ownership interest held by APC (see Note 5).

During the three months ended March 31, 2020 and 2019, APC paid approximately $39,800 and $92,000, respectively, to Advanced Diagnostic Surgery Center for services as a provider. Advanced Diagnostic Surgery Center shares common ownership with certain board members of APC.

During the three months ended March 31, 2020 and 2019, APC paid an aggregate of approximately $7.3 million and $9.3 million, respectively, to shareholders of APC for provider services, which include approximately $1.7 million and $3.3 million, respectively, to shareholders who are also officers of APC.

During the three months ended March 31, 2020 and 2019, NMM paid approximately $0.3 million, respectively, to Medical Property Partners (“MPP”) for an office lease. MPP shares common ownership with certain board members of NMM.

During the three months ended March 31, 2020, NMM paid approximately $0.4 million, respectively, to One MSO, Inc. ("One MSO") for an office lease. One MSO shares common ownership with certain board members of NMM. As of March 31, 2020, the Company had $10.8 million of ROU assets and lease liabilities, respectively, related to its office lease with One MSO to be amortized over the remaining life of the lease.

During the three months ended March 31, 2020 and 2019, the Company paid approximately $0.1 million, respectively, to Critical Quality Management Corporation (“CQMC”) for an office lease. CQMC shares common ownership with certain board members of APC.

During the three months ended March 31, 2020 and 2019, SCHC paid approximately $0.1 million, respectively, to Numen, LLC (“Numen”) for an office lease. Numen is owned by a shareholder of APC.

The Company has agreements with HSMSO, Aurion Corporation (“Aurion”), and AHMC Healthcare (“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. The following table sets forth fees incurred and income earned related to AHMC, HSMSO and Aurion (in thousands):

	Three Months Ended March 31,
	2020			2019
AHMC – Risk pool and capitation	$	11,999		$	11,600
HSMSO – Management fees, net	(132		)	(650		)
Aurion – Management fees	(75		)	(100		)
Net total	$	11,792		$	10,850

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. During the three months ended March 31, 2020 and 2019, the Company has recognized risk pool revenue under this agreement of $12.0 million and $10.1 million, respectively, for which $47.2 million and $40.4 million remain outstanding as of March 31, 2020 and December 31, 2019, respectively.

During the quarter ended March 31, 2020, NMM paid approximately $26,600 to an Apollo board member for consulting services.

In addition, affiliates wholly owned by the Company’s officers, including the Company's Co-CEOs, Dr. Sim and Dr. Lam, 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.

For equity method investments, loans receivable and line of credits from related parties, see Notes 5, 6 and 9, respectively.

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Intangible Assets, Net

3 Months Ended

Mar. 31, 2020

Goodwill and Intangible Assets Disclosure [Abstract]

Intangible Assets, Net

Intangible Assets, Net

At March 31, 2020, the Company’s intangible assets, net, consisted of the following (in thousands):

	Useful Life (Years)	Gross March 31, 2020		Accumulated Amortization			Net March 31, 2020
Amortized intangible assets:
Network relationships	11-15	143,930		(63,831		)	80,099
Management contracts	15	22,832		(10,206		)	12,626
Member relationships	12	6,696		(2,573		)	4,123
Patient management platform	5	2,060		(961		)	1,099
Trade name/trademarks	20	1,011		(118		)	893
		$	176,529	$	(77,689	)	$	98,840

At December 31, 2019, the Company’s intangible assets, net, consisted of the following (in thousands):

	Useful Life (Years)	Gross December 31, 2019		Accumulated Amortization			Net December 31, 2019
Amortized intangible assets:
Network relationships	11-15	143,930		(60,526		)	83,404
Management contracts	15	22,832		(9,676		)	13,156
Member relationships	12	6,696		(2,352		)	4,344
Patient management platform	5	2,060		(858		)	1,202
Trade name/trademarks	20	1,011		(105		)	906
		$	176,529	$	(73,517	)	$	103,012

Amortization expense was $4.2 million and $3.9 million for the three months ended March 31, 2020 and 2019, respectively.

Future amortization expense is estimated to be as follows for the years ending December 31 (in thousands):

	Amount
2020 (excluding the three months ended March 31, 2020)	$	11,856
2021	14,524
2022	12,673
2023	10,842
2024	9,830
Thereafter	39,115
Total	$	98,840

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Medical Liabilities

3 Months Ended

Mar. 31, 2020

Liability for Unpaid Claims and Claims Adjustment Expense, Activity in Liability [Abstract]

Medical Liabilities

Medical Liabilities

The Company’s medical liabilities consisted of the following (in thousands):

	March 31, 2020			March 31, 2019
Medical liabilities, beginning of period	$	58,725		$	33,642
Components of medical care costs related to claims incurred:
Current period	85,928			31,870
Prior periods	(602		)	3,105
Total medical care costs	85,326			34,975
Payments for medical care costs related to claims incurred:
Current period	(37,004		)	(16,587		)
Prior periods	(43,247		)	(28,850		)
Total paid	(80,251		)	(45,437		)
Adjustments	(102		)	86
Medical liabilities, ending balance	$	63,698		$	23,266

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Description of Business - Additional Information (Details) $ in Millions				1 Months Ended
	Apr. 30, 2020 USD ($)	Aug. 30, 2019 USD ($)	Jul. 01, 1999	Sep. 30, 2019 USD ($) shares	Mar. 31, 2020 clinic	Mar. 31, 2020 medical_center	Mar. 31, 2020	Mar. 31, 2020 plan	Mar. 31, 2020 specialty_care_physician	Mar. 31, 2020 primary_care_physician	Mar. 31, 2020 enrollee	Mar. 31, 2020 member	Dec. 31, 2019	Jun. 30, 2014
Accountable Health Care
Description Of Business [Line Items]
Consideration transferred		$ 25.1
AMG, Inc
Description Of Business [Line Items]
Consideration transferred				$ 1.6
AP-AMH Medical Corporation | Affiliated Entity
Description Of Business [Line Items]
Amount of loan				$ 545.0
Term of receivable				10 years
Stated rate of note of loan receivable				10.00%
Interest rate in the event of default				10.75%
APC | Affiliated Entity
Description Of Business [Line Items]
Number of shares purchased by related party | shares				15,015,015
Stock subscription				$ 300.0
Proxy votes				9.99%
APC
Description Of Business [Line Items]
Fixed term of amended and restated management and administrative services agreement			30 years
APC | Accountable Health Care
Description Of Business [Line Items]
Interest acquired		25.00%
APC | AMG, Inc
Description Of Business [Line Items]
Value of shares transferred in acquisition				$ 0.4
APC | Universal Care Acquisition Partners, LLC
Description Of Business [Line Items]
Investment, ownership interest														100.00%
APC | Apollo Medical Holdings, Inc
Description Of Business [Line Items]
Investment, ownership interest							32.44%						32.50%
APC | Concourse Diagnostic Surgery Center, LLC
Description Of Business [Line Items]
Investment, ownership interest							45.01%
APC | Universal Care, Inc. | Subsequent Event
Description Of Business [Line Items]
Ownership interest disposed	48.90%
Cash consideration received, sale of equity method investment	$ 69.2
Repayment of indebtedness received	16.5
Additional cash consideration entitled to be received	15.6
APC | AP-AMH Medical Corporation | Affiliated Entity | Series A Preferred Stock
Description Of Business [Line Items]
Number of shares purchased by related party | shares				1,000,000
APC | Bright | Preferred Stock | Universal Care, Inc. | Subsequent Event
Description Of Business [Line Items]
Value of non-cash consideration received	33.3
Value of additional non-cash consideration to be received	$ 5.9
APC LSMA | Accountable Health Care
Description Of Business [Line Items]
Interest acquired		75.00%
APC LSMA | AMG, Inc
Description Of Business [Line Items]
Interest acquired				100.00%
Payments to acquire business				$ 1.2
APC LSMA | Maverick Medical Group, Inc
Description Of Business [Line Items]
Ownership interest							100.00%
Alpha Care Medical Group, Inc.
Description Of Business [Line Items]
Number of healthcare enrollees (over) | enrollee											170,000
Accountable Health Care
Description Of Business [Line Items]
Number of employees (more than)									700	300
Number of medical centers | medical_center						4
Number of members of federally qualified health plans (more than) | member												80,000
Number federally qualified health plans | plan								3
AMG, Inc
Description Of Business [Line Items]
Number of family practice clinics | clinic					3
Universal Care Acquisition Partners, LLC | APC | Universal Care, Inc. | Subsequent Event
Description Of Business [Line Items]
Investment, ownership interest	48.90%

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Related-Party Transactions (Tables)

3 Months Ended

Mar. 31, 2020

Related Party Transactions [Abstract]

Schedule of Fees Incurred and Income Received from Related Party Transactions

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

	Three Months Ended March 31,
	2020			2019
AHMC – Risk pool and capitation	$	11,999		$	11,600
HSMSO – Management fees, net	(132		)	(650		)
Aurion – Management fees	(75		)	(100		)
Net total	$	11,792		$	10,850

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Loan Receivable and Loan Receivable - Related Parties - Additional Information (Details) - USD ($) $ in Thousands		3 Months Ended
	Apr. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Dec. 13, 2019	Jun. 28, 2019	Nov. 28, 2018	Jun. 29, 2018	Dec. 31, 2015
Accounts, Notes, Loans and Financing Receivable [Line Items]
Prepaid expenses and other current assets		$ 11,811	$ 10,315
APC | Universal Care, Inc. | Subsequent Event
Accounts, Notes, Loans and Financing Receivable [Line Items]
Cash consideration received, sale of equity method investment	$ 69,200
Repayment of indebtedness received	16,500
Additional cash consideration entitled to be received	15,600
APC | Bright | Preferred Stock | Universal Care, Inc. | Subsequent Event
Accounts, Notes, Loans and Financing Receivable [Line Items]
Value of non-cash consideration received	33,300
Value of additional non-cash consideration to be received	$ 5,900
Universal Care Acquisition Partners, LLC | APC | Universal Care, Inc. | Subsequent Event
Accounts, Notes, Loans and Financing Receivable [Line Items]
Ownership interest	48.90%
Convertible Secured Promissory Note | Dr. Arteaga | LMA
Accounts, Notes, Loans and Financing Receivable [Line Items]
Ownership upon conversion of finance receivable					53.75%
Convertible Secured Promissory Note | Dr. Arteaga
Accounts, Notes, Loans and Financing Receivable [Line Items]
Amount of loan		$ 6,400
Convertible Secured Promissory Note | Dr. Arteaga | APC
Accounts, Notes, Loans and Financing Receivable [Line Items]
Amount of loan					$ 6,400
Interest rate on loan receivable		4.25%
Percentage of outstanding stock convertible					21.25%
Convertible Secured Promissory Note | Dr. Arteaga | APC and APC-LSMA | LMA
Accounts, Notes, Loans and Financing Receivable [Line Items]
Ownership upon conversion of finance receivable					46.25%
Convertible Secured Promissory Note | Dr. Arteaga | Prime Rate | APC
Accounts, Notes, Loans and Financing Receivable [Line Items]
Basis spread on variable rate		1.00%
Financing Receivable | APC | Universal Care, Inc.
Accounts, Notes, Loans and Financing Receivable [Line Items]
Interest rate on loan receivable		4.25%
Advance for working capital								$ 5,000
Additional advances				$ 4,000		$ 5,000	$ 2,500
Loans receivable - related parties		$ 16,500	$ 16,500
Financing Receivable | Prime Rate | APC | Universal Care, Inc.
Accounts, Notes, Loans and Financing Receivable [Line Items]
Basis spread on variable rate		1.00%
Financing Receivable | Dr. Arteaga
Accounts, Notes, Loans and Financing Receivable [Line Items]
Amount of loan		$ 2,200
Prepaid expenses and other current assets		$ 1,600
Financing Receivable | Dr. Jay Loan | APC | Universal Care, Inc.
Accounts, Notes, Loans and Financing Receivable [Line Items]
Interest rate on loan receivable			5.75%

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Credit Facility, Bank Loan and Lines of Credit - Schedule of Maturities (Details) $ in Thousands	Mar. 31, 2020 USD ($)
Debt Disclosure [Abstract]
2020 (excluding the three months ended March 31, 2020)	$ 7,125
2021	10,688
2022	14,250
2023	15,437
2024	197,750
Total	$ 245,250

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Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands			3 Months Ended
	Mar. 31, 2020	Dec. 31, 2019	Mar. 31, 2020	Mar. 31, 2019
Leases [Abstract]
Operating lease cost			$ 1,942	$ 1,102
Finance lease cost
Amortization of lease expense	$ 300	$ 300	26	25
Interest on lease liabilities			4	5
Sublease income			(134)	(100)
Total finance lease cost, net			$ 1,838	$ 1,032

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Intangible Assets, Net - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 4.2	$ 3.9

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Business Combination and Goodwill - Additional Information (Details) - USD ($) $ in Thousands			1 Months Ended
	Aug. 30, 2019	May 31, 2019	Sep. 30, 2019
Accountable Health Care
Business Acquisition [Line Items]
Consideration transferred	$ 25,100
Liabilities assumed	15,400
Accountable Health Care | Dr. Jay
Business Acquisition [Line Items]
Cash paid	$ 7,250
AMG, Inc
Business Acquisition [Line Items]
Consideration transferred			$ 1,600
APC and APC-LSMA | Alpha Care Medical Group, Inc.
Business Acquisition [Line Items]
Interest acquired		100.00%
Cash paid		$ 45,056
Escrow deposit for potential post-closing adjustments		$ 2,000
APC and APC-LSMA | Accountable Health Care | Dr. Jay
Business Acquisition [Line Items]
Interest acquired	75.00%
Consideration transferred	$ 7,300
APC | Accountable Health Care
Business Acquisition [Line Items]
Interest acquired	25.00%
Payments to acquire investments	$ 2,400
APC | AMG, Inc
Business Acquisition [Line Items]
Value of shares transferred in acquisition			$ 400

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Earnings Per Share - Shares Included in Diluted Earnings Per Share Computations (Details) - shares	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Earnings Per Share [Line Items]
Weighted average shares of common stock outstanding – basic (in shares)	36,010,268	34,496,622
Weighted average shares of common stock outstanding – diluted (in shares)	37,439,099	38,074,174
Stock options
Earnings Per Share [Line Items]
Adjustments to weighted average shares of common stock (in shares)	185,830	455,381
Restricted Stock Units (RSUs)
Earnings Per Share [Line Items]
Adjustments to weighted average shares of common stock (in shares)	35,556	0
10% shares held back pursuant to indemnification clause
Earnings Per Share [Line Items]
Adjustments to weighted average shares of common stock (in shares)	0	1,519,805
Warrants
Earnings Per Share [Line Items]
Adjustments to weighted average shares of common stock (in shares)	1,207,445	1,602,366

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Mezzanine and Stockholders' Equity - Stock Option Activity Under Black-Scholes Option (Details) - Board Members	3 Months Ended
	Mar. 31, 2020 $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term	3 years
Expected volatility	90.01%
Risk-free interest rate	1.43%
Market value of common stock (in dollars per share)	$ 10.56
Annual dividend yield	0.00%
Forfeiture rate	0.00%

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Related-Party Transactions - Additional Information (Details)	3 Months Ended
	Mar. 31, 2020 USD ($)	Mar. 31, 2019 USD ($)	Dec. 31, 2019 USD ($)	Nov. 28, 2018 USD ($) agreement	Jun. 28, 2018 USD ($)	Nov. 16, 2015 USD ($)
Related Party Transaction [Line Items]
Operating lease right-of-use assets	$ 18,199,000		$ 14,248,000
Lease liabilities	18,702,000
NMM | Board Members
Related Party Transaction [Line Items]
Consulting services paid	$ 26,600
NMM | LMA
Related Party Transaction [Line Items]
Ownership interest	25.00%
Revenue from related parties	$ 4,200,000	$ 3,200,000
APC | PMIOC | Service
Related Party Transaction [Line Items]
Payments to related parties	600,000	700,000
APC | DMG | Service
Related Party Transaction [Line Items]
Payments to related parties	1,800,000	2,000,000
Universal Care, Inc.
Related Party Transaction [Line Items]
Ownership interest						48.90%
Amount of subordinated note receivable agreement						$ 5,000,000
Universal Care Acquisition Partners, LLC
Related Party Transaction [Line Items]
Amount of subordinated note receivable agreement				$ 5,000,000	$ 2,500,000
Number of additional subordinated note receivable agreements | agreement				2
APC Shareholders | APC | Service
Related Party Transaction [Line Items]
Payments to related parties	$ 7,300,000	9,300,000
APC Shareholders | APC | PMIOC | Service
Related Party Transaction [Line Items]
Ownership interest	40.00%
APC Shareholders | APC | DMG | Service
Related Party Transaction [Line Items]
Ownership interest	40.00%
Advance Diagnostic Surgery Center | APC | Service
Related Party Transaction [Line Items]
Payments to related parties	$ 39,800	92,000
APC Shareholders and Officers | APC
Related Party Transaction [Line Items]
Payments to related parties	1,700,000	3,300,000
Medical Property Partners | NMM
Related Party Transaction [Line Items]
Payments to related parties	300,000	300,000
One MSO, Inc. | NMM
Related Party Transaction [Line Items]
Payments to related parties	400,000
Operating lease right-of-use assets	10,800,000
Lease liabilities	10,800,000
Critical Quality Management Corp
Related Party Transaction [Line Items]
Payments to related parties	100,000	100,000
Numen LLC | SCHC
Related Party Transaction [Line Items]
Payments to related parties	100,000	100,000
AHMC
Related Party Transaction [Line Items]
Risk pool revenue	12,000,000	$ 10,100,000
Amount outstanding under agreement	$ 47,200,000		$ 40,400,000

XML

CONSOLIDATED STATEMENTS OF INCOME (UNAUDITED) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Revenue
Total revenue	$ 165,105	$ 95,758
Operating expenses
Cost of services	144,204	83,432
General and administrative expenses	11,834	10,264
Depreciation and amortization	4,702	4,418
Provision for doubtful accounts	0	951
Total expenses	160,740	99,065
Income (loss) from operations	4,365	(3,307)
Other income (expense)
Income (loss) from equity method investments	2,054	(850)
Interest expense	(2,868)	(211)
Interest income	929	323
Other income	102	187
Total other income (expense), net	217	(551)
Income (loss) before provision for (benefit from) income taxes	4,582	(3,858)
Provision for (benefit from) income taxes	1,595	(1,408)
Net income (loss)	2,987	(2,450)
Net loss attributable to noncontrolling interests	(1,065)	(2,590)
Net income attributable to Apollo Medical Holdings, Inc.	$ 4,052	$ 140
Earnings per share – basic (in dollars per share)	$ 0.11	$ 0.00
Earnings per share – diluted (in dollars per share)	$ 0.11	$ 0.00
Weighted average shares of common stock outstanding – basic (in shares)	36,010,268	34,496,622
Weighted average shares of common stock outstanding – diluted (in shares)	37,439,099	38,074,174
Capitation, net
Revenue
Total revenue	$ 140,421	$ 71,517
Risk pool settlements and incentives
Revenue
Total revenue	11,236	10,094
Management fee income
Revenue
Total revenue	8,815	8,997
Fee-for-service, net
Revenue
Total revenue	3,427	4,081
Other income
Revenue
Total revenue	$ 1,206	$ 1,069

XML

Basis of Presentation and Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2020

Accounting Policies [Abstract]

Basis of Presentation and Summary of Significant Accounting Policies

Basis of Presentation and Summary of Significant Accounting Policies

Basis of Presentation

The accompanying consolidated balance sheet at December 31, 2019, has been derived from the Company's audited consolidated financial statements, but does not include all disclosures required by generally accepted accounting principles in the United States of America (“U.S. GAAP”). The accompanying unaudited consolidated financial statements as of March 31, 2020 and for the three months ended March 31, 2020 and 2019, have been prepared in accordance with U.S. GAAP for interim financial information and with the instructions to Form 10-Q and Article 8 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by U.S. GAAP for complete financial statements, and should be read in conjunction with the audited consolidated financial statements and related notes to the financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 as filed with the SEC on March 16, 2020. In the opinion of management, all material adjustments (consisting of normal recurring adjustments) considered necessary for a fair presentation have been made to make the consolidated financial statements not misleading as required by Regulation S-X, Rule 10-01. Operating results for the three months ended March 31, 2020 are not necessarily indicative of the results that may be expected for the year ending December 31, 2020 or any future periods.

Principles of Consolidation

The consolidated balance sheets as of March 31, 2020 and December 31, 2019, and the consolidated statements of income for the three months ended March 31, 2020 and 2019,  include the accounts of ApolloMed, its consolidated subsidiaries NMM, AMM, APAACO, and Apollo Care Connect, including ApolloMed's consolidated VIE, AP-AMH, NMM’s subsidiaries, NMM’s consolidated VIE, APC, APC’s subsidiary, UCAP, and APC’s consolidated VIEs, CDSC, APC-LSMA, ICC, and APC-LSMA's consolidated subsidiaries Alpha Care and Accountable Health Care.

All material intercompany balances and transactions have been eliminated in consolidation.

Use of Estimates

The preparation of the consolidated financial statements and related disclosures in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include collectability of receivables, recoverability of long-lived and intangible assets, business combination and goodwill valuation and impairment, accrual of medical liabilities (incurred, but not reported (“IBNR”) claims), determination of full-risk and shared-risk revenue and receivables (including constraints and completion factors, including historical medical loss ratios (“MLR”)), income taxes, valuation of share-based compensation and right-of-use ("ROU") assets and lease liabilities. Management evaluates its estimates and assumptions on an ongoing basis using historical experience and other factors, including the current economic environment, and makes adjustments when facts and circumstances dictate. As future events and their effects cannot be determined with precision, actual results could differ materially from those estimates and assumptions.

Reportable Segments

The Company operates as one reportable segment, the healthcare delivery segment, and implements and operates innovative health care models to create a patient-centered, physician-centric experience. The Company reports its consolidated financial statements in the aggregate, including all activities in one reportable segment.

Reclassifications

Certain amounts disclosed in prior period financial statements have been reclassified to conform to the current period presentation. These reclassifications had no material effect on the Company’s reported revenue, net income, cash flows or total assets.

Cash and Cash Equivalents

The Company’s cash and cash equivalents primarily consist of money market funds and certificates of deposit. The Company considers all highly liquid investments that are both readily convertible into known amounts of cash and mature within ninety days from their date of purchase to be cash equivalents.

The Company maintains its cash in deposit accounts with several banks, which at times may exceed the insured limits of the Federal Deposit Insurance Corporation (“FDIC”). The Company believes it is not exposed to any significant credit risk with respect to its cash, cash equivalents and restricted cash. As of March 31, 2020, the Company’s deposit accounts with banks exceeded the FDIC’s insured limit by approximately $209.3 million, including approximately $117.0 million in certificates of deposit that were recognized as investments in marketable securities. The Company has not experienced any losses to date and performs ongoing evaluations of these financial institutions to limit the Company’s concentration of risk exposure.

Restricted Cash

Restricted cash consists of cash held as collateral to secure standby letters of credits as required by certain contracts.

Investments in Marketable Securities

The appropriate classification of investments is determined at the time of purchase and such designation is reevaluated at each balance sheet date. As of March 31, 2020 and December 31, 2019, short-term marketable securities in the amount of approximately $117.1 million and $116.5 million, respectively, consist of equity securities and certificates of deposit with various financial institutions, reported at par value, plus accrued interest, with maturity dates from 4 months to 24 months (see fair value measurements of financial instruments below). Investments in certificates of deposits are classified as Level 1 investments in the fair value hierarchy.

Receivables and Receivables – Related Parties

The Company’s receivables are comprised of accounts receivable, capitation and claims receivable, risk pool settlements and incentive receivables, management fee income and other receivables. Accounts receivable are recorded and stated at the amount expected to be collected.

The Company’s receivables – related parties are comprised of risk pool settlements, management fee income and incentive receivables, and other receivables. Receivables – related parties are recorded and stated at the amount expected to be collected.

Capitation and claims receivable relate to each health plan’s capitation, is received by the Company in the month following the month of service. Risk pool settlements and incentive receivables mainly consist of the Company’s full risk pool receivable that is recorded quarterly based on reports received from the Company's hospital partners and management’s estimate of the Company’s portion of the estimated risk pool surplus for open performance years. Settlement of risk pool surplus or deficits occurs approximately 18 months after the risk pool performance year is completed. During the three months ended March 31, 2020, recoverable claims paid related to the 2019 APAACO performance year to be administered following instructions from CMS, fee-for-services (“FFS”) reimbursement for patient care, certain expense reimbursements, transportation reimbursements from the hospitals, and stop loss insurance premium reimbursements are included in “Other receivables” in the accompanying consolidated balance sheets.

The Company maintains reserves for potential credit losses on accounts receivable. Management reviews the composition of accounts receivable and analyzes historical bad debts, customer concentrations, customer credit worthiness, current economic trends and changes in customer payment patterns to evaluate the adequacy of these reserves. The Company also regularly analyzes the ultimate collectability of accounts receivable after certain stages of the collection cycle using a look-back analysis to determine the amount of receivables subsequently collected and adjustments are recorded when necessary. Reserves are recorded primarily on a specific identification basis.

Receivables are recorded when the Company is able to determine amounts receivable under these contracts and/or agreements based on information provided and collection is reasonably likely to occur. In regards to the credit loss standard, the Company continuously monitors its collections of receivables and our expectation is that the historical credit loss experienced across our receivable portfolio is materially similar to any current expected credit losses that would be estimated under the current expected credit losses (CECL) model. At both March 31, 2020 and December 31, 2019, the Company’s allowance for doubtful accounts was approximately $2.9 million.

Concentrations of Risks

The Company disaggregates revenue from contracts by service type and payor type. This level of detail provides useful information pertaining to how the Company generates revenue by significant revenue stream and by type of direct contracts. The consolidated statements of income present disaggregated revenue by service type. The following table presents disaggregated revenue generated by each payor type for the three months ended March 31, 2020 and 2019 (in thousands):

	For the Three Months Ended March 31,
	2020		2019
Commercial	$	24,710	$	26,761
Medicare	68,641		25,465
Medicaid	62,690		37,232
Other third parties	9,064		6,300
Revenue	$	165,105	$	95,758

The Company had major payors that contributed the following percentages of net revenue:

	For the Three Months Ended March 31,
	2020		2019
Payor A	12.1	%	17.4	%
Payor B	10.3	%	15.3	%
Payor C	*		12.0	%
Payor D	17.6	%	*
Payor E	13.3	%	*

* Less than 10% of total net revenues

The Company had major payors that contributed to the following percentages of receivables and receivables – related parties before the allowance for doubtful accounts:

	As of March 31, 2020		As of December 31, 2019
Payor D	13.6	%	*
Payor F	33.5	%	30.4	%
Payor G	33.6	%	36.0	%

* Less than 10% of total receivables and receivables — related parties, net

Fair Value Measurements of Financial Instruments

The Company’s financial instruments consist of cash and cash equivalents, fiduciary cash, restricted cash, investment in marketable securities, receivables, loans receivable, accounts payable, certain accrued expenses, finance lease obligations, and long-term debt. The carrying values of the financial instruments classified as current in the accompanying consolidated balance sheets are considered to be at their fair values, due to the short maturity of these instruments. The carrying amounts of the finance lease obligations and long term debt approximate fair value as they bear interest at rates that approximate current market rates for debt with similar maturities and credit quality.

Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) 820, Fair Value Measurement (“ASC 820”), applies to all financial assets and financial liabilities that are measured and reported on a fair value basis and requires disclosure that establishes a framework for measuring fair value and expands disclosure about fair value measurements. ASC 820 establishes a fair value hierarchy for disclosure of the inputs to valuations used to measure fair value.

This hierarchy prioritizes the inputs into three broad levels as follows:

Level 1 —Inputs are unadjusted quoted prices in active markets for identical assets or liabilities that can be accessed at the measurement date.

Level 2 —Inputs include quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets or liabilities in markets that are not active, inputs other than quoted prices that are observable for the asset or liability (i.e., interest rates and yield curves), and inputs that are derived principally from or corroborated by observable market data by correlation or other means (market corroborated inputs).

Level 3 —Unobservable inputs that reflect assumptions about what market participants would use in pricing the asset or liability. These inputs would be based on the best information available, including the Company’s own data.

The carrying amounts and fair values of the Company’s financial instruments as of March 31, 2020 are presented below (in thousands):

	Fair Value Measurements
	Level 1		Level 2		Level 3		Total
Assets
Money market funds*	$	41,675	$	—	$	—	$	41,675
Marketable securities – certificates of deposit	117,036		—		—		117,036
Marketable securities – equity securities	39		—		—		39
Total	$	158,750	$	—	$	—	$	158,750

The carrying amounts and fair values of the Company’s financial instruments as of December 31, 2019 are presented below (in thousands):

	Fair Value Measurements
	Level 1		Level 2		Level 3		Total
Assets
Money market funds*	$	50,731	$	—	$	—	$	50,731
Marketable securities – certificates of deposit	116,469		—		—		116,469
Marketable securities – equity securities	70		—		—		70
Total	$	167,270	$	—	$	—	$	167,270

*    Included in cash and cash equivalents

There were no Level 2 or Level 3 inputs measured on a recurring basis for the three months ended March 31, 2020.

There have been no changes in Level 1, Level 2, or Level 3 classification and no changes in valuation techniques for these assets for the three months ended March 31, 2020.

Intangible Assets and Long-Lived Assets

Intangible assets with finite lives include network-payor relationships, management contracts and member relationships and are stated at cost, less accumulated amortization and impairment losses. These intangible assets are amortized on the accelerated method using the discounted cash flow rate.

Intangible assets with finite lives also include a patient management platform, as well as trade names and trademarks, whose valuations were determined using the cost to recreate method and the relief from royalty method, respectively. These assets are stated at cost, less accumulated amortization and impairment losses, and are amortized using the straight-line method.

Finite-lived intangibles and long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. If the expected future cash flows from the use of such assets (undiscounted and without interest charges) are less than the carrying value, a write-down would be recorded to reduce the carrying value of the asset to its estimated fair value. Fair value is determined based on appropriate valuation techniques. The Company determined that there was no impairment of its finite-lived intangible or long-lived assets during the three months ended March 31, 2020 and 2019.

Goodwill and Indefinite-Lived Intangible Assets

Under ASC 350, Intangibles – Goodwill and Other, goodwill and indefinite-lived intangible assets are reviewed at least annually for impairment.

At least annually, at the Company’s fiscal year-end, or sooner if events or changes in circumstances indicate that an impairment has occurred, the Company performs a qualitative assessment to determine whether it is more likely than not that the fair value of each reporting unit is less than its carrying amount as a basis for determining whether it is necessary to complete quantitative impairment assessments for each of the Company’s three main reporting units (1) management services, (2) IPAs, and (3) ACOs. The Company is required to perform a quantitative goodwill impairment test only if the conclusion from the qualitative assessment is that it is more likely than not that a reporting unit’s fair value is less than the carrying value of its assets. Should this be the case, a quantitative analysis is performed to identify whether a potential impairment exists by comparing the estimated fair values of the reporting units with their respective carrying values, including goodwill.

An impairment loss is recognized if the implied fair value of the asset being tested is less than its carrying value. In this event, the asset is written down accordingly. The fair values of goodwill are determined using valuation techniques based on estimates, judgments and assumptions management believes are appropriate in the circumstances.

At least annually, indefinite-lived intangible assets are tested for impairment. Impairment for intangible assets with indefinite lives exists if the carrying value of the intangible asset exceeds its fair value. The fair values of indefinite-lived intangible assets are determined using valuation techniques based on estimates, judgments and assumptions management believes are appropriate in the circumstances.

The Company had no impairment of its goodwill or indefinite-lived intangible assets during the three months ended March 31, 2020 and 2019.

Investments in Other Entities — Equity Method

The Company accounts for certain investments using the equity method of accounting when it is determined that the investment provides the Company with the ability to exercise significant influence, but not control, over the investee. Significant influence is generally deemed to exist if the Company has an ownership interest in the voting stock of the investee of between 20% and 50%, although other factors, such as representation on the investee’s board of directors, are considered in determining whether the equity method of accounting is appropriate. Under the equity method of accounting, the investment, originally recorded at cost, is adjusted to recognize the Company’s share of net earnings or losses of the investee and is recognized in the accompanying consolidated statements of income under “Income (loss) from equity method investments” and also is adjusted by contributions to and distributions from the investee. Equity method investments are subject to impairment evaluation.

Medical Liabilities

APC, Alpha Care, Accountable Health Care, APAACO and MMG are responsible for integrated care that the associated physicians and contracted hospitals provide to their enrollees. APC, Alpha Care, Accountable Health Care, APAACO and MMG, provide integrated care to HMOs, Medicare and Medi-Cal enrollees through a network of contracted providers under sub-capitation and direct patient service arrangements. Medical costs for professional and institutional services rendered by contracted providers are recorded as cost of services expenses in the accompanying consolidated statements of income.

An estimate of amounts due to contracted physicians, hospitals, and other professional providers is included in medical liabilities in the accompanying consolidated balance sheets. Medical liabilities include claims reported as of the balance sheet date and estimates IBNR claims. Such estimates are developed using actuarial methods and are based on numerous variables, including the utilization of health care services, historical payment patterns, cost trends, product mix, seasonality, changes in membership, and other factors. The estimation methods and the resulting reserves are periodically reviewed and updated. Many of the medical contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of various services. Such differing interpretations may not come to light until a substantial period of time has passed following the contract implementation.

Revenue Recognition

The Company receives payments from the following sources for services rendered: (i) commercial insurers; (ii) the federal government under the Medicare program administered by CMS; (iii) state governments under the Medicaid and other programs; (iv) other third party payors (e.g., hospitals and IPAs); and (v) individual patients and clients.

Nature of Services and Revenue Streams

Revenue primarily consists of capitation revenue, risk pool settlements and incentives, NGACO All-Inclusive Population-Based Payments (“AIPBP”), management fee income, and FFS revenue. Revenue is recorded in the period in which services are rendered or the period in which the Company is obligated to provide services. The form of billing and related risk of collection for such services may vary by type of revenue and the customer. The following is a summary of the principal forms of the Company’s billing arrangements and how revenue is recognized for each.

Capitation, Net

Managed care revenues of the Company consist primarily of capitated fees for medical services provided by the Company under a capitated arrangement directly made with various managed care providers including HMOs. Capitation revenue is typically prepaid monthly to the Company based on the number of enrollees selecting the Company as their healthcare provider. Capitation revenue is recognized in the month in which the Company is obligated to provide services to plan enrollees under contracts with various health plans. Minor ongoing adjustments to prior months’ capitation, primarily arising from contracted HMOs finalizing their monthly patient eligibility data for additions or subtractions of enrollees, are recognized in the month they are communicated to the Company. Additionally, Medicare pays capitation using a “Risk Adjustment” model, which compensates managed care organizations and providers based on the health status (acuity) of each individual enrollee. Health plans and providers with higher acuity enrollees will receive more and those with lower acuity enrollees will receive less. Under Risk Adjustment, capitation is determined based on health severity, measured using patient encounter data. Capitation is paid on a monthly basis based on data submitted for the enrollee for the preceding year and is adjusted in subsequent periods after the final data is compiled. Positive or negative capitation adjustments are made for Medicare enrollees with conditions requiring more or less healthcare services than assumed in the interim payments. Since the Company cannot reliably predict these adjustments, periodic changes in capitation amounts earned as a result of Risk Adjustment are recognized when those changes are communicated by the health plans to the Company.

PMPM managed care contracts generally have a term of one year or longer. All managed care contracts have a single performance obligation that constitutes a series for the provision of managed healthcare services for a population of enrolled members for the duration of the contract. The transaction price for PMPM contracts is variable as it primarily includes PMPM fees associated with unspecified membership that fluctuates throughout the contract. In certain contracts, PMPM fees also include adjustments for items such as performance incentives, performance guarantees and risk shares. The Company generally estimates the transaction price using the most likely amount methodology and amounts are only included in the net transaction price to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. The majority of the Company’s net PMPM transaction price relates specifically to the Company’s efforts to transfer the service for a distinct increment of the series (e.g., day or month) and is recognized as revenue in the month in which members are entitled to service.

Risk Pool Settlements and Incentives

APC enters into full risk capitation arrangements with certain health plans and local hospitals, which are administered by a third party, where the hospital is responsible for providing, arranging and paying for institutional risk and APC is responsible for providing, arranging and paying for professional risk. Under a full risk pool sharing agreement, APC generally receives a percentage of the net surplus from the affiliated hospital’s risk pools with HMOs after deductions for the affiliated hospitals costs. Advance settlement payments are typically made quarterly in arrears if there is a surplus. The Company's risk pool settlements under arrangements with health plans and hospitals are recognized using the most likely amount methodology and amounts are only included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. The assumptions for historical MLR, IBNR completion factors and constraint percentages were used by management in applying the most likely amount methodology.

Under capitated arrangements with certain HMOs, APC participates in one or more shared risk arrangements relating to the provision of institutional services to enrollees (shared risk arrangements) and thus can earn additional revenue or incur losses based upon the enrollee utilization of institutional services. Shared risk capitation arrangements are entered into with certain health plans, which are administered by the health plan, where APC is responsible for rendering professional services, but the health plan does not enter into a capitation arrangement with a hospital and therefore the health plan retains the institutional risk. Shared risk deficits, if any, are not payable until and unless (and only to the extent of any) risk sharing surpluses are generated. At the termination of the HMO contract, any accumulated deficit will be extinguished.

The Company's risk pool settlements under arrangements with HMOs are recognized, using the most likely methodology, and only included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur. Given the lack of access to the health plans’ data and control over the members assigned to APC, the adjustments and/or the withheld amounts are unpredictable and as such APC’s risk share revenue is deemed to be fully constrained until APC is notified of the amount by the health plan. Risk pools for the prior contract years are generally final settled in the third or fourth quarter of the following year.

In addition to risk-sharing revenues, the Company also receives incentives under “pay-for-performance” programs for quality medical care, based on various criteria. As an incentive to control enrollee utilization and to promote quality care, certain HMOs have designed quality incentive programs and commercial generic pharmacy incentive programs to compensate the Company for its efforts to improve the quality of services and efficient and effective use of pharmacy supplemental benefits provided to HMO members. The incentive programs track specific performance measures and calculate payments to the Company based on the performance measures. The Company's incentives under “pay-for-performance” programs are recognized using the most likely methodology. However, as the Company does not have sufficient insight from the health plans on the amount and timing of the shared risk pool and incentive payments these amounts are considered to be fully constrained and only recorded when such payments are known and/or received.

Generally, for the foregoing arrangements, the final settlement is dependent on each distinct day’s performance within the annual measurement period but cannot be allocated to specific days until the full measurement period has occurred and performance can be assessed. As such, this is a form of variable consideration estimated at contract inception and updated through the measurement period (i.e., the contract year), to the extent the risk of reversal does not exist and the consideration is not constrained.

NGACO AIPBP Revenue

APAACO and CMS entered into a NGACO Model Participation Agreement (the “Participation Agreement”) with an initial term of two performance years through December 31, 2018, which term was extended for two additional renewal years.

For each performance year, the Company must submit to CMS its selections for risk arrangement; the amount of the profit/loss cap; alternative payment mechanism; benefits enhancements, if any; and its decision regarding voluntary alignment under the NGACO Model. The Company must obtain CMS consent before voluntarily discontinuing any benefit enhancement during a performance year.

Under the NGACO Model, CMS aligns beneficiaries to the Company to manage (direct care and pay providers) based on a budgetary benchmark established with CMS. The Company is responsible for managing medical costs for these beneficiaries. The beneficiaries will receive services from physicians and other medical service providers that are both in-network and out-of-network. The Company receives capitation from CMS on a monthly basis to pay claims from in-network providers. The Company records such capitation received from CMS as revenue as the Company is primarily responsible and liable for managing the patient care and for satisfying provider obligations, is assuming the credit risk for the services provided by in-network providers through its arrangement with CMS, and has control of the funds, the services provided and the process by which the providers are ultimately paid. Claims from out-of-network providers are processed and paid by CMS and the Company’s shared savings or losses in managing the services provided by out-of-network providers are generally determined on an annual basis after reconciliation with CMS. Pursuant to the Company’s risk share agreement with CMS, the Company will be eligible to receive the savings or be liable for the deficit according to the budget established by CMS based on the Company’s efficiency in managing how the beneficiaries aligned to the Company by CMS are served by in-network and out-of-network providers. The Company’s savings or losses on providing such services are both capped by CMS, and are subject to significant estimation risk, whereby payments can vary significantly depending upon certain patient characteristics and other variable factors. Accordingly, the Company recognizes such surplus or deficit upon substantial completion of reconciliation and determination of the amounts. The Company records NGACO capitation revenues monthly. Excess over claims paid, plus an estimate for the related IBNR (see Note 8), monthly capitation received are deferred and recorded as a liability until actual claims are paid or incurred. CMS will determine if there were any excess capitation paid for the performance year and the excess is refunded to CMS.

For each performance year, CMS pays the Company in accordance with the alternative payment mechanism, if any, for which CMS has approved the Company; the risk arrangement for which the Company has been approved by CMS; and as otherwise provided in the Participation Agreement. Following the end of each performance year and at such other times as may be required under the Participation Agreement, CMS will issue a settlement report to the Company setting forth the amount of any shared savings or shared losses and the amount of other monies. If CMS owes the Company shared savings or other monies, CMS shall pay the Company in full within 30 days after the date on which the relevant settlement report is deemed final, except as provided in the Participation Agreement. If the Company owes CMS shared losses or other monies owed as a result of a final settlement, the Company shall pay CMS in full within 30 days after the relevant settlement report is deemed final. If the Company fails to pay the amounts due to CMS in full within 30 days after the date of a demand letter or settlement report, CMS shall assess simple interest on the unpaid balance at the rate applicable to other Medicare debts under current provisions of law and applicable regulations. In addition, CMS and the U.S. Department of the Treasury may use any applicable debt collection tools available to collect any amounts owed by the Company.

The Company participates in the AIPBP track of the NGACO Model. Under the AIPBP track, CMS estimates the total annual expenditures for APAACO’s assigned patients and pays that projected amount to the Company in monthly installments, and the Company is responsible for all Part A and Part B costs for in-network participating providers and preferred providers contracted by the Company to provide services to the assigned patients.

As APAACO does not have sufficient insight into the financial performance of the shared risk pool with CMS because of unknown factors related to IBNR, risk adjustment factors, stop loss provisions, among other factors, an estimate cannot be developed. Due to these limitations, APAACO cannot determine the amount of surplus or deficit that will likely be recognized in the future and therefore this shared risk pool revenue is considered fully constrained.

For performance year 2020, the Company continues to receive monthly AIPBP payments at a rate of approximately $7.5 million per month from CMS, and will need to continue to comply with all terms and conditions in the Participation Agreement and various regulatory requirements to be eligible to participate in the AIPBP mechanism and/or NGACO Model. The Company has received approximately $22.6 million in total AIPBP payments for the three months ended March 31, 2020 of which $21.9 million has been recognized as revenue. The Company also recorded assets of approximately $8.5 million related to IBNR during the three months ended March 31, 2020 and $3.2 million related to final settlement of the 2018 performance year. These balances are included in “Other receivables” in the accompanying consolidated balance sheets.

Management Fee Income

Management fee income encompasses fees paid for management, physician advisory, healthcare staffing, administrative and other non-medical services provided by the Company to IPAs, hospitals and other healthcare providers. Such fees may be in the form of billings at agreed-upon hourly rates, percentages of revenue or fee collections, or amounts fixed on a monthly, quarterly or annual basis. The revenue may include variable arrangements measuring factors such as hours staffed, patient visits or collections per visit against benchmarks, and, in certain cases, may be subject to achieving quality metrics or fee collections. The Company recognizes such variable supplemental revenues in the period when such amounts are determined to be fixed and therefore contractually obligated as payable by the customer under the terms of the applicable agreement.

The Company provides a significant service of integrating the services selected by the Company’s clients into one overall output for which the client has contracted. Therefore, such management contracts generally contain a single performance obligation. The nature of the Company’s performance obligation is to stand ready to provide services over the contractual period. Also, the Company’s performance obligation forms a series of distinct periods of time over which the Company stands ready to perform. The Company’s performance obligation is satisfied as the Company completes each period’s obligations.

Consideration from management contracts is variable in nature because the majority of the fees are generally based on revenue or collections, which can vary from period to period. The Company has control over pricing. Contractual fees are invoiced to the Company’s clients generally monthly and payment terms are typically due within 30 days. The variable consideration in the Company’s management contracts meets the criteria to be allocated to the distinct period of time to which it relates because (i) it is due to the activities performed to satisfy the performance obligation during that period and (ii) it represents the consideration to which the Company expects to be entitled.

The Company’s management contracts generally have long terms (e.g., 10 years), although they may be terminated earlier under the terms of the applicable contracts. Since the remaining variable consideration will be allocated to a wholly unsatisfied promise that forms part of a single performance obligation recognized under the series guidance, the Company has applied the optional exemption to exclude disclosure of the allocation of the transaction price to remaining performance obligations.

Fee-for-Services Revenue

FFS revenue represents revenue earned under contracts in which the Company bills and collects the professional component of charges for medical services rendered by the Company’s contracted physicians and employed physicians. Under the FFS arrangements, the Company bills the hospitals and third-party payors for the physician staffing and further bills patients or their third-party payors for patient care services provided and receives payment. FFS revenue related to the patient care services is reported net of contractual allowances and policy discounts and are recognized in the period in which the services are rendered to specific patients. All services provided are expected to result in cash flows and are therefore reflected as net revenue in the consolidated financial statements. The recognition of net revenue (gross charges less contractual allowances) from such services is dependent on such factors as proper completion of medical charts following a patient visit, the forwarding of such charts to the Company’s billing center for medical coding and entering into the Company’s billing system and the verification of each patient’s submission or representation at the time services are rendered as to the payor(s) responsible for payment of such services. Revenue is recorded based on the information known at the time of entering of such information into the Company’s billing systems, as well as an estimate of the revenue associated with medical services.

The Company is responsible for confirming member eligibility, performing program utilization review, potentially directing payment to the provider and accepting the financial risk of loss associated with services rendered, as specified within the Company’s client contracts. The Company has the ability to adjust contractual fees with clients and possess the financial risk of loss in certain contractual obligations. These factors indicate the Company is the principal and, as such, the Company records gross fees contracted with clients in revenues.

Consideration from FFS arrangements is variable in nature because fees are based on patient encounters, credits due to clients and reimbursement of provider costs, all of which can vary from period to period. Patient encounters and related episodes of care and procedures qualify as distinct goods and services, provided simultaneously together with other readily available resources, in a single instance of service, and thereby constitute a single performance obligation for each patient encounter and, in most instances, occur at readily determinable transaction prices. As a practical expedient, the Company adopted a portfolio approach for the FFS revenue stream to group together contracts with similar characteristics and analyze historical cash collections trends. The contracts within the portfolio share the characteristics conducive to ensuring that the results do not materially differ under the new standard if it were to be applied to individual patient contracts related to each patient encounter. Accordingly, there was no change in the Company's method to recognize revenue under ASC 606 Revenue from Contracts with Customers (“ASC 606”) from the previous accounting guidance.

Estimating net FFS revenue is a complex process, largely due to the volume of transactions, the number and complexity of contracts with payors, the limited availability at times of certain patient and payor information at the time services are provided, and the length of time it takes for collections to fully mature. These expected collections are based on fees and negotiated payment rates in the case of third-party payors, the specific benefits provided for under each patient's healthcare plans, mandated payment rates in the case of Medicare and Medicaid programs, and historical cash collections (net of recoveries) in combination with expected collections from third party payors.

The relationship between gross charges and the transaction price recognized is significantly influenced by payor mix, as collections on gross charges may vary significantly, depending on whether and with whom the patients the Company provides services to in the period are insured and the Company's contractual relationships with those payors. Payor mix is subject to change as additional patient and payor information is obtained after the period services are provided. The Company periodically assesses the estimates of unbilled revenue, contractual adjustments and discounts, and payor mix by analyzing actual results, including cash collections, against estimates. Changes in these estimates are charged or credited to the consolidated statements of income in the period that the assessment is made. Significant changes in payor mix, contractual arrangements with payors, specialty mix, acuity, general economic conditions and health care coverage provided by federal or state governments or private insurers may have a significant impact on estimates and significantly affect the results of operations and cash flows.

Contract Assets

Typically, revenues and receivables are recognized once the Company has satisfied its performance obligation. Accordingly, the Company’s contract assets are comprised of receivables and receivables – related parties.

The Company's billing and accounting systems provide historical trends of cash collections and contractual write-offs, accounts receivable agings and established fee adjustments from third-party payors. These estimates are recorded and monitored monthly as revenues are recognized. The principal exposure for uncollectible fee for service visits is from self-pay patients and, to a lesser extent, for co-payments and deductibles from patients with insurance.

Contract Liabilities (Deferred Revenue)

Contract liabilities are recorded when cash payments are received in advance of the Company’s performance, or in the case of the Company’s NGACO, the excess of AIPBP capitation received and the actual claims paid or incurred. The Company’s contract liability balance was $0.7 million and $8.9 million as of March 31, 2020 and December 31, 2019, respectively, and is presented within “Accounts payable and accrued expenses” in the accompanying consolidated balance sheets. During the three months ended March 31, 2020, $0.4 million of the Company’s contract liability accrued in 2019 has been recognized as revenue and $8.5 million was repaid back to CMS for AIPBP capitation received and not earned.

Other Financial Information

In March 2020, the Company made a deposit of $4.0 million for future investment opportunities. The investment was made with cash strictly related to the APC excluded assets that was generated from the series of transactions with AP-AMH. The deposit is included in “Other assets” in the accompanying consolidated balance sheets.

Income Taxes

Federal and state income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a change in judgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reduce deferred tax assets to amounts expected to be realized.

The Company uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to be taken in a tax return in order to be recognized in the consolidated financial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the consolidated financial statements.

Share-Based Compensation

The Company maintains a stock-based compensation program for employees, non-employees, directors and consultants. The value of share-based awards such as options is recognized as compensation expense on a cumulative straight-line basis over the vesting period of the awards, adjusted for expected forfeitures. From time to time, the Company issues shares of its common stock to its employees, directors and consultants, which shares may be subject to the Company’s repurchase right (but not obligation) that lapses based on time-based and performance-based vesting schedules.

The Company accounts for share-based awards granted to persons other than employees and directors under ASC 505-50 Equity-Based Payments to Non-Employees. As such the fair value of such shares of stock is periodically remeasured using an appropriate valuation model and income or expense is recognized over the vesting period.

Basic and Diluted Earnings Per Share

Basic earnings per share is computed by dividing net income attributable to holders of the Company’s common stock by the weighted average number of shares of common stock outstanding during the periods presented. Diluted earnings per share is computed using the weighted average number of shares of common stock outstanding, plus the effect of dilutive securities outstanding during the periods presented, using the treasury stock method. Refer to Note 14 for a discussion of shares treated as treasury shares for accounting purposes.

Noncontrolling Interests

The Company consolidates entities in which the Company has a controlling financial interest. The Company consolidates subsidiaries in which the Company holds, directly or indirectly, more than 50% of the voting rights, and VIEs in which the Company is the primary beneficiary. Noncontrolling interests represent third-party equity ownership interests (including certain VIEs) in the Company’s consolidated entities. The amount of net income attributable to noncontrolling interests is disclosed in the consolidated statements of income.

Mezzanine Equity

Pursuant to APC’s shareholder agreements, in the event of a disqualifying event, as defined in the agreements, APC could be required to repurchase the shares from the respective shareholders based on certain triggers outlined in the shareholder agreements. As the redemption feature of the shares is not solely within the control of APC, the equity of APC does not qualify as permanent equity and has been classified as mezzanine or temporary equity. Accordingly, the Company recognizes noncontrolling interests in APC as mezzanine equity in the consolidated financial statements. As of March 31, 2020 and December 31, 2019, APC's shares were not redeemable, nor was it probable the shares would become redeemable.

Recent Accounting Pronouncements

In June 2016, the FASB issued Accounting Standards Update (“ASU”) No. 2016-13, Financial Instruments-Credit Losses (Topic 326)-Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”). The new standard requires entities to measure all expected credit losses for financial assets held at the reporting date based on historical experience, current conditions and reasonable and supportable forecasts. ASU 2016-13 became effective for fiscal years beginning after December 15, 2019, with early adoption permitted. The Company adopted ASU 2016-13 on January 1, 2020. The adoption of ASU 2016-13 did not have a material impact on the consolidated financial statements.

In October 2018, the FASB issued ASU No. 2018-17, Consolidation (Topic 810): Targeted Improvements to Related Party Guidance for Variable Interest Entities (“ASU 2018-17”). This ASU reduces the cost and complexity of financial reporting associated with consolidation of VIEs. A VIE is an organization in which consolidation is not based on a majority of voting rights. The new guidance supersedes the private company alternative for common control leasing arrangements issued in 2014 and expands it to all qualifying common control arrangements. The amendments in this ASU became effective for fiscal years beginning after December 15, 2019, and interim periods within those fiscal years. The Company adopted ASU 2018-17 on January 1, 2020. The adoption of ASU 2018-17 did not have a material impact on the consolidated financial statements.

In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”). This ASU simplifies the accounting for income taxes by eliminating certain exceptions to the guidance in ASC 740 Income Taxes related to the approach for intraperiod tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. The amendments in this ASU are effective for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years. The Company is currently assessing the impact that the adoption of ASU 2019-12 will have on the Company's consolidated financial statements.

In January 2020, the FASB issued ASU No. 2020-01, Investments - Equity Securities (Topic 321), Investments - Equity Method and Joint Ventures (Topic 323), and Derivatives and Hedging (Topic 815) (“ASU 2020-01”). This ASU clarifies the interaction between accounting for equity securities, equity method investments and certain derivative instruments. This amendment in this ASU are effective for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years. The Company is currently assessing the impact that the adoption of ASU 2020-01 will have on the Company's consolidation financial statements.

Other than the standards discussed above, there have been no other new accounting pronouncements that have significance, or potential significance, to the Company’s financial position, results of operations and cash flows.

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Leases

3 Months Ended

Mar. 31, 2020

Leases [Abstract]

Leases

Leases

The Company has operating and finance leases for corporate offices, doctors’ offices, and certain equipment. These leases have remaining lease terms of 1 month to 5 years, some of which may include options to extend the leases for up to 10 years, and some of which may include options to terminate the leases within one year. As of March 31, 2020 and December 31, 2019, assets recorded under finance leases were $0.5 million, respectively, and accumulated depreciation associated with finance leases was $0.3 million, respectively.

Also, the Company rents or subleases certain real estate to third parties, which are accounted for as operating leases.

Leases with an initial term of 12 months or less are not recorded on the balance sheet.

The components of lease expense were as follows (in thousands):

	Three Months Ended March 31,
	2020			2019
Operating lease cost	$	1,942		$	1,102
Finance lease cost
Amortization of lease expense	$	26		$	25
Interest on lease liabilities	4			5
Sublease income	$	(134	)	$	(100	)
Total finance lease cost, net	$	1,838		$	1,032

Other information related to leases was as follows (in thousands):

	Three Months Ended March 31,
	2020			2019
Supplemental Cash Flows Information
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	1,547		$	1,034
Operating cash flows from finance leases	4			5
Financing cash flows from finance leases	26			25
Right-of-use assets obtained in exchange for lease liabilities:
Operating leases	4,745			8,855
	Three Months Ended March 31,
	2020			2019
Weighted Average Remaining Lease Term
Operating leases	7.33 years			4.30 years
Finance leases	4.42 years			5.25 years
Weighted Average Discount Rate
Operating leases	6.10		%	6.13		%
Finance leases	3.00		%	3.00		%

Future minimum lease payments under non-cancellable leases as of March 31, 2020 is as follows (in thousands):

March 31, 2020	Operating Leases		Finance Leases
2020 (excluding the three months ended March 31, 2020)	$	3,227	$	89
2021	3,745		119
2022	2,970		119
2023	2,724		119
2024	2,340		79
Thereafter	8,484		—
Total future minimum lease payments	23,490		525
Less: imputed interest	4,788		33
Total lease liabilities	18,702		492
Less: current portion	3,119		102
Long-term lease liabilities	$	15,583	$	390

As of March 31, 2020, the Company does not have additional operating and finance leases that have not yet commenced.

Leases

Leases

The Company has operating and finance leases for corporate offices, doctors’ offices, and certain equipment. These leases have remaining lease terms of 1 month to 5 years, some of which may include options to extend the leases for up to 10 years, and some of which may include options to terminate the leases within one year. As of March 31, 2020 and December 31, 2019, assets recorded under finance leases were $0.5 million, respectively, and accumulated depreciation associated with finance leases was $0.3 million, respectively.

Also, the Company rents or subleases certain real estate to third parties, which are accounted for as operating leases.

Leases with an initial term of 12 months or less are not recorded on the balance sheet.

The components of lease expense were as follows (in thousands):

	Three Months Ended March 31,
	2020			2019
Operating lease cost	$	1,942		$	1,102
Finance lease cost
Amortization of lease expense	$	26		$	25
Interest on lease liabilities	4			5
Sublease income	$	(134	)	$	(100	)
Total finance lease cost, net	$	1,838		$	1,032

Other information related to leases was as follows (in thousands):

	Three Months Ended March 31,
	2020			2019
Supplemental Cash Flows Information
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	1,547		$	1,034
Operating cash flows from finance leases	4			5
Financing cash flows from finance leases	26			25
Right-of-use assets obtained in exchange for lease liabilities:
Operating leases	4,745			8,855
	Three Months Ended March 31,
	2020			2019
Weighted Average Remaining Lease Term
Operating leases	7.33 years			4.30 years
Finance leases	4.42 years			5.25 years
Weighted Average Discount Rate
Operating leases	6.10		%	6.13		%
Finance leases	3.00		%	3.00		%

Future minimum lease payments under non-cancellable leases as of March 31, 2020 is as follows (in thousands):

March 31, 2020	Operating Leases		Finance Leases
2020 (excluding the three months ended March 31, 2020)	$	3,227	$	89
2021	3,745		119
2022	2,970		119
2023	2,724		119
2024	2,340		79
Thereafter	8,484		—
Total future minimum lease payments	23,490		525
Less: imputed interest	4,788		33
Total lease liabilities	18,702		492
Less: current portion	3,119		102
Long-term lease liabilities	$	15,583	$	390

As of March 31, 2020, the Company does not have additional operating and finance leases that have not yet commenced.

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Business Combination and Goodwill (Tables)

3 Months Ended

Mar. 31, 2020

Business Combinations [Abstract]

Summary of Estimated Fair Values of Assets Acquired and Liabilities Assumed

The following table summarizes the estimated fair values of the assets acquired and liabilities assumed, as of the acquisition date (in thousands):

	Balance Sheet
Assets acquired
Cash and cash equivalents	$	3,569
Accounts receivable, net	10,336
Other current assets	4,342
Network relationship intangible assets	22,636
Goodwill	28,585
Accounts payable	(2,758		)
Deferred tax liabilities	(6,334		)
Medical liabilities	(15,320		)
Net assets acquired	$	45,056
Cash paid	$	45,056

The following table summarizes the estimated fair values of the assets acquired and liabilities assumed, as of the acquisition date (in thousands):

	Balance Sheet
Assets acquired
Cash and cash equivalents	$	582
Accounts receivable, net	5,150
Other current assets	198
Network relationship intangible assets	11,411
Goodwill	23,052
Accounts payable	(3,245		)
Medical liabilities	(12,154		)
Subordinated loan	(15,327		)
Net asset acquired	$	9,667
Equity investment contributed	$	2,417
Cash paid	$	7,250

Schedule of Carrying Value of Goodwill

The change in the carrying value of goodwill for the three months ended March 31, 2020 was as follows (in thousands);

Balance, January 1, 2020	$	238,505
Adjustments	34
Balance, March 31, 2020	$	238,539

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Intangible Assets, Net - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Accumulated Amortization	$ (77,689)	$ (73,517)
Total	98,840
Intangible Assets, Gross	176,529	176,529
Intangible Assets, Net	98,840	103,012
Network relationships
Finite-Lived Intangible Assets [Line Items]
Amortized intangible assets, Gross	143,930	143,930
Accumulated Amortization	(63,831)	(60,526)
Total	$ 80,099	$ 83,404
Network relationships | Minimum
Finite-Lived Intangible Assets [Line Items]
Useful Life	11 years	11 years
Network relationships | Maximum
Finite-Lived Intangible Assets [Line Items]
Useful Life	15 years	15 years
Management contracts
Finite-Lived Intangible Assets [Line Items]
Useful Life	15 years	15 years
Amortized intangible assets, Gross	$ 22,832	$ 22,832
Accumulated Amortization	(10,206)	(9,676)
Total	$ 12,626	$ 13,156
Member relationships
Finite-Lived Intangible Assets [Line Items]
Useful Life	12 years	12 years
Amortized intangible assets, Gross	$ 6,696	$ 6,696
Accumulated Amortization	(2,573)	(2,352)
Total	$ 4,123	$ 4,344
Patient management platform
Finite-Lived Intangible Assets [Line Items]
Useful Life	5 years	5 years
Amortized intangible assets, Gross	$ 2,060	$ 2,060
Accumulated Amortization	(961)	(858)
Total	$ 1,099	$ 1,202
Trade name/trademarks
Finite-Lived Intangible Assets [Line Items]
Useful Life	20 years	20 years
Amortized intangible assets, Gross	$ 1,011	$ 1,011
Accumulated Amortization	(118)	(105)
Total	$ 893	$ 906

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Basis of Presentation and Summary of Significant Accounting Policies - Carrying Amounts and Fair Values of Financial Instruments (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Assets
Money market funds	$ 41,675	$ 50,731
Marketable securities – certificates of deposit	117,036	116,469
Marketable securities – equity securities	39	70
Total	158,750	167,270
Level 1
Assets
Money market funds	41,675	50,731
Marketable securities – certificates of deposit	117,036	116,469
Marketable securities – equity securities	39	70
Total	158,750	167,270
Level 2
Assets
Money market funds	0	0
Marketable securities – certificates of deposit	0	0
Marketable securities – equity securities	0	0
Total	0	0
Level 3
Assets
Money market funds	0	0
Marketable securities – certificates of deposit	0	0
Marketable securities – equity securities	0	0
Total	$ 0	$ 0

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Mezzanine and Stockholders' Equity - Summary of Warrant (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Shares
Warrants outstanding, beginning balance (in shares)	3,154,590
Warrants granted (in shares)	0
Warrants exercised (in shares)	(51,601)
Warrants expired/forfeited (in shares)	0
Warrants outstanding, ending balance (in shares)	3,102,989	3,154,590
Weighted Average Exercise Price
Warrants outstanding, beginning balance (in dollars per share)	$ 9.96
Warrants granted (in dollars per share)	0.00
Warrants exercised (in dollars per share)	9.50
Warrants expired/forfeited (in dollars per share)	0.00
Warrants outstanding, ending balance (in dollars per share)	$ 9.97	$ 9.96
Weighted Average Remaining Contractual Term (Years)
Warrants outstanding	1 year 9 months 11 days	2 years 4 days
Aggregate Intrinsic Value (in thousands)
Warrants outstanding, beginning balance	$ 26,700
Warrants granted	0
Warrants exercised	400
Warrants expired/forfeited	0
Warrants outstanding, ending balance	$ 9,200	$ 26,700

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Related-Party Transactions - Fees Incurred and Income Received (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Related Party Transaction [Line Items]
Net total	$ 11,792	$ 10,850
AHMC
Related Party Transaction [Line Items]
AHMC – Risk pool and capitation	11,999	11,600
HSMSO
Related Party Transaction [Line Items]
Management fees	(132)	(650)
Aurion
Related Party Transaction [Line Items]
Management fees	$ (75)	$ (100)

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Variable Interest Entities (VIEs) (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019	Mar. 31, 2019
Current assets
Cash and cash equivalents	$ 80,892	$ 103,189	$ 93,008
Restricted cash	75	75
Investment in marketable securities	117,075	116,539
Receivables, net	18,012	11,004
Receivables, net – related party	50,911	48,136
Other receivables	16,362	16,885
Prepaid expenses and other current assets	11,811	10,315
Loans receivable	6,425	6,425
Loans receivable – related parties	16,500	16,500
Total current assets	318,063	329,068
Noncurrent assets
Intangible assets, net	98,840	103,012
Goodwill	238,539	238,505
Investments in other entities – equity method	30,781	28,427
Restricted cash	746	746
Operating lease right-of-use assets	18,199	14,248
Other assets	6,475	1,681
Total noncurrent assets	406,352	399,645
Total assets	724,415	728,713
Current liabilities
Accounts payable and accrued expenses	20,106	27,279
Fiduciary accounts payable	1,709	2,027
Dividend payable	337	271
Finance lease liabilities	102	102
Operating lease liabilities	3,119	2,990
Total current liabilities	106,605	105,423
Noncurrent liabilities
Deferred tax liability	16,332	18,269
Finance lease liabilities, net of current portion	390	416
Operating lease liabilities, net of current portion	15,583	11,373
Total noncurrent liabilities	262,410	262,230
Total liabilities	369,015	367,653
Variable Interest Entity, Primary Beneficiary
Current assets
Cash and cash equivalents	57,015	87,110
Restricted cash	75	75
Investment in marketable securities	117,036	123,948
Receivables, net	16,332	9,300
Receivables, net – related party	49,279	42,976
Other receivables	734	744
Prepaid expenses and other current assets	7,257	7,403
Loans receivable	6,425	6,425
Loans receivable – related parties	16,500	16,500
Total current assets	270,653	294,481
Noncurrent assets
Land, property and equipment, net	9,304	9,547
Intangible assets, net	78,247	81,439
Goodwill	108,946	108,913
Investment in privately held entities	223,796	319,930
Investments in other entities – equity method	30,785	28,427
Restricted cash	746	746
Operating lease right-of-use assets	4,444	4,751
Other assets	5,040	1,057
Total noncurrent assets	461,308	554,810
Total assets	731,961	849,291
Current liabilities
Accounts payable and accrued expenses	11,317	11,187
Fiduciary accounts payable	1,709	2,027
Medical liabilities	45,029	49,019
Income taxes payable	8,034	4,530
Amount due to affiliate	23,128	28,058
Dividend payable	337	271
Finance lease liabilities	102	102
Operating lease liabilities	1,217	1,088
Total current liabilities	90,873	96,282
Noncurrent liabilities
Deferred tax liability	12,587	14,059
Finance lease liabilities, net of current portion	390	416
Operating lease liabilities, net of current portion	3,336	3,742
Total noncurrent liabilities	16,313	18,217
Total liabilities	$ 107,186	$ 114,499

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Business Combination and Goodwill

3 Months Ended

Mar. 31, 2020

Business Combinations [Abstract]

Business Combination and Goodwill

Business Combination and Goodwill

Alpha Care Medical Group

On May 31, 2019, APC and APC-LSMA completed their acquisition of 100% of the capital stock of Alpha Care from Dr. Kevin Tyson for an aggregate purchase price of approximately $45.1 million in cash, subject to post-closing adjustments. As part of the transaction the Company deposited $2.0 million into an escrow account for potential post-closing adjustments. As of March 31, 2020 no post-closing adjustment is expected to be paid to Dr. Tyson and the full amount of the escrow account is expected to be returned to the Company. As such, the escrow amount is presented within prepaid expenses and other current assets in the accompanying consolidated balance sheets.

The following table summarizes the estimated fair values of the assets acquired and liabilities assumed, as of the acquisition date (in thousands):

	Balance Sheet
Assets acquired
Cash and cash equivalents	$	3,569
Accounts receivable, net	10,336
Other current assets	4,342
Network relationship intangible assets	22,636
Goodwill	28,585
Accounts payable	(2,758		)
Deferred tax liabilities	(6,334		)
Medical liabilities	(15,320		)
Net assets acquired	$	45,056
Cash paid	$	45,056

Accountable Health Care, IPA

On August 30, 2019, APC and APC-LSMA, acquired the remaining outstanding shares of capital stock (comprising 75%) in Accountable Health Care in exchange for $7.3 million. In addition to the payment of $7.3 million APC assumed all assets and liabilities of Accountable Health Care, including loans payable to NMM and APC of $15.4 million, which have been eliminated upon consolidation and contributed the 25% investment totaling $2.4 million, total purchase price was $25.1 million (see Note 5).

The following table summarizes the estimated fair values of the assets acquired and liabilities assumed, as of the acquisition date (in thousands):

	Balance Sheet
Assets acquired
Cash and cash equivalents	$	582
Accounts receivable, net	5,150
Other current assets	198
Network relationship intangible assets	11,411
Goodwill	23,052
Accounts payable	(3,245		)
Medical liabilities	(12,154		)
Subordinated loan	(15,327		)
Net asset acquired	$	9,667
Equity investment contributed	$	2,417
Cash paid	$	7,250

The Company acquired AMG in September 2019 for total consideration of $1.6 million, of which $0.4 million was in the form of APC common stock. The business combination did not meet the quantitative thresholds to require separate disclosures based on the Company's consolidated net assets, investments and net income.

The acquisitions were accounted for under the acquisition method of accounting. The fair value of the consideration for the acquired company was allocated to acquired tangible and intangible assets and liabilities based upon their fair values. The excess of the purchase consideration over the fair value of the net tangible and identifiable intangible assets acquired was recorded as goodwill. The determination of the fair value of assets and liabilities acquired requires the Company to make estimates and use valuation techniques when market value is not readily available. The results of operations of the company acquired have been included in the Company's financial statements from the date of acquisition. Transaction costs associated with business acquisitions are expensed as they are incurred.

At the time of acquisition, the Company estimates the amount of the identifiable intangible assets based on a valuation and the facts and circumstances available at the time. The Company determines the final value of the identifiable intangible assets as soon as information is available, but not more than 12 months from the date of acquisition.

Goodwill is not deductible for tax purposes.

The change in the carrying value of goodwill for the three months ended March 31, 2020 was as follows (in thousands);

Balance, January 1, 2020	$	238,505
Adjustments	34
Balance, March 31, 2020	$	238,539

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CONSOLIDATED STATEMENTS OF MEZZANINE AND STOCKHOLDERS' EQUITY (UNAUDITED) - USD ($) $ in Thousands	Total	Common Stock Outstanding	Additional Paid-in Capital	Retained Earnings	Noncontrolling Interest	Noncontrolling Interest Mezzanine
Equity, beginning balance at Dec. 31, 2018	$ 181,544	$ 35	$ 162,723	$ 17,788	$ 998	$ 225,117
Equity, beginning balance (in shares) at Dec. 31, 2018		34,578,040
Net (loss) income	550			140	410	(3,000)
Purchase of treasury shares	0					(40)
Purchase of treasury shares (in shares)		(93,451)
Shares issued for exercise of options and warrants	140		140			155
Shares issued for exercise of options and warrants (in shares)		17,516
Share-based compensation	143		143			202
Share-based compensation (in shares)		1,599
Dividends	0					(10,000)
Equity, ending balance at Mar. 31, 2019	182,377	$ 35	163,006	17,928	1,408	212,434
Equity, ending balance (in shares) at Mar. 31, 2019		34,503,704
Equity, beginning balance at Dec. 31, 2019	192,335	$ 36	159,608	31,905	786	168,725
Equity, beginning balance (in shares) at Dec. 31, 2019		35,908,057
Net (loss) income	4,147			4,052	95	(1,161)
Purchase of treasury shares	(301)
Purchase of treasury shares (in shares)		(16,897)
Purchase of noncontrolling interest	0					(125)
Shares issued for exercise of options and warrants	722		722
Shares issued for exercise of options and warrants (in shares)		151,601
Share-based compensation	1,058		1,058
Dividends	0					(10,000)
Equity, ending balance at Mar. 31, 2020	$ 197,961	$ 36	$ 161,087	$ 35,957	$ 881	$ 157,439
Equity, ending balance (in shares) at Mar. 31, 2020		36,042,761

XML

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2020	May 26, 2020
Document and Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q1
Entity Registrant Name	Apollo Medical Holdings, Inc.
Entity Central Index Key	0001083446
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Current Reporting Status	Yes
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		53,077,073
Entity Emerging Growth Company	false
Entity Small Business	false

XML

Subsequent Events

3 Months Ended

Mar. 31, 2020

Subsequent Events [Abstract]

Subsequent Events

Subsequent Events

Universal Care Inc.

On December 31, 2019, UCAP, entered into an SPA among UCAP, Bright, Bright Health, Inc., UCI, Howard E. And Elaine H. Davis Family Trust, Howard E. And Elaine H. Davis Grandchildren’s Trust, Jeffrey V. Davis, Jay B. Davis, Laura Davis-Loschiavo, Marc M. Davis, Peter And Helen Lee Family Trust, and, in their respective capacities as seller representatives, Kenneth Sim, M.D., Thomas Lam, M.D., Jay Davis and Jeffrey Davis. Pursuant to the SPA, UCAP and all of the other shareholders of UCI agreed to sell to Bright all of their respective shares of capital stock in UCI.

On April 30, 2020, the Closing Date, and pursuant to the SPA, UCAP and all of the other shareholders of UCI sold to Bright all of their respective shares of capital stock in UCI. In connection with such sale, on the Closing Date, APC received approximately $69.2 million in cash proceeds (including $16.5 million as repayment of indebtedness owed to APC), plus non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $33.3 million. In addition, pursuant to the terms of the SPA, upon release from escrow, APC is entitled to receive all or that portion of the following escrowed amounts that have not been offset or reserved for claims: (i) cash consideration of approximately $15.6 million, plus (ii) non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $5.9 million.

Dividends

On May 4, 2020 APC’s board of directors approved a dividend distribution on a pro rata basis to APC’s shareholders totaling $20.0 million, which was paid on May 6, 2020.

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Intangible Assets, Net (Tables)

3 Months Ended

Mar. 31, 2020

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Intangible Assets, Net

At March 31, 2020, the Company’s intangible assets, net, consisted of the following (in thousands):

	Useful Life (Years)	Gross March 31, 2020		Accumulated Amortization			Net March 31, 2020
Amortized intangible assets:
Network relationships	11-15	143,930		(63,831		)	80,099
Management contracts	15	22,832		(10,206		)	12,626
Member relationships	12	6,696		(2,573		)	4,123
Patient management platform	5	2,060		(961		)	1,099
Trade name/trademarks	20	1,011		(118		)	893
		$	176,529	$	(77,689	)	$	98,840

At December 31, 2019, the Company’s intangible assets, net, consisted of the following (in thousands):

	Useful Life (Years)	Gross December 31, 2019		Accumulated Amortization			Net December 31, 2019
Amortized intangible assets:
Network relationships	11-15	143,930		(60,526		)	83,404
Management contracts	15	22,832		(9,676		)	13,156
Member relationships	12	6,696		(2,352		)	4,344
Patient management platform	5	2,060		(858		)	1,202
Trade name/trademarks	20	1,011		(105		)	906
		$	176,529	$	(73,517	)	$	103,012

Schedule of Future Amortization Expense

Future amortization expense is estimated to be as follows for the years ending December 31 (in thousands):

	Amount
2020 (excluding the three months ended March 31, 2020)	$	11,856
2021	14,524
2022	12,673
2023	10,842
2024	9,830
Thereafter	39,115
Total	$	98,840

XML

Label	Element	Value
Dividends Payable	us-gaap_DividendsPayableCurrentAndNoncurrent	$ 0
Dividends Payable	us-gaap_DividendsPayableCurrentAndNoncurrent	$ 66,000

XML

Investments in Other Entities - Equity Method

3 Months Ended

Mar. 31, 2020

Equity Method Investments and Joint Ventures [Abstract]

Investments in Other Entities - Equity Method

Investments in Other Entities — Equity Method

Rollforward of Equity Method Investment (in thousands)

	December 31, 2019		Allocation of Income (Loss)			Contribution		March 31, 2020
LaSalle Medical Associates – IPA Line of Business	$	6,397	$	(643	)	$	—	$	5,754
Pacific Medical Imaging & Oncology Center, Inc.	1,396		87			—		1,483
Universal Care, Inc.	1,438		2,670			—		4,108
Diagnostic Medical Group	2,334		(5		)	—		2,329
531 W. College, LLC – related party	16,698		(111		)	300		16,887
MWN, LLC – related party	164		56			—		220
	$	28,427	$	2,054		$	300	$	30,781

LaSalle Medical Associates — IPA Line of Business

LMA was founded by Dr. Albert Arteaga in 1996 and currently operates six neighborhood medical centers through its network of more than 2,300 PCP and Specialists providers, treating children, adults and seniors in San Bernardino County, California. LMA’s patients are primarily served by Medi-Cal and they also accept Blue Cross, Blue Shield, Molina, Care 1st, Health Net and Inland Empire Health Plan. LMA is also an IPA of independently contracted doctors, hospitals and clinics, delivering high-quality care to more than 295,000 patients in Fresno, Kings, Los Angeles, Madera, Riverside, San Bernardino and Tulare Counties. During 2012, APC-LSMA and LMA entered into a share purchase agreement whereby APC-LSMA invested $5.0 million for a 25% interest in LMA’s IPA line of business. NMM has a management services agreement with LMA. APC accounts for its investment in LMA under the equity method as APC has the ability to exercise significant influence, but not control over LMA’s operations. For the three months ended March 31, 2020 and 2019, APC recorded losses from this investment of $0.6 million and $1.1 million, respectively, in the accompanying consolidated statements of income. The accompanying consolidated balance sheets include the related investment balance of $5.8 million and $6.4 million at March 31, 2020 and December 31, 2019, respectively.

LMA’s summarized balance sheets at March 31, 2020 and December 31, 2019 and summarized statements of operations for the three months ended March 31, 2020 and 2019 with respect to its IPA line of business are as follows (in thousands):

Balance Sheets

	March 31, 2020			December 31, 2019
Assets
Cash and cash equivalents	$	—		$	6,345
Receivables, net	8,901			5,124
Other current assets	3,380			3,526
Loan receivable	2,250			2,250
Restricted cash	686			683
Total assets	$	15,217		$	17,928
Liabilities and Stockholders’ (Deficit) Equity
Current liabilities	$	23,390		$	23,530
Stockholders’ deficit	(8,173		)	(5,602		)
Total liabilities and stockholders’ deficit	$	15,217		$	17,928

Statements of Operations

	Three Months Ended March 31,
	2020			2019
Revenues	$	46,304		$	46,406
Expenses	48,730			50,702
Net loss	$	(2,426	)	$	(4,296	)

Pacific Medical Imaging and Oncology Center, Inc.

Incorporated in California in 2004, PMIOC provides comprehensive diagnostic imaging services using state-of-the-art technology. PMIOC offers high-quality diagnostic services, such as MRI/MRA, PET/CT, CT, nuclear medicine, ultrasound, digital x-rays, bone densitometry and digital mammography, at its facilities.

In July 2015, APC-LSMA and PMIOC entered into a share purchase agreement whereby APC-LSMA invested $1.2 million for a 40% ownership interest in PMIOC.

APC and PMIOC have an Ancillary Service Contract together whereby PMIOC provides covered services on behalf of APC to enrollees of the plans of APC. Under the Ancillary Service Contract, APC paid PMIOC fees of approximately $0.6 million and $0.7 million, for the three months ended March 31, 2020 and 2019, respectively. APC accounts for its investment in PMIOC under the equity method of accounting as APC has the ability to exercise significant influence, but not control over PMIOC’s operations. During the three months ended March 31, 2020 and 2019, APC recorded income from this investment of approximately $0.1 million and $0.1 million, respectively, in the accompanying consolidated statements of income and has investment balances of $1.5 million and $1.4 million at March 31, 2020 and December 31, 2019, respectively.

Universal Care, Inc.

UCI is a privately held health plan that has been in operation since 1985. UCI holds a license under the California Knox-Keene Health Care Services Plan Act to operate as a full-service health plan. UCI contracts with CMS under the Medicare Advantage Prescription Drug Program.

On August 10, 2015, UCAP purchased 100,000 shares of UCI class A-2 voting common stock from UCI for $10.0 million, which shares comprise 48.9% of UCI's total outstanding shares and 50% of UCI’s voting common stock. APC accounts for its investment in UCI under the equity method of accounting as APC has the ability to exercise significant influence, but not control over UCI’s operations. During the three months ended March 31, 2020 and 2019, the Company recorded income from this investment of approximately $2.7 million and $1.0 million, respectively, in the accompanying consolidated statements of income and had investment balances of $4.1 million and $1.4 million at March 31, 2020 and December 31, 2019, respectively.

On April 30, 2020, UCAP completed its disposition of its 48.9% ownership interest in UCI to Bright for approximately $69.2 million in cash proceeds (including $16.5 million as repayment of indebtedness owed to APC), plus non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $33.3 million. In addition, pursuant to the terms of the SPA, upon release from escrow, APC is entitled to receive all or that portion of the following escrowed amounts that have not been offset or reserved for claims: (i) cash consideration of approximately $15.6 million, plus (ii) non-cash consideration consisting of shares of Bright Health, Inc.’s preferred stock having a stipulated value of approximately $5.9 million (see Note 17).

UCI’s balance sheets at March 31, 2020 and December 31, 2019 and statements of income for the three months ended March 31, 2020 and 2019 are as follows (in thousands):

Balance Sheets

	March 31, 2020			December 31, 2019
Assets
Cash	$	34,757		$	33,890
Receivables, net	83,454			63,843
Other current assets	43,417			38,280
Other assets	885			882
Property and equipment, net	4,429			4,021
Total assets	$	166,942		$	140,916
Liabilities and Stockholders’ (Deficit) Equity
Current liabilities	$	148,902		$	128,330
Other liabilities	33,126			33,133
Stockholders’ deficit	(15,086		)	(20,547		)
Total liabilities and stockholders’ deficit	$	166,942		$	140,916

Statements of Income

	Three Months Ended March 31,
	2020		2019
Revenues	$	146,481	$	113,319
Expenses	141,771		111,408
Income before benefit from income taxes	4,710		1,911
Benefit from income taxes	—		(211		)
Net income	$	4,710	$	2,122

Diagnostic Medical Group

In May 2016, David C.P. Chen M.D., individually, and APC-LSMA, entered into a share purchase agreement whereby APC-LSMA acquired a 40% ownership interest in DMG.

APC accounts for its investment in DMG under the equity method of accounting as APC has the ability to exercise significant influence, but not control over DMG’s operations. For the three months ended March 31, 2020 and 2019, APC recorded losses and income from this investment of $5,244 and $0.2 million, respectively, in the consolidated statements of income. The accompanying consolidated balance sheets include the related investment balances of $2.3 million as of March 31, 2020 and December 31, 2019, respectively.

531 W. College LLC – Related Party

In June 2018, College Street Investment LP, a California limited partnership (“CSI”), APC and NMM entered into an operating agreement to govern the limited liability company, 531 W. College, LLC and the conduct of its business, and to specify their relative rights and obligations. CSI, APC and NMM, each owns 50%, 25% and 25%, respectively, of member units based on initial capital contributions of $16.7 million, $8.3 million, and $8.3 million, respectively.

On June 29, 2018, 531 W. College, LLC closed its purchase of a non-operational hospital located in Los Angeles from Societe Francaise De Bienfaisance Mutuelle De Los Angeles, a California nonprofit corporation, for a total purchase price of $33.3 million. On April 23, 2019, NMM and APC entered into an agreement whereby NMM assigned and APC assumed NMM's 25% membership interest in 531 W. College, LLC for approximately $8.3 million. Subsequently, APC has a 50% ownership in 531 W. College LLC with a total investment balance of approximately $16.9 million.

APC accounts for its investment in 531 W. College, LLC under the equity method of accounting as APC has the ability to exercise significant influence, but not control over the operations of this joint venture. For the three months ended March 31, 2020 and March 31, 2019, APC recorded losses of $0.1 million and $46,968, respectively, in the accompanying consolidated statements of income. During the period ended March 31, 2020, the Company contributed $0.3 million to 531 W. College LLC as part of its 50% interest and had investment balances of $16.9 million and $16.7 million, respectively, at March 31, 2020 and December 31, 2019.

531 W. College LLC’s balance sheets at March 31, 2020 and December 31, 2019 and statements of operations for the three months ended March 31, 2020 and 2019 are as follows (in thousands):

Balance Sheets

	March 31, 2020		December 31, 2019
Assets
Cash	$	48	$	139
Other current assets	124		17
Other assets	70		70
Property and equipment, net	33,697		33,581
Total assets	$	33,939	$	33,807
Liabilities and Members’ Equity
Current liabilities	$	1,114	$	1,062
Stockholders’ equity	32,825		32,745
Total liabilities and members’ equity	$	33,939	$	33,807

Statements of Operation

	Three Months Ended March 31,
	2020			2019
Revenues	—			—
Expenses	338			469
Loss from operations	(338		)	(469		)
Other income	$	21		$	289
Net loss	$	(317	)	$	(180	)

MWN LLC – Related Party

On December 18, 2018, NMM, 6 Founders LLC, a California limited liability company doing business as Pacific6 Enterprises (“Pacific6”), and Health Source MSO Inc., a California corporation (“HSMSO”) entered into an operating agreement to govern MWN Community Hospital, LLC and the conduct of its business and to specify their relative rights and obligations. NMM, Pacific6, and HSMSO each own 33.3% of the membership shares based on each member’s initial capital contributions of $3,000 and working capital contributions of $30,000. NMM invested an additional $0.3 million for working capital purposes in August, 2019. For the three months ended March 31, 2020, NMM recorded income from its investment in MWN LLC of $0.1 million in the accompanying consolidated statements of income and had an investment balance of $0.2 million as of March 31, 2020 and December 31, 2019.

Investment in privately held entity that does not report net asset value per share

MediPortal, LLC

In May 2018, APC purchased 270,000 membership interests of MediPortal LLC, a New York limited liability company, for $0.4 million or $1.50 per membership interest, which represented an approximately 2.8% ownership interest. In connection with the initial purchase, APC received a five-year warrant to purchase an additional 270,000 membership interests. Additionally, APC received a five-year option to purchase an additional 380,000 membership interests and a five-year warrant to purchase 480,000 membership interests, which MediPortal LLC will grant APC upon completion of its health portal. As of March 31, 2020, the health portal has not been completed. As APC does not have the ability to exercise significant influence, and lacks control, over the investee, this investment is accounted for using a measurement alternative which allows the investment to be measured at cost, adjusted for observable price changes and impairments, with changes recognized in net income.

AchievaMed

On July 1, 2019, NMM and AchievaMed, Inc., a California corporation ("AchievaMed"), entered into an agreement in which NMM would purchase 50% of the aggregate shares of capital stock of AchievaMed over a period of time not to exceed five years. As a result of this transaction NMM invested $0.5 million for a 10% interest. The related investment balance of $0.5 million is included in "Investment in privately held entities" in the accompanying consolidated balance sheets as of March 31, 2020.

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Credit Facility, Bank Loan and Lines of Credit

3 Months Ended

Mar. 31, 2020

Debt Disclosure [Abstract]

Credit Facility, Bank Loan and Lines of Credit

Credit Facility, Bank Loan and Lines of Credit

Credit Facility

The Company's credit facility consisted of the following (in thousands):

	March 31, 2020
Term loan A	$	185,250
Revolver loan	60,000
Total debt	245,250
Less: Current portion of debt	(9,500		)
Less: Unamortized financing costs	(5,645		)
Long-term debt	$	230,105

Future maturities of the Company's credit facility is to be as follows for the years ending December 31 (in thousands):

	Amount
2020 (excluding the three months ended March 31, 2020)	$	7,125
2021	10,688
2022	14,250
2023	15,437
2024	197,750
Total	$	245,250

Credit Agreement

In September 2019, the Company entered into a secured credit agreement (the “Credit Agreement,” and the credit facility thereunder, the "Credit Facility") with Truist Financial Corporation (formerly known as SunTrust Bank), in its capacity as administrative agent for the lenders (in such capacity, the “Agent”), as a lender, an issuer of letters of credit and as swingline lender, and Preferred Bank, JPMorgan Chase Bank, N.A., MUFG Union Bank, N.A., Royal Bank of Canada, Fifth Third Bank and City National Bank, as lenders (the “Lenders”). In connection with the closing of the Credit Agreement, the Company, its subsidiary, NMM, and the Agent entered into a Guaranty and Security Agreement (the “Guaranty and Security Agreement”), pursuant to which, among other things, NMM guaranteed the obligations of the Company under the Credit Agreement.

The Credit Agreement provides for a five-year revolving credit facility to the Company of $100.0 million ("Revolver Loan"), which includes a letter of credit subfacility of up to $25.0 million. The Credit Agreement also provides for a term loan of $190.0 million, ("Term Loan A"). The unpaid principal amount of the term loan is payable in quarterly installments on the last day of each fiscal quarter commencing on December 31, 2019. The principal payment for each of the first eight fiscal quarters is $2.4 million, for the following eight fiscal quarters thereafter is $3.6 million and for the following three fiscal quarters thereafter is $4.8 million. The remaining principal payment on the term loan is due on September 11, 2024.

The proceeds of the term loan and up to $60.0 million of the revolving credit facility were used to (i) finance a portion of the AP-AMH Loan, (ii) refinance certain indebtedness of the Company and its subsidiaries and, indirectly, APC, (iii) pay transaction costs and expenses arising in connection with the Credit Agreement, the AP-AMH Loan and certain other related transactions and (iv) provide for working capital, capital expenditures and other general corporate purposes. The remainder of the revolving credit facility will be used to finance future acquisitions and investments and to provide for working capital needs, capital expenditures and other general corporate purposes.

The Company is required to pay an annual facility fee of 0.20% to 0.35% on the available commitments under the Credit Agreement, regardless of usage, with the applicable fee determined on a quarterly basis based on the Company’s leverage ratio. The Company is also required to pay customary fees as specified in a separate fee agreement between the Company and SunTrust Robinson Humphrey, Inc., the lead arranger of the Credit Agreement.

Amounts borrowed under the Credit Agreement will bear interest at an annual rate equal to either, at the Company’s option, (a) the rate for Eurocurrency deposits for the corresponding deposits of U.S. dollars appearing on Reuters Screen LIBOR01 Page (“LIBOR”), adjusted for any reserve requirement in effect, plus a spread of between 2.00% and 3.00%, as determined on a quarterly basis based on the Company’s leverage ratio, or (b) a base rate, plus a spread between 1.00% and 2.00%, as determined on a quarterly basis based on the Company’s leverage ratio. As of March 31, 2020, the interest rate on Term Loan A and Revolver Loan was 3.57% and 3.24%, respectively. The base rate is defined in a manner such that it will not be less than LIBOR. The Company will pay fees for standby letters of credit at an annual rate of between 2.00% and 3.00%, as determined on a quarterly basis based on the Company’s leverage ratio, plus facing fees and standard fees payable to the issuing bank on the respective letter of credit. Loans outstanding under the Credit Agreement may be prepaid at any time without penalty, except for LIBOR breakage costs and expenses. If LIBOR ceases to be reported, the Credit Agreement requires the Company and the Agent to endeavor to establish a commercially reasonable alternative rate of interest and until they are able to do so, all borrowings must be at the base rate.

The Credit Agreement requires the Company and its subsidiaries to comply with various affirmative covenants, including, without limitation, furnishing updated financial and other information, preserving existence and entitlements, maintaining properties and insurance, complying with laws, maintaining books and records, requiring any new domestic subsidiary meeting a materiality threshold specified in the Credit Agreement to become a guarantor thereunder and paying obligations. The Credit Agreement requires the Company and its subsidiaries to comply with, and to use commercially reasonable efforts to the extent permitted by law to cause certain material associated practices of the Company, including APC, to comply with, restrictions on liens, indebtedness and investments (including restrictions on acquisitions by the Company), subject to specified exceptions. The Credit Agreement also contains various other negative covenants binding the Company and its subsidiaries, including, without limitation, restrictions on fundamental changes, dividends and distributions, sales and leasebacks, transactions with affiliates, burdensome agreements, use of proceeds, maintenance of business, amendments of organizational documents, accounting changes and prepayments and modifications of subordinated debt.

The Credit Agreement requires the Company to comply with two key financial ratios, each calculated on a consolidated basis. The Company must maintain a maximum consolidated leverage ratio of not greater than 3.75 to 1.00 as of the last day of each fiscal quarter. The maximum consolidated leverage ratio decreases by 0.25 each year, until it is reduced to 3.00 to 1.00 for each fiscal quarter ending after September 30, 2022. The Company must maintain a minimum consolidated interest coverage ratio of not less than 3.25 to 1.00 as of the last day of each fiscal quarter. As of March 31, 2020, the Company was in compliance with the covenants relating to its credit facility.

Pursuant to the Guaranty and Security Agreement, the Company and NMM have granted the Lenders a security interest in all of their assets, including, without limitation, all stock and other equity issued by their subsidiaries (including NMM) and all rights with respect to the AP-AMH Loan. The Guaranty and Security Agreement requires the Company and NMM to comply with various affirmative and negative covenants, including, without limitation, covenants relating to maintaining perfected security interests, providing information and documentation to the Agent, complying with contractual obligations relating to the collateral, restricting the sale and issuance of securities by their respective subsidiaries and providing the Agent access to the collateral.

The Credit Agreement contains events of default, including, without limitation, failure to make a payment when due, default on various covenants in the Credit Agreement, breach of representations or warranties, cross-default on other material indebtedness, bankruptcy or insolvency, occurrence of certain judgments and certain events under the Employee Retirement Income Security Act of 1974 aggregating more than $10.0 million, invalidity of the loan documents, any lien under the Guaranty and Security Agreement ceasing to be valid and perfected, any change in control, as defined in the Credit Agreement, an event of default under the AP-AMH Loan, failure by APC to pay dividends in cash for any period of two consecutive fiscal quarters, failure by AP-AMH to pay cash interest to the Company, or if any modification is made to the Certificate of Determination or the Special Purpose Shareholder Agreement that directly or indirectly restricts, conditions, impairs, reduces or otherwise limits the payment of the Series A Preferred dividend by APC to AP-AMH. In addition, it will constitute an event of default under the Credit Agreement if APC uses all or any portion of the consideration received by APC from AP-AMH on account of AP-AMH’s purchase of Series A Preferred Stock for any purpose other than certain specific approved uses described in the following sentence, unless not less than 50.01% of all holders of common stock of APC at such time approve such use; provided that APC may use up to $50.0 million in the aggregate of such consideration for any purpose without any requirement to obtain such approval of the holders of common stock of APC. The approved uses include (i) any permitted investment, (ii) any dividend or distribution to the holders of the common stock of APC, (iii) any repurchase of common stock of APC, (iv) paying taxes relating to or arising from certain assets and transactions, or (v) funding losses, deficits or working capital support on account of certain non-healthcare assets in an amount not to exceed $125.0 million. If any event of default occurs and is continuing under the Credit Agreement, the Lenders may terminate their commitments, and may require the Company and its guarantors to repay outstanding debt and/or to provide a cash deposit as additional security for outstanding letters of credit. In addition, the Agent, on behalf of the Lenders, may pursue remedies under the Guaranty and Security Agreement, including, without limitation, transferring pledged securities of the Company’s subsidiaries in the name of the Agent and exercising all rights with respect thereto (including the right to vote and to receive dividends), collect on pledged accounts, instruments and other receivables (including the AP-AMH Loan), and all other rights provided by law or under the loan documents and the AP-AMH Loan.

In the ordinary course of business, certain of the Lenders under the Credit Agreement and their affiliates have provided to the Company and its subsidiaries and the associated practices, and may in the future provide, (i) investment banking, commercial banking (including pursuant to certain existing business loan and credit agreements being terminated in connection with entering into the Credit Agreement), cash management, foreign exchange or other financial services, and (ii) services as a bond trustee and other trust and fiduciary services, for which they have received compensation and may receive compensation in the future.

Deferred Financing Costs

The Company recorded deferred financing costs of $6.5 million related to the issuance of the Credit Facility. This amount was recorded as a direct reduction of the carrying amount of the related debt liability. The deferred financing costs will be amortized over the life of the Credit Facility using the effective interest rate method.

Effective Interest Rate

The Company’s average effective interest rate on its total debt during the three months ended March 31, 2020 and 2019 was 4.24% and 5.47%, respectively. Interest expense in the consolidated statements of income included amortization of deferred debt issuance costs for the three months ended March 31, 2020 and 2019 of $0.3 million and $0, respectively.

Lines of Credit – Related Party

NMM Business Loan

On June 14, 2018, NMM amended its promissory note agreement with Preferred Bank (“NMM Business Loan Agreement”), which provides for loan availability of up to $20.0 million with a maturity date of June 22, 2020. One of the Company’s board members is the chairman and CEO of Preferred Bank. The NMM Business Loan Agreement was subsequently amended on September 1, 2018 to temporarily increase the loan availability from $20.0 million to $27.0 million for the period from September 1, 2018 through January 31, 2019, further extended to October 31, 2019 to facilitate the issuance of an additional standby letter of credit for the benefit of CMS. The interest rate is based on the Wall Street Journal “prime rate,” plus 0.125%, or 5.625% as of December 31, 2018. The loan was guaranteed by Apollo Medical Holdings, Inc. and is collateralized by substantially all of the assets of NMM. The amounts outstanding as of June 30, 2019 of $5.0 million was fully repaid on September 11, 2019.

On September 5, 2018, NMM entered into a non-revolving line of credit agreement with Preferred Bank, which provides for loan availability of up to $20.0 million with a maturity date of September 5, 2019. This credit facility was subsequently amended on April 17, 2019 and July 29, 2019 to reduce the loan availability from $20.0 million to $16.0 million and from $16.0 million to $2.2 million, respectively. The interest rate is based on the Wall Street Journal “prime rate,” plus 0.125%, or 3.375% as of March 31, 2020 and 4.875% as of December 31, 2019. The line of credit is guaranteed by Apollo Medical Holdings, Inc. and is collateralized by substantially all assets of NMM. NMM obtained this line of credit to finance potential acquisitions. Each drawdown from the line of credit is converted into a five-year term loan with monthly principal payments, plus interest based on a five-year amortization schedule.

On September 11, 2019, the NMM Business Loan Agreement, dated as of June 14, 2018, between NMM and Preferred Bank, as amended, and the Line of Credit Agreement, dated as of September 5, 2018, between NMM and Preferred Bank, as amended, was terminated in connection with the closing of the Credit Facility. Certain letters of credit issued by Preferred Bank under the Line of Credit Agreement was terminated and reissued under the Credit Agreement. These outstanding letters of credit totaled $14.8 million as of March 31, 2020 and the Company has $10.2 million available under the revolving Credit Facility for letter of credit.

APC Business Loan

On June 14, 2018, APC amended its promissory note agreement with Preferred Bank, which provides for loan availability of up to $10.0 million with a maturity date of June 22, 2020. This credit facility was subsequently amended on April 17, 2019 and June 11, 2019 to increase the loan availability from $10.0 million to $40.0 million and extend the maturity date through December 31, 2020. On August 1, 2019 and September 10, 2019, this credit facility was further amended to increase loan availability from $40.0 million to $43.8 million, and decrease loan availability from $43.8 million to $4.1 million, respectively. This decrease further limited the purpose of the indebtedness under APC Business Loan Agreement to the issuance of standby letters of credit, and added as a permitted lien the security interest in all of its assets granted by APC in favor of NMM under a Security Agreement dated on or about September 11, 2019 securing APC’s obligations to NMM under, and as required pursuant to, the APC management services agreement dated as of July 1, 1999, as amended. The interest rate is based on the Wall Street Journal “prime rate,” plus 0.125%, or 3.375% and 4.875% as of March 31, 2020 and December 31, 2019, respectively.

As of March 31, 2020 and December 31, 2019, there was no availability under this line of credit.

Standby Letters of Credit

On October 2, 2018, APAACO established a second irrevocable standby letter of credit with Preferred Bank (through the NMM Business Loan Agreement) for $6.6 million for the benefit of CMS. The letter of credit expires on December 31, 2020 and is automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution to terminate prior to 90 days from any expiration date. APAACO may continue to draw from the letter of credit for one year following the bank’s notification of non-renewal. This standby letter of credit was subsequently amended on August 14, 2019 to increase amount from $6.6 million to $14.8 million and extended expiration date on December 31, 2020 with all other terms and conditions remain unchanged. In connection with the closing of the Credit Facility, this letter of credit was terminated and reissued under the Credit Agreement.

APC established irrevocable standby letters of credit with Preferred Bank under the APC Business Loan Agreement for a total of $0.3 million for the benefit of certain health plans. The standby letters of credit are automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution in advance of the expiration date that the letter will be terminated.

Alpha Care established irrevocable standby letters of credit with Preferred Bank under the APC Business Loan Agreement for a total of $3.8 million for the benefit of certain health plans. The standby letters of credit are automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution in advance of the expiration date that the letter will be terminated.

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Income Taxes

3 Months Ended

Mar. 31, 2020

Income Tax Disclosure [Abstract]

Income Taxes

Income Taxes

The Company uses the liability method of accounting for income taxes as set forth in ASC 740. Under the liability method, deferred taxes are determined based on differences between the financial statement and tax bases of assets and liabilities using enacted tax rates.

On an interim basis, the Company estimates what its anticipated annual effective tax rate will be and records a quarterly income tax provision (benefit) in accordance with the estimated annual rate, plus the tax effect of certain discrete items that arise during the quarter. As the fiscal year progresses, the Company refines its estimates based on actual events and financial results during the quarter. This process can result in significant changes to the Company’s estimated effective tax rate. When this occurs, the income tax provision (benefit) is adjusted during the quarter in which the estimates are refined so that the year-to-date provision reflects the estimated annual effective tax rate. These changes, along with adjustments to the Company’s deferred taxes and related valuation allowance, may create fluctuations in the overall effective tax rate from quarter to quarter.

As of March 31, 2020 due to the overall cumulative losses incurred in recent years, the Company maintained a full valuation allowance against its deferred tax assets related to loss entities the Company cannot consolidate under the federal consolidation rules, as realization of these assets is uncertain.

The Company’s effective tax rate for the three months ended March 31, 2020 differed from the U.S. federal statutory rate primarily due to state income taxes, income from flow through entities, nondeductible permanent items, and change in valuation allowance.

As of March 31, 2020, the Company does not have any unrecognized tax benefits related to various federal and state income tax matters. The Company will recognize accrued interest and penalties related to unrecognized tax benefits in income tax expense.

The Company is subject to U.S. federal income tax as well as income tax in California. The Company and its subsidiaries’ state and Federal income tax returns are open to audit under the statute of limitations for the years ended December 31, 2015 through December 31, 2018 and for the years ended December 31, 2016 through December 31, 2018, respectively. The Company does not anticipate material unrecognized tax benefits within the next 12 months.

On March 27, 2020, the Coronavirus Aid, Relief and Economic Security Act ("CARES Act") was signed into law. The CARES Act includes various income and payroll tax provisions that we are in the process of analyzing to determine the tax impacts. However, we do not expect the benefits of the CARES Act to impact the Company’s annual estimated tax rate for the period March 31, 2020.

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Leases (Tables)

3 Months Ended

Mar. 31, 2020

Leases [Abstract]

Information Related to Lease Costs

The components of lease expense were as follows (in thousands):

	Three Months Ended March 31,
	2020			2019
Operating lease cost	$	1,942		$	1,102
Finance lease cost
Amortization of lease expense	$	26		$	25
Interest on lease liabilities	4			5
Sublease income	$	(134	)	$	(100	)
Total finance lease cost, net	$	1,838		$	1,032

	Three Months Ended March 31,
	2020			2019
Operating lease cost	$	1,942		$	1,102
Finance lease cost
Amortization of lease expense	$	26		$	25
Interest on lease liabilities	4			5
Sublease income	$	(134	)	$	(100	)
Total finance lease cost, net	$	1,838		$	1,032

Other information related to leases was as follows (in thousands):

	Three Months Ended March 31,
	2020			2019
Supplemental Cash Flows Information
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	1,547		$	1,034
Operating cash flows from finance leases	4			5
Financing cash flows from finance leases	26			25
Right-of-use assets obtained in exchange for lease liabilities:
Operating leases	4,745			8,855
	Three Months Ended March 31,
	2020			2019
Weighted Average Remaining Lease Term
Operating leases	7.33 years			4.30 years
Finance leases	4.42 years			5.25 years
Weighted Average Discount Rate
Operating leases	6.10		%	6.13		%
Finance leases	3.00		%	3.00		%

Schedule of Future Minimum Operating Lease Payments After Adoption of 842

Future minimum lease payments under non-cancellable leases as of March 31, 2020 is as follows (in thousands):

March 31, 2020	Operating Leases		Finance Leases
2020 (excluding the three months ended March 31, 2020)	$	3,227	$	89
2021	3,745		119
2022	2,970		119
2023	2,724		119
2024	2,340		79
Thereafter	8,484		—
Total future minimum lease payments	23,490		525
Less: imputed interest	4,788		33
Total lease liabilities	18,702		492
Less: current portion	3,119		102
Long-term lease liabilities	$	15,583	$	390

Schedule of Future Minimum Finance Lease Payments After Adoption of 842

Future minimum lease payments under non-cancellable leases as of March 31, 2020 is as follows (in thousands):

March 31, 2020	Operating Leases		Finance Leases
2020 (excluding the three months ended March 31, 2020)	$	3,227	$	89
2021	3,745		119
2022	2,970		119
2023	2,724		119
2024	2,340		79
Thereafter	8,484		—
Total future minimum lease payments	23,490		525
Less: imputed interest	4,788		33
Total lease liabilities	18,702		492
Less: current portion	3,119		102
Long-term lease liabilities	$	15,583	$	390

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Mezzanine and Stockholders' Equity (Tables)

3 Months Ended

Mar. 31, 2020

Stockholders' Equity Note [Abstract]

Stock Option Transactions Under Stock Option Plans

The Company’s outstanding stock options consisted of the following:

	Shares		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)	Aggregate Intrinsic Value (in thousands)
Options outstanding at January 1, 2020	607,346		$	9.22	3.42	$	5,600
Options granted	11,742		18.41		—	—
Options exercised	(100,000	)	2.10		—	1,600
Options forfeited	(12,228	)	17.57		—	—
Options outstanding at March 31, 2020	506,860		$	10.63	3.31	$	2,000
Options exercisable at March 31, 2020	375,960		$	6.25	2.11	$	2,000

Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions

During the three months ended March 31, 2020, the Company granted 11,742five-year stock options to certain ApolloMed board members with an exercise price of $18.41, which were recognized at fair value, as determined using the Black-Scholes option pricing model and the following assumptions:

March 31, 2020	Board Members
Expected term	3.0 years
Expected volatility	90.01		%
Risk-free interest rate	1.43		%
Market value of common stock	$	10.56
Annual dividend yield	—		%
Forfeiture rate	—		%

Schedule of Outstanding Warrants

The Company’s outstanding warrants consisted of the following:

	Shares		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)	Aggregate Intrinsic Value (in thousands)
Warrants outstanding at January 1, 2020	3,154,590		$	9.96	2.01	$	26,700
Warrants granted	—		—		—	—
Warrants exercised	(51,601	)	9.50		—	400
Warrants expired/forfeited	—		—		—	—
Warrants outstanding at March 31, 2020	3,102,989		$	9.97	1.78	$	9,200

Exercise Price Per Share		Warrants Outstanding	Weighted Average Remaining Contractual Life	Warrants Exercisable	Weighted Average Exercise Price Per Share
$	9.00	919,048	0.54	919,048	$	9.00
10.00		1,367,451	2.06	1,367,451	10.00
11.00		816,490	2.69	816,490	11.00
$ 9.00 –11.00		3,102,989	1.78	3,102,989	$	9.97

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Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Payables and Accruals [Abstract]
Accounts payable	$ 7,745	$ 6,914
Capitation payable	2,802	2,813
Subcontractor IPA payable	2,886	3,360
Professional fees	1,792	1,837
Due to related parties	55	225
Accrued compensation	4,162	3,238
Contract liabilities	664	8,892
Total accounts payable and accrued expenses	$ 20,106	$ 27,279

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Credit Facility, Bank Loan and Lines of Credit - Additional Information (Details)				1 Months Ended	3 Months Ended
	Dec. 31, 2018	Oct. 02, 2018 USD ($)	Sep. 05, 2018 USD ($)	Sep. 30, 2019 USD ($)	Mar. 31, 2020 USD ($) financial_ratio	Mar. 31, 2019 USD ($)	Dec. 31, 2019 USD ($)	Sep. 10, 2019 USD ($)	Aug. 14, 2019 USD ($)	Aug. 01, 2019 USD ($)	Jul. 29, 2019 USD ($)	Jun. 30, 2019 USD ($)	Jun. 11, 2019 USD ($)	Apr. 17, 2019 USD ($)	Sep. 01, 2018 USD ($)	Jun. 14, 2018 USD ($)
Debt Instrument [Line Items]
Amount outstanding					$ 245,250,000
Interest expense					$ 2,868,000	$ 211,000
Credit Agreement
Debt Instrument [Line Items]
Number of key financial ratios | financial_ratio					2
Maximum consolidated leverage ratio (not greater than)					0.0375
Consolidated leverage ratio, annual decrease					0.0025
Consolidated leverage ratio minimum					0.0300
Minimum consolidated interest coverage ratio (not less than)					0.0325
Default amount of debt instrument				$ 10,000,000
Average effective interest rate					4.24%	5.47%
Interest expense					$ 300,000	$ 0
Credit Agreement | Preferred Bank
Debt Instrument [Line Items]
Amount outstanding					$ 14,800,000
Credit Agreement | Minimum
Debt Instrument [Line Items]
Required annual facility fee					0.20%
Credit Agreement | Minimum | NMM
Debt Instrument [Line Items]
Basis spread on variable rate					1.00%
Credit Agreement | Minimum | NMM | London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Basis spread on variable rate					2.00%
Credit Agreement | Maximum
Debt Instrument [Line Items]
Required annual facility fee					0.35%
Credit Agreement | Maximum | NMM
Debt Instrument [Line Items]
Basis spread on variable rate					2.00%
Credit Agreement | Maximum | NMM | London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Basis spread on variable rate					3.00%
Credit Agreement | Payment Period One
Debt Instrument [Line Items]
Principal payment on credit agreement				2,400,000
Credit Agreement | Payment Period Two
Debt Instrument [Line Items]
Principal payment on credit agreement				3,600,000
Credit Agreement | Payment Period Three
Debt Instrument [Line Items]
Principal payment on credit agreement				$ 4,800,000
NMM Line of Credit Agreement
Debt Instrument [Line Items]
Default amount of debt instrument					$ 50,000,000
Shareholder approval percentage (not less than)					50.01%
Approved use of funds (not to exceed)					$ 125,000,000
Revolver Loan
Debt Instrument [Line Items]
Amount outstanding					$ 60,000,000
interest rate at end of period					3.24%
Revolver Loan | Credit Agreement
Debt Instrument [Line Items]
Revolving credit facility term				5 years
Amount outstanding				$ 60,000,000
Deferred financing costs				6,500,000
Revolver Loan | Credit Agreement | Line of Credit
Debt Instrument [Line Items]
Maximum loan availability				100,000,000
Letter of Credit | Credit Agreement | Preferred Bank
Debt Instrument [Line Items]
Amount available					$ 10,200,000
Letter of Credit | Credit Agreement | Line of Credit
Debt Instrument [Line Items]
Maximum loan availability				25,000,000
Term loan A
Debt Instrument [Line Items]
Amount outstanding					$ 185,250,000
interest rate at end of period					3.57%
Term loan A | Credit Agreement | Line of Credit
Debt Instrument [Line Items]
Maximum loan availability				$ 190,000,000
Standby Letters of Credit | APC
Debt Instrument [Line Items]
Maximum loan availability					$ 300,000
Term of facility					1 year
Standby Letters of Credit | APAACO | Preferred Bank
Debt Instrument [Line Items]
Maximum loan availability		$ 6,600,000							$ 14,800,000
Term of facility		1 year
Period of notification of termination		90 days
Standby Letters of Credit | Alpha Care Medical Group, Inc.
Debt Instrument [Line Items]
Term of facility					1 year
Standby Letters of Credit | Alpha Care Medical Group, Inc. | Preferred Bank
Debt Instrument [Line Items]
Maximum loan availability					$ 3,800,000.0
Term of facility					1 year
Standby Letters of Credit | Credit Agreement | Minimum | NMM
Debt Instrument [Line Items]
Required annual facility fee					2.00%
Standby Letters of Credit | Credit Agreement | Maximum | NMM
Debt Instrument [Line Items]
Required annual facility fee					3.00%
Line of Credit | NMM Line of Credit Agreement | NMM | Preferred Bank
Debt Instrument [Line Items]
Maximum loan availability			$ 20,000,000								$ 2,200,000			$ 16,000,000
interest rate at end of period					3.375%		4.875%
Term of converted loan			5 years
Term of facility			5 years
Line of Credit | NMM Line of Credit Agreement | NMM | Prime Rate | Preferred Bank
Debt Instrument [Line Items]
Basis spread on variable rate					0.125%
Line of Credit | NMM Business Loan Agreement | NMM | Preferred Bank
Debt Instrument [Line Items]
Maximum loan availability															$ 27,000,000	$ 20,000,000
Amount outstanding												$ 5,000,000
interest rate at end of period	5.625%
Line of Credit | NMM Business Loan Agreement | NMM | Prime Rate | Preferred Bank
Debt Instrument [Line Items]
Basis spread on variable rate	0.125%
Line of Credit | APC Business Loan Agreement | APC | Preferred Bank
Debt Instrument [Line Items]
Maximum loan availability								$ 4,100,000		$ 43,800,000			$ 40,000,000			$ 10,000,000
interest rate at end of period					3.375%		4.875%
Amount available					$ 0		$ 0
Line of Credit | APC Business Loan Agreement | APC | Prime Rate | Preferred Bank
Debt Instrument [Line Items]
Basis spread on variable rate					0.125%

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Subsequent Events - Additional Information (Details) - USD ($) $ in Thousands			3 Months Ended
	May 06, 2020	Apr. 30, 2020	Mar. 31, 2020	Mar. 31, 2019
Subsequent Event [Line Items]
Dividends paid			$ 9,934	$ 10,000
Subsequent Event | APC
Subsequent Event [Line Items]
Dividends paid	$ 20,000
Subsequent Event | Universal Care, Inc. | APC
Subsequent Event [Line Items]
Cash consideration received, sale of equity method investment		$ 69,200
Repayment of indebtedness received		16,500
Additional cash consideration entitled to be received		15,600
Subsequent Event | Universal Care, Inc. | APC | Preferred Stock | Bright
Subsequent Event [Line Items]
Value of non-cash consideration received		33,300
Value of additional non-cash consideration to be received		$ 5,900

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Leases - Additional information (Details) - USD ($) $ in Thousands			3 Months Ended
	Mar. 31, 2020	Dec. 31, 2019	Mar. 31, 2020	Mar. 31, 2019
Lessee, Lease, Description [Line Items]
Operating lease option to extend (up to)	10 years		10 years
Finance lease option to extend (up to)	10 years		10 years
Operating lease, termination period, if applicable			1 year
Finance lease, termination period, if applicable			1 year
Assets recorded under finance leases	$ 500	$ 500	$ 500
Accumulated depreciation associated with finance leases	$ 300	$ 300	$ 26	$ 25
Minimum
Lessee, Lease, Description [Line Items]
Remaining lease terms, operating	1 month		1 month
Remaining lease terms, finance	1 month		1 month
Maximum
Lessee, Lease, Description [Line Items]
Remaining lease terms, operating	5 years		5 years
Remaining lease terms, finance	5 years		5 years