Equity Method Investments

During the years ended December 31, 2025, 2024, and 2023, the Company paid approximately $6.1 million, $6.4 million, and $3.8 million, respectively, to our equity method investments, for management fee and provider services. During the years ended December 31, 2025, 2024, and 2023, the Company recognized approximately $2.2 million, $1.0 million, and $16.7 million, respectively, from our equity method investments, in management fee income. See Note 6 — “Investments in Other Entities”.

Astrana Board Members and Officers

During the years ended December 31, 2025, 2024, and 2023, the Company incurred rent expense of approximately $4.7 million, $4.0 million, and $3.8 million, respectively, from certain properties that are managed by Allied Pacific Holdings Investment Management, LLC. As of December 31, 2025 and 2024, the Company’s operating right-of-use asset balance included $10.1 million and $2.7 million, respectively, and the Company’s operating lease liabilities, included, $10.7 million and $2.7 million, respectively, for certain properties that are managed by Allied Pacific Holdings Investment Management, LLC. The chief executive officer of Allied Pacific Holdings Investment Management, LLC, is a member of the Company’s board of directors.

During the year ended December 31, 2024, Allied Pacific Holdings Investment Management, LLC paid APC $5.3 million for taxes associated with the APC Excluded Assets Spin-off on December 26, 2023 (see Note 20 — “Segments”). There were no similar payments made to APC during the year ended December 31, 2025.

During the years ended December 31, 2025, 2024, and 2023, the Company incurred approximately $5.0 million, $3.6 million, and $1.3 million, respectively, in expenses payable to Third Way Health for call center and credentialing services. One of Astrana’s officers is a board member of Third Way Health. In December 2025, the Company, under the terms of its SAFE with Third Way Health, converted its $6.0 million investment into common and preferred stock that resulted in approximately 27.7% ownership of all common stock in Third Way Health and accounted for the investment as an equity method investment (see Note 6 — “Investments in Other Entities”).

During the years ended December 31, 2025, 2024, and 2023, Astrana paid approximately $0.4 million, $0.9 million, and $9.8 million, respectively, to purchase Astrana’s stock from certain board members.

The Company has an agreement with AHMC for services provided to the Company, involving payment for hospital and other inpatient-related services, at rates similar to other hospitals with which the Company contracts. Revenue with AHMC consists of capitation, risk pool, and miscellaneous fees. Expenses involved with AHMC includes primarily claims expenses. One of the Company’s directors is an officer of AHMC.

The Company and AHMC have a risk-sharing agreement with certain AHMC hospitals to share the surplus and deficits of each of the hospital pools. Under this agreement, during the years ended December 31, 2025, 2024, and 2023, the Company had recognized risk pool revenue of $13.8 million, $34.1 million, and $43.8 million, respectively, of which $40.5 million and $47.7 million remained outstanding as of December 31, 2025 and 2024, respectively.

APC Board Members

During the years ended December 31, 2025, 2024, and 2023, the Company paid an aggregate of approximately $21.1 million, $19.5 million, and $23.1 million, respectively, to board members for provider services which included approximately $3.2 million, $3.1 million, and $4.2 million, respectively, to Astrana board members who are also board members and officers of APC.

In addition, affiliates wholly owned by the Company’s key personnel are reported in the accompanying consolidated statements of income on a consolidated basis, together with the Company’s subsidiaries, and therefore, the Company does not separately disclose transactions between such affiliates and the Company’s subsidiaries as related-party transactions.

Intercompany Transactions

Because of corporate practice of medicine laws, the Company uses designated shareholder professional corporations, of which the sole shareholder is a member of the Company’s key personnel, to engage in certain transactions and make intercompany loans from time to time.