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What changed in CLOVER HEALTH INVESTMENTS, CORP. /DE's 10-K2023 vs 2024

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Paragraph-level year-over-year comparison of CLOVER HEALTH INVESTMENTS, CORP. /DE's 2023 and 2024 10-K annual filings, covering the Business, Risk Factors, Legal Proceedings, Cybersecurity, MD&A and Market Risk sections. Every new, removed and edited paragraph is highlighted side-by-side so you can see exactly what management changed in the 2024 report.

+544 added912 removedSource: 10-K (2025-03-03) vs 10-K (2024-03-14)

Top changes in CLOVER HEALTH INVESTMENTS, CORP. /DE's 2024 10-K

544 paragraphs added · 912 removed · 278 edited across 7 sections

Item 1. Business

Business — how the company describes what it does

2 edited+195 added475 removed0 unchanged
Biggest changeFor additional information related to the Company's Non-Insurance operations, see Note 20 (Non-Insurance) in these financial statements. The Company was originally incorporated as a Cayman Islands exempted company on October 18, 2019, as a special purpose acquisition company under the name Social Capital Hedosophia Holdings Corp. III ("SCH").
Biggest changeClover Health was incorporated on October 18, 2019, as a special purpose acquisition company and a Cayman Islands exempted company under the name Social Capital Hedosophia Holdings Corp. III ("SCH"). On April 24, 2020, SCH completed its initial public offering.
Clover focuses on minimizing members' out-of-pocket costs and offers many plans that allow members to pay the same co-pays for primary care provider visits regardless of whether their physician is in- or out-of-network.
Most of our members are enrolled in plans that offer among the lowest average out-of-pocket costs for PCP co-pays in their markets while also providing wide network access and the same in- and out-of-network costs for primary care provider visits.
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Item 1. Financial Statements and Supplementary Data Report of Independent Registered Public Accounting Firm To the Shareholders and the Board of Directors of Clover Health Investments, Corp. Opinion on the Financial Statements We have audited the accompanying consolidated balance sheets of Clover Health Investments, Corp.
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Item 1. Business. General At Clover Health, our vision is to empower every physician with technology to identify, manage, and treat chronic diseases earlier. This results in earlier diagnosis and treatment, earlier disease management and more affordable and accessible care.
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(the Company) as of December 31, 2023 and 2022, the related consolidated statements of operations and comprehensive loss , changes in convertible preferred stock and stockholders' equity and cash flows for each of the three years in the period ended December 31, 2023, and the related notes and financial statement schedules listed in the Index at Item 15 (collectively referred to as the “consolidated financial statements”).
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Our strategy is to improve the care of our Medicare beneficiaries, develop wide physician networks, and provide technology to help empower physicians. Our proprietary software platform, Clover Assistant (licensed externally as Counterpart Assistant) helps us execute this strategy by enabling physicians to detect, identify, and manage chronic diseases better than they otherwise could.
Removed
In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position of the Company at December 31, 2023 and 2022, and the results of its operations and its cash flows for each of the three years in the period ended December 31, 2023, in conformity with U.S. generally accepted accounting principles.
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This technology is a cloud-based software platform, that curates medical records from over 100 data sources and provides physicians with access to data-driven insights and personalized care recommendations for the patients.
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We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the Company's internal control over financial reporting as of December 31, 2023, based on criteria established in Internal Control-Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission ( 2013 framework), and our report dated March 14, 2024 expressed an unqualified opinion thereon .
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Our differentiated approach can be summarized as follows: (1) Represents full year 2024 MCR and BER ratios for Clover Health, as well as most recent results of other public companies with “Traditional MA Plan” approaches that have reported results as of the time of filing of this Form 10-K. (2) Insurance Benefits expense ratio (“BER”) is a non-GAAP financial measure.
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Basis for Opinion These financial statements are the responsibility of the Company's management. Our responsibility is to express an opinion on the Company’s financial statements based on our audits.
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We calculate our Insurance BER by taking the total of Insurance net medical expenses incurred and quality improvements, and dividing that total by premiums earned on a net basis, in a given period.
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We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB. We conducted our audits in accordance with the standards of the PCAOB.
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Provider use of Clover Assistant enables data-driven clinical decision-making that benefits our members and drives rapid software iteration: the more that providers use Clover Assistant, the more it learns and furthers the precision of personalized data-driven recommendations.
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Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement, whether due to error or fraud. Our audits included performing procedures to assess the risks of material misstatement of the financial statements, whether due to error or fraud, and performing procedures that respond to those risks.
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We combine our beneficiary data with provider-generated data and use this powerful closed feedback loop to continuously fine-tune our proprietary clinical rules and machine learning models, as well as to select and prioritize future software capabilities. We believe the use and continuous improvement of Clover Assistant has resulted in not only improved clinical decision-making but also enhanced MA plan performance.
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Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. Our audits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that our audits provide a reasonable basis for our opinion.
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The platform facilitates identifying and engaging with our most at-risk members for our clinical programs. These programs are designed to provide additional targeted care support and to further drive better plan performance. We leverage Clover Assistant in our Preferred Provider Organization ("PPO") and Health Maintenance Organization ("HMO") plans.
Removed
Critical Audit Matter The critical audit matter communicated below is a matter arising from the current period audit of the financial statements that was communicated or required to be communicated to the audit committee and that: (1) relates to accounts or disclosures that are material to the financial statements and (2) involved our especially challenging, subjective or complex judgments.
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We aim to provide affordable, high-quality healthcare and we offer most of our members (referred to as "members") in our Medicare Advantage ("MA") plans among the lowest average out-of-pocket costs for primary care provider ("PCP") and specialist co-pays in their respective markets.
Removed
The communication of the critical audit matter does not alter in any way our opinion on the consolidated financial statements, taken as a whole, and we are not, by communicating the critical audit matter below, providing separate opinion on the critical audit matter or on the accounts or disclosures to which it relates. 75 Valuation of incurred but not reported reserves Description of the Matter As of December 31, 2023, the Company’s unpaid claims was $138.6 million, a significant portion is incurred but not reported reserves.
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We strongly believe in providing our members with provider choice and consider our PPO plans to be our flagship insurance product. An important feature of our MA product is its wide physician network. We often offer the same cost-sharing (co-pays and deductibles) for visits with primary care providers who are in-network and out-of-network.
Removed
As discussed in Notes 2 and 9 to the consolidated financial statements, the Company’s incurred but not reported (IBNR) liability is determined by using actuarial methods that include a number of factors and assumptions, including completion factors, which seek to measure the cumulative percentage of claims expense that have been paid as of the reporting date based on historical claim payment patterns, and assumed medical cost trend factors, which represent an estimate of claims expense based on recent claims expense levels and medical cost levels.
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We manage care on our wide network by empowering providers with intuitive data-driven, personalized insights for their patients (our members) through the use of Clover Assistant. We believe this enables providers to make improved clinical decisions. We reach a broad array of consumers, including traditionally underserved markets.
Removed
There is significant uncertainty inherent in determining management’s best estimate of completion and trend factors, which are used to calculate actuarial estimates of IBNR. Auditing management’s best estimate of the IBNR was complex and required the involvement of our actuarial specialists due to the highly judgmental nature of completion and trend factor assumptions used in the valuation process.
Added
At January 1, 2025, we operated our MA plans in five states and 200 counties. 7 We complement our wide-network physicians and their patients with our longitudinal home-based primary care program for our highest acuity members, Clover Home Care, powered by Clover Assistant. This program covers the most medically complex patients, often with advanced comorbidities.
Removed
These assumptions have a significant effect on the valuation of the IBNR liability. How We Addressed the Matter in Our Audit We obtained an understanding, evaluated the design and tested the operating effectiveness of controls over the Company’s actuarial process for estimating the liability for incurred but not paid claims.
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We believe Clover Assistant makes home care for high-risk individuals more scalable than fixed-site-based care. It permits technology deployment to enhance care and outcomes directly where patients live because our value proposition is centered around software. Clover Home Care seeks to preserve the PCP-to-patient relationship through collaboration, which aims to improve health outcomes and reduce medical expenses.
Removed
These audit procedures included among others, testing management review controls over the application of the actuarial assumptions within the reserve models and the review and approval processes that management has in place for estimating the liability for incurred but not paid claims.
Added
We have made it a priority to work with Medicare beneficiaries in underserved markets. This includes MA members diagnosed with at least two chronic diseases, as well as members living in communities that fall within the top five deciles of what the government defines as areas of socioeconomic deprivation.
Removed
To test the Company’s liability for IBNR, our audit procedures included, among others, testing the completeness and accuracy of data used in the calculation by testing reconciliations of underlying claims and membership data recorded in source systems to the actuarial reserving calculations, and comparing a sample of claims to source documentation.
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We are heavily invested in helping provide care for those who are most in need. During 2024, the Company launched Counterpart Health, Inc., a new Software-as-a-Service (“SaaS”) and Tech Enabled Services Solution to bring the power of Clover Assistant technology to external payors and providers serving the Medicare eligible population.
Removed
We involved actuarial specialists to assist with our audit procedures, which included, among others, evaluating the methodologies and assumptions applied by the Company in determining the IBNR and independently calculating a range of IBNR estimates for comparison to management’s actuarial best estimate of the IBNR.
Added
This external offering aims to equip clinician users with the Company's already built, clinician-centric, and AI-powered care management platform. Strategically, Counterpart Health, Inc., a subsidiary of Clover Health, aims to extend the benefits of data-driven proven technology and personalized care to a wider audience, enabling enhanced patient outcomes and reduced healthcare costs across the nation.
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Additionally, we performed a review of the prior period IBNR liabilities to subsequent claims development. /s/ Ernst & Young LLP We have served as the Company’s auditor since 2018. New York, New York March 14, 2024 76 CLOVER HEALTH INVESTMENTS, CORP.
Added
Counterpart Health is complementary to Clover Health, and enables the Company to deploy and expand the reach of its existing technology asset for new potential growth and high margin business opportunities, with low startup costs. Unless the context otherwise provides, references to Clover Assistant in this report also refer to Counterpart Assistant, as applicable.
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CONSOLIDATED BALANCE SHEETS (Dollars in thousands, except share amounts) December 31, 2023 2022 Assets Current assets Cash and cash equivalents $ 122,863 $ 103,791 Short-term investments 12,218 41,457 Investment securities, available-for-sale (Amortized cost: 2023: $101,412; 2022: $193,300) 100,702 189,498 Investment securities, held-to-maturity (Fair value: 2023: $6,778; 2022: $15) 6,902 15 Accrued retrospective premiums 22,076 20,387 Other receivables 16,666 23,596 Healthcare receivables 64,164 70,607 Non-Insurance receivable 10,926 52,955 Surety bonds and deposits 55,631 100,502 Prepaid expenses 14,418 18,146 Other assets, current 1,404 4,043 Total current assets 427,970 624,997 Investment securities, available-for-sale (Amortized cost: 2023: $121,868; 2022: $142,940) 120,208 137,368 Investment securities, held-to-maturity (Fair value: 2023: $692; 2022: $636) 793 742 Property and equipment, net 5,082 5,753 Operating lease right-of-use assets 3,382 4,025 Goodwill and other intangible assets 2,990 20,000 Other assets, non-current 10,246 15,735 Total assets $ 570,671 $ 808,620 The accompanying notes are an integral part of these consolidated financial statements. 77 CLOVER HEALTH INVESTMENTS, CORP.
Added
On January 7, 2021, SCH consummated a business combination with Clover Health Investments, Corp. and changed its name to Clover Health Investments, Corp. We are a remote first company. Accordingly, we do not maintain a headquarters.
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CONSOLIDATED BALANCE SHEETS (Dollars in thousands, except share amounts) December 31, 2023 2022 Liabilities and Stockholders' Equity Current liabilities Unpaid claims $ 138,593 $ 141,947 Due to related parties, net 1,363 1,566 Non-Insurance performance year obligation, current 15,568 73,844 Non-Insurance payable 41,565 148,191 Accounts payable and accrued expenses 37,184 32,445 Accrued salaries and benefits 21,061 23,962 Deferred revenue 3,099 — Operating lease liabilities 1,665 1,827 Premium deficiency reserve — 7,239 Other liabilities, current 1,017 486 Total current liabilities 261,115 431,507 Long-term operating lease liabilities 2,998 4,033 Other liabilities, non-current 20,164 16,193 Total liabilities 284,277 451,733 Commitments and Contingencies (Note 19) Stockholders' equity Class A Common Stock, $0.0001 par value; 2,500,000,000 shares authorized at December 31, 2023 and December 31, 2022; 401,183,882 and 383,998,718 issued and outstanding at December 31, 2023 and December 31, 2022, respectively 40 37 Class B Common Stock, $0.0001 par value; 500,000,000 shares authorized at December 31, 2023 and December 31, 2022; 87,867,732 and 94,394,852 issued and outstanding at December 31, 2023 and December 31, 2022, respectively 9 9 Additional paid-in capital 2,461,238 2,319,157 Accumulated other comprehensive loss (2,370) (9,374) Accumulated deficit (2,159,794) (1,946,433) Less: Treasury stock, at cost; 7,912,750 and 2,072,752 shares held at December 31, 2023 and December 31, 2022, respectively (12,729) (6,509) Total stockholders' equity 286,394 356,887 Total liabilities and stockholders' equity $ 570,671 $ 808,620 The accompanying notes are an integral part of these consolidated financial statements. 78 CLOVER HEALTH INVESTMENTS, CORP.
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Stockholder communications required to be sent to our principal executive offices may be directed to the email address: secretary@cloverhealth.com, or to our agent for service of process at The Corporation Trust Company, 1209 Orange Street, Wilmington, Delaware 19801. Our telephone number is (201) 432-2133. Our website address is www.cloverhealth.com.
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CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS (Dollars in thousands, except per share and share amounts) Years ended December 31, 2023 2022 2021 Revenues: Premiums earned, net (Net of ceded premiums of $444, $470, and $489 for the years ended December 31, 2023 and 2022, and 2021 respectively) $ 1,235,769 $ 1,084,869 $ 799,414 Non-Insurance revenue 773,177 2,380,135 667,639 Other income 24,774 11,683 4,943 Total revenues 2,033,720 3,476,687 1,471,996 Operating expenses: Net medical claims incurred 1,776,388 3,453,952 1,551,178 Salaries and benefits 257,157 278,725 260,458 General and administrative expenses 187,571 207,917 185,287 Impairment of goodwill and other intangible assets 15,945 — — Premium deficiency reserve expense (benefit) (7,239) (93,517) 110,628 Depreciation and amortization 2,509 1,187 1,246 Restructuring costs 9,931 — — Other expense — 70 191 Total operating expenses 2,242,262 3,848,334 2,108,988 Loss from operations (208,542) (371,647) (636,992) Change in fair value of warrants 86 (900) (66,146) Interest expense 7 1,333 3,193 Amortization of notes and securities discounts — 30 13,717 Loss (gain) on investment 4,726 (9,217) — Gain on extinguishment of note payable $ — $ (23,326) $ — Net loss $ (213,361) $ (339,567) $ (587,756) Per share data: Net loss per share attributable to Class A and Class B common stockholders – basic and diluted (1) $ (0.44) $ (0.71) $ (1.42) Weighted average number of common shares outstanding Basic and diluted weighted average number of Class A and Class B common shares and common share equivalents outstanding (1) 482,176,127 476,244,262 412,922,424 Net unrealized gain (loss) on available-for-sale investments $ 7,004 $ (7,440) $ (1,944) Comprehensive loss $ (206,357) $ (347,007) $ (589,700) (1) Because the Company had a Net loss during the years ended December 31, 2023, 2022, and 2021, the Company's potentially dilutive securities, which include stock options, restricted stock units, preferred stock, and warrants to purchase shares of common stock and preferred stock, have been excluded from the computation of diluted net loss per share, as the effect would be anti-dilutive.
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The information contained on or accessible through our website is not part of this Annual Report on Form 10-K and is not incorporated by reference in this Annual Report on Form 10-K. Our Opportunity We believe we have an opportunity to fundamentally change healthcare by providing easy access to care via technology-enabled providers across the country.
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The accompanying notes are an integral part of these consolidated financial statements. 79 CLOVER HEALTH INVESTMENTS, CORP.
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By leveraging our Clover Assistant platform, we believe we can raise the level of care provided by every provider and scale in ways that traditional managed care plans and risk-bearing provider groups cannot. We principally scale our model of care by deploying physician-enablement software to providers.
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CONSOLIDATED STATEMENTS OF CHANGES IN CONVERTIBLE PREFERRED STOCK AND STOCKHOLDERS' EQUITY (Dollars in thousands, except share amounts) Convertible Preferred Stock Class A Common Stock Class B Common Stock Treasury Stock Additional paid-in capital Accumulated deficit Accumulated other comprehensive income (loss) Noncontrolling interest Total stockholders' equity (deficit) Shares Amount Shares Amount Shares Amount Shares Amount Balance, December 31, 2020 139,444,346 $ 447,747 — $ — 89,206,266 $ 9 — $ — $ 411,867 $ (1,028,982) $ 10 $ 3,903 $ (613,193) Stock issuance for exercise of stock options, net of early exercise liability — — 4,303,062 — — — — — 6,144 — — — 6,144 Stock-based compensation — — — — — — — — 163,723 — — — 163,723 Vested restricted stock units — — 541,076 — — — — — — — — — — Unrealized holdings gain on investment securities, available-for-sale — — — — — — — — — — (1,944) — (1,944) Preferred stock conversion (139,444,346) (447,747) — — 139,444,346 14 — — 447,733 — — — 447,747 Issuance of common stock related to exercises of legacy warrants — — — — 7,205,490 1 — — 97,781 — — — 97,782 Convertible debt conversion and other issuances — — — — 75,084,703 7 — — 16,052 — — — 16,059 Issuance of common stock in connection with 2021 Business Combination and PIPE offering — — 143,475,108 14 (49,975,104) (5) — — 666,232 — — — 666,241 Conversion from Class B Common Stock to Class A Common Stock — — 231,273,129 23 (231,273,129) (23) — — — — — — — Conversion from Class A Common Stock to Class B Common Stock — — (88,514,196) (9) 88,514,196 9 — — — — — — — Capital contribution for extinguishment of debt — — — — — — — — 126,795 — — — 126,795 Acquisition of Public and Private Placement Warrants — — — — — — — — (147,582) — — — (147,582) Issuance of common stock related to exercises of Public and Private Placement Warrants — — 9,408,264 1 — — — — 81,672 — — — 81,673 Issuance of common stock, net of stock issuance costs — — 52,173,913 5 — — — — 283,770 — — — 283,775 Treasury stock acquired — — (14,730) — — — 14,730 (147) — — — — (147) Net loss — — — — — — — — — (587,756) — — (587,756) Balance, December 31, 2021 — $ — 352,645,626 $ 34 118,206,768 $ 12 14,730 $ (147) $ 2,154,187 $ (1,616,738) $ (1,934) $ 3,903 $ 539,317 80 Convertible Preferred Stock Class A Common Stock Class B Common Stock Treasury Stock Additional paid-in capital Accumulated deficit Accumulated other comprehensive income (loss) Noncontrolling interest Total stockholders' equity (deficit) Shares Amount Shares Amount Shares Amount Shares Amount Change in accounting policy — $ — — $ — — $ — — $ — $ — $ 723 $ — $ — $ 723 Adjusted balance, beginning of period — $ — 352,645,626 $ 34 118,206,768 $ 12 $ 15 $ (147) $ 2,154,187 $ (1,616,015) $ (1,934) $ 3,903 $ 540,040 Stock issuance for exercise of stock options, net of early exercise liability — — 4,367,985 — — — — — 1,400 — — — 1,400 Stock-based compensation — — — — — — — — 164,305 — — — 164,305 Vested restricted stock units — — 2,974,581 — 1,677,873 — — — — — — — — Vested performance stock units — — 8,951 — — — — — — — — — — Unrealized holdings gain on investment securities, available for sale — — — — — — — — — — (7,440) — (7,440) Conversion from Class B Common Stock to Class A Common Stock — — 25,489,789 3 (25,489,789) (3) — — — — — — — Treasury Stock — — (2,058,022) — — — 2,058,022 (6,362) — — — — (6,362) Issuance of Common Stock under Employee Stock Purchase Plan — — 569,808 — — — — — — — — — — Activities from Seek Dissolution — — — — — — — — (735) — — — (735) Derecognition of Non-controlling interest — — — — — — — — — — — (3,903) (3,903) Net loss — — — — — — — — — (339,567) — — (339,567) Balance, December 31, 2022 — $ — 383,998,718 $ 37 94,394,852 $ 9 2,072,752 $ (6,509) $ 2,319,157 $ (1,955,582) $ (9,374) $ — $ 347,738 Change in accounting policy — $ — — $ — — $ — — $ — $ — $ 9,149 $ — $ — $ 9,149 Adjusted balance, beginning of period — $ — 383,998,718 $ 37 94,394,852 $ 9 2,073 $ (6,509) $ 2,319,157 $ (1,946,433) $ (9,374) $ — $ 356,887 Stock issuance for exercise of stock options, net of early exercise liability — — 79,189 — — — — — 1,150 — — — 1,150 Stock-based compensation — — — — — — — — 140,931 — — — 140,931 Vested restricted stock units — — 14,117,561 2 1,773,104 — — — — — — — 2 Unrealized holdings gain on investment securities, available for sale — — — — — — — — — — 7,004 — 7,004 Conversion from Class B Common Stock to Class A Common Stock — — 8,300,224 1 (8,300,224) — — — — — — — 1 Treasury Stock — — (5,839,998) — — — 5,839,998 (6,220) — — — — (6,220) Issuance of Common Stock under Employee Stock Purchase Plan — — 528,188 — — — — — — — — — — Net loss — — — — — — — — — (213,361) — — (213,361) Balance, December 31, 2023 — $ — 401,183,882 $ 40 87,867,732 $ 9 7,912,750 $ (12,729) $ 2,461,238 $ (2,159,794) $ (2,370) $ — $ 286,394 The accompanying notes are an integral part of these consolidated financial statements. 81 CLOVER HEALTH INVESTMENTS, CORP.
Added
We do this primarily by entering into contracts with our providers in which they agree to use Clover Assistant in connection with their primary care office visits in exchange for a flat fee.
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CONSOLIDATED STATEMENTS OF CASH FLOWS (Dollars in thousands) Years ended December 31, 2023 2022 2021 Cash flows from operating activities: Net loss $ (213,361) $ (339,567) $ (587,756) Adjustments to reconcile net loss to net cash used in operating activities: Depreciation and amortization expense 2,509 1,187 1,246 Amortization of notes and securities discounts and debt issuance costs — 30 13,717 Stock-based compensation expense 140,931 164,305 163,723 Change in fair value of warrants and amortization of warrants 86 (900) (66,146) Accretion, net of amortization (4,014) (1,503) 200 Net realized (gains) losses on investment securities (20) 267 53 Gain on extinguishment of note payable — (23,326) — Gain on investment 4,726 (9,217) — Impairment of goodwill and other intangible assets 15,945 — — Premium deficiency reserve (7,239) (93,517) 110,628 Changes in operating assets and liabilities: Accrued retrospective premiums (1,689) 14,536 (94) Other receivables 6,930 (8,988) (2,914) Reinsurance recoverable — — (96) Surety bonds and deposits 44,871 (89,846) (10,656) Prepaid expenses 3,728 (3,415) (6,863) Other assets 1,828 (1,204) (4,296) Healthcare receivables 6,443 (22,565) (9,297) Non-Insurance receivable 42,029 (40,785) (12,170) Operating lease right-of-use assets 643 1,984 3,591 Unpaid claims (3,557) 2,589 36,948 Accounts payable and accrued expenses 4,739 7,635 5,307 Accrued salaries and benefits (2,901) 8,784 11,169 Deferred revenue 3,099 — — Deferred rent — — 68 Other liabilities 4,502 2,468 979 Non-Insurance performance year obligation (58,276) 36,953 36,891 Non-Insurance payable (106,626) 110,418 37,773 Operating lease liabilities (1,197) (2,671) (4,331) Net cash used in operating activities (115,871) (286,348) (282,326) Cash flows from investing activities: Purchases of short-term investments, available-for-sale, and held-to-maturity securities (175,567) (369,396) (876,252) Proceeds from sales of short-term investments and available-for-sale securities 60,436 13,348 126,862 Proceeds from maturities of short-term investments, available-for-sale, and held-to-maturity securities 255,728 472,098 314,666 Acquisition of business, net of cash acquired — (16,200) — Purchases of property and equipment (584) (4,467) (723) Acquisition of Character Biosciences, Inc.
Added
Our platform, which enables differentiated patient care, supports our expansion into virtually any market, including traditionally underserved markets that are generally not viable for others because those markets often lack providers willing or able to assume financial risk for the costs of patient care. Medicare is the focal point of our opportunity.
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Series A preferred shares — (250) — Net cash provided by (used in) investing activities 140,013 95,133 (435,447) Cash flows from financing activities: Payment of notes payable principal — — (30,925) Change in restricted cash related to surety bonds, deposits, and escrow accounts (28,791) 82,422 — Issuance of common stock, net of early exercise liability 1,150 1,400 6,144 Proceeds from reverse recapitalization, net of transaction costs — — 666,241 Proceeds received for the exercise of public and private warrants — — 390 Issuance of common stock, net of stock issuance costs — — 283,775 Payment for the redemptions of public warrants — — (85) Treasury stock acquired (6,220) (6,362) (147) Net cash (used in) provided by financing activities $ (33,861) $ 77,460 $ 925,393 82 Years ended December 31, 2023 2022 2021 Net (decrease) increase in cash, cash equivalents, and restricted cash $ (9,719) $ (113,755) $ 207,620 Cash, cash equivalents, and restricted cash, beginning of period 186,213 299,968 92,348 Cash, cash equivalents, and restricted cash, end of period $ 176,494 $ 186,213 $ 299,968 Reconciliation of cash and cash equivalents and restricted cash Cash and cash equivalents $ 122,863 $ 103,791 $ 299,968 Restricted cash 53,631 82,422 — Total cash, cash equivalents, and restricted cash $ 176,494 $ 186,213 $ 299,968 Supplemental cash flow disclosures Cash paid during the period for interest $ — $ — $ 1,677 Supplemental disclosure of non-cash activities Conversion of preferred stock to common stock — — 447,747 Issuance of common stock related to convertible debt — — 16,059 Capital contribution for extinguishment of debt — — 126,795 Activities from Seek Dissolution — 735 — Issuance of common stock related to warrants exercised — — 97,782 Acquisition of public and private warrants — — 147,582 Issuance of common stock related to the exercise of public and private warrants — — 81,283 Right-of-use assets obtained in exchange for lease liabilities — 642 1,076 Recognition of equity method investments and preferred stock — 8,644 — Derecognition of noncontrolling interest — 3,903 — Conversion of Character Biosciences, Inc. convertible note to preferred stock — 250 — The accompanying notes are an integral part of these consolidated financial statements. 83 CLOVER HEALTH INVESTMENTS, CORP.
Added
Approximately 68 million people were enrolled in Medicare in 2024. That number is expected to rise, equating to approximately $1.5 trillion in total expenditures by 2030. Within Medicare, the MA market made up approximately $503 billion of annual spend in 2024 and is expected to grow to approximately $857 billion by 2030.
Removed
Notes to Audited Consolidated Financial Statements 1. Organization and Operations Clover Health Investments, Corp. (collectively with its affiliates and subsidiaries, "Clover" or the "Company") is focused on empowering physicians to identify and manage chronic diseases early.
Added
Original Medicare is expected to grow from $427 billion to $602 billion over the same period. 8 Our Technology Platform: Clover Assistant For a given patient, we aim to equip physicians utilizing Clover Assistant with synthesized sets of collated and actionable data, to identify, manage and subsequently treat disease burdens earlier.
Removed
Clover has centered its strategy on building and deploying technology through its flagship software platform, Clover Assistant, to help America's seniors receive better care at lower costs. Clover aims to provide affordable, high-quality Medicare Advantage plans, including Preferred Provider Organization ("PPO") and Health Maintenance Organization ("HMO") plans, through its regulated insurance subsidiaries.
Added
The combination of these features enables physicians to deliver a better patient experience for our beneficiaries, as physicians are able to more effectively identify clinical opportunities to treat patients using data-driven, personalized insights. Clover Assistant is a purpose-built technology platform that empowers providers to deliver intuitive data-driven, personalized care to help physicians detect, identify, and manage diseases earlier.
Removed
The Company's regulated insurance subsidiaries consist of Clover Insurance Company and Clover HMO of New Jersey Inc., which operate the Company's PPO and HMO health plans, respectively.
Added
This physician-enablement platform is designed to synthesize comprehensive, longitudinal sets of data to generate provider-focused machine learning, artificial intelligence and rules-based insights, and to drive action by surfacing the most relevant, personalized information about each patient to his or her provider.
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On April 1, 2021, the Company's subsidiary, Clover Health Partners, LLC ("Health Partners"), began participating as a Direct Contracting Entity ("DCE") in the Global and Professional Direct Contracting Model ("DC Model") of the Centers for Medicare and Medicaid Services ("CMS"), an agency of the United States Department of Health and Human Services, through which the Company provides care to aligned Medicare fee-for-service ("FFS") beneficiaries (the "Non-Insurance Beneficiaries").
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Through this democratization of data access for providers, we seek to reduce the variability in clinical decision-making, drive improved adherence to evidence-based protocols, and help providers deliver better care. Our proprietary technology platform is at the center of the Company's technology-first approach to driving better care management.
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CMS redesigned the DC Model and renamed it the Accountable Care Organization ("ACO") Realizing Equity, Access, and Community Health ("REACH") ("ACO REACH") Model effective January 1, 2023.
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The image below represents an example of the Clover Assistant interface: 9 We believe the key features that differentiate our Clover Assistant platform from other healthcare technology include the following: Enables intuitive data-driven, personalized and actionable insights Clover Assistant aggregates and structures millions of data points per day, derived from a variety of data sets, such as claims data, medical charts, medication data, diagnostic data, and data generated from electronic health records ("EHR"), across dozens of typically siloed and inconsistently formatted data feeds.
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On December 1, 2023, the Company notified CMS that it will no longer participate as a REACH ACO in the CMS ACO Reach Program, effective as of the end of the 2023 performance year.
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It connects this data with up-to-date, evidence-based protocols and patient-specific plan information to generate intuitive data-driven, personalized and actionable insights available to providers for use in their treatment and management of patient care.
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The Company’s exit from the ACO REACH Program follows its November 2022 announcement of a strategic reduction in the number of ACO REACH participating physicians in 2023, and was made after the Company determined that it is in the Company's best interest to fully exit the ACO REACH Program.
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Engages healthcare providers Since launching our platform in July 2018, we have driven provider adoption of our Clover Assistant platform through its user-centric design, highly actionable and real-time clinical content, enhanced fee for service payment model and simple onboarding. Our platform provides actionable clinical content through an intuitive interface that easily integrates into the providers' workflow.
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Medical Service Professionals of NJ, LLC, houses Clover's employed physicians and the related support staff for Clover's in-home care program. Clover's administrative functions and insurance operations are primarily operated by its Clover Health, LLC and Clover Health Labs, LLC subsidiaries.
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Offers integration into provider workflows via EHRs We have made significant investments into extending our proprietary technology platform, enabling Clover Assistant functionality to be embedded quickly and seamlessly into major EHR systems, including Epic, Cerner, Athena and others. This further improves physician workflows and reduces duplicative actions by providers and administrators.
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For any information following the aforementioned paragraph, the Company will refer to its participation in ACO REACH Model or the Company's participation in the predecessor DC Model as ACO REACH Model henceforth. Clover's approach is to combine technology, data analytics, and preventive care to lower costs and increase the quality of health and life of Medicare beneficiaries.
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We aim to make Clover Assistant available to physicians in ways that best suit them and their practices. Delivers differentiated plan performance The Clover Assistant platform is designed to enable our mission-aligned business model to drive the empowerment of providers and improve care for beneficiaries while contributing to improved margins for our MA plans.
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Clover's technology platform is designed to use machine learning-powered systems to deliver data and insights to physicians in order to improve outcomes for beneficiaries through the early identification and management of chronic disease and drive down costs.
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As a result of our provider-focused, data-driven platform, providers who have been using Clover Assistant and are treating returning members, on average, have had lower medical care ratios ("MCRs") than providers who have not used Clover Assistant and are treating returning members.
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Clover's MA plans generally provide access to a wide network of primary care providers, specialists, and hospitals, enabling its members to see any doctor participating in Medicare willing to accept them.
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Enables rapid software iteration via our closed feedback loop Our platform is highly dynamic and continues to improve as we capture more data. As an MA plan that builds our own internally-developed physician-enablement software, we believe we are differentiated in our ability to continuously build upon our broad sets of rich data, resulting in a rapid learn-iterate-deploy software improvement cycle.
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Through its Non-Insurance operations, the Company assumes full risk (i.e., 100.0% shared savings and shared losses) for the total cost of care of aligned Non-Insurance Beneficiaries, empowers providers with Clover Assistant, and offers a variety of programs aimed at reducing expenditures and preserving or enhancing the quality of care for Non-Insurance Beneficiaries.
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We capture real-time data via live provider use and feedback through Clover Assistant. This bi-directional data sharing creates a closed feedback loop, allowing us to continuously measure the results of our platform's recommendations in real-time and improve our platform. Delivers differentiated clinical care capabilities We work hard to drive better care for our lives under Clover management.
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On October 5, 2020, SCH entered into a Merger Agreement (the "Merger Agreement") with Clover Health Investments, Corp., a corporation originally incorporated on July 17, 2014, in the state of Delaware ("Legacy Clover").
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To accomplish this goal, we aim to establish with Clover Assistant a comprehensive understanding of each patient, their conditions and needs as well as how those factors change over time, so that we can provide support to their providers as they determine when appropriate interventions should be delivered.
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Pursuant to the Merger Agreement, on January 7, 2021, Asclepius Merger Sub Inc., a Delaware corporation and a newly formed, wholly-owned subsidiary of SCH ("Merger Sub"), merged with and into Legacy Clover.
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We monitor a range of data sources over time to create a comprehensive view of each patient's disease trajectory. Taking this holistic approach helps us to improve personalized chronic disease management and care coordination.
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The separate corporate existence of Merger Sub ceased, Legacy Clover survived and merged with and into SCH, with SCH as the surviving corporation, and SCH was redomesticated as a Delaware corporation and renamed Clover Health Investments, Corp. (the "2021 Business Combination").
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Clover Health has published data demonstrating the technology’s impact on Medication Adherence, as well as the earlier identification and management of Diabetes and Chronic Kidney Disease. 10 The following features of our clinical care capabilities provide significant value to providers and our beneficiaries: Providers are provided with data-driven and actionable insights for each patient For a given patient, a provider utilizing Clover Assistant may experience any of the following: • Synthesized sets of collated, actionable data.

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Item 1A. Risk Factors

Risk Factors — what could go wrong, per management

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Biggest changeOverall, there are various factors, some of which are beyond our control, that could negatively affect the market price of our Class A common stock or result in fluctuations in the price or trading volume of our Class A common stock, including the following overall performance of the equity markets and the economy as a whole; changes in the financial projections we may provide to the public or our failure to meet these projections; actual or anticipated changes in our growth rate relative to that of our competitors; changes in the anticipated future size or growth rate of our addressable markets; announcements of new products and services, technological and platform updates or enhancements, or of acquisitions, strategic partnerships, joint ventures or capital-raising activities or commitments, by us or by our competitors; disruptions to Clover Assistant or our other technology; additions or departures of board members, management or key personnel; failure of securities analysts to initiate or maintain coverage of us, changes in financial estimates by any securities analysts who follow our company or our failure to meet these estimates or the expectations of investors; rumors and market speculation involving us or other companies in our industry; research or reports that securities analysts or others publish about us or our business; new laws or regulations or new interpretations of existing laws or regulations applicable to our business, including those related to Medicare; lawsuits threatened or filed against us or investigations by governmental authorities; other events or factors, including those resulting from war, incidents of terrorism, or responses to these events; health epidemics, such as the COVID-19 pandemic, influenza, and other highly communicable diseases; and sales of shares of our Class A common stock by us or our stockholders. 49 In addition, the stock market with respect to newly public companies, particularly companies in the healthcare and technology industries, have experienced significant price and volume fluctuations that have affected and continue to affect the market prices of stock prices of these companies.
Biggest changeVolatility or declines in our trading price could make it more difficult to attract and retain talent, adversely impact employee retention and morale, and may require us to issue more equity to incentivize team members, which could dilute stockholders. 49 Overall, there are various factors, some of which are beyond our control, that could negatively affect the market price of our Class A common stock or result in fluctuations in the price or trading volume of our Class A common stock, including the following; overall performance of the equity markets and the economy as a whole; changes in the financial guidance we may provide to the public or our failure to meet this guidance; actual or anticipated changes in our growth rate relative to that of our competitors; changes in the anticipated future size or growth rate of our addressable markets; announcements of new products and services, technological and platform updates or enhancements, or of acquisitions, strategic partnerships, joint ventures or capital-raising activities or commitments, by us or by our competitors; disruptions to Clover Assistant or our other technology; additions or departures of board members, management or key personnel; failure of securities analysts to initiate or maintain coverage of us, changes in financial estimates by any securities analysts who follow our company or our failure to meet these estimates or the expectations of investors; rumors and market speculation involving us or other companies in our industry; research or reports that securities analysts or others publish about us or our business; new laws or regulations or new interpretations of existing laws or regulations applicable to our business, including those related to Medicare; lawsuits threatened or filed against us or investigations by governmental authorities; other events or factors, including those resulting from war, incidents of terrorism, or responses to these events; health epidemics, such as pandemics, influenza, and other highly communicable diseases; and sales of shares of our Class A common stock by us or our stockholders.
If we are not able to achieve or maintain profitability or positive cash flow, we will require additional financing, which may not be available on favorable terms, or at all, and which could be dilutive to our stockholders.
If we are not able to maintain profitability or achieve positive cash flow, we will require additional financing, which may not be available on favorable terms, or at all, and which could be dilutive to our stockholders.
Our ability to attract and retain members may be impacted by several factors, including, without limitation: lack of brand recognition; difficulties developing strategic co-marketing relationships; general lack of shopping for plans by MA eligible beneficiaries; shifting consumer preferences, including a preference by members to enroll with an MA plan sponsored by the insurer of the commercial plan in which they enrolled before they became eligible for Medicare, and a preference by members to enroll in various special needs plans, which we do not offer; a failure to effectively compete and offer low cost and high value plans; difficulties establishing an attractive network in new markets; regulatory changes affecting the overall pool of MA eligible beneficiaries; and difficulties growing our provider networks and contracting with providers and medical facilities on competitive terms.
Our ability to attract and retain members may be impacted by several factors, including, without limitation: lack of brand recognition for our MA plans; difficulties developing strategic co-marketing relationships; general lack of shopping for plans by MA eligible beneficiaries; shifting consumer preferences, including a preference by members to enroll with an MA plan sponsored by the insurer of the commercial plan in which they enrolled before they became eligible for Medicare, and a preference by members to enroll in various special needs plans, which we do not offer; a failure to effectively compete and offer low cost and high value plans; difficulties establishing an attractive network in new markets; regulatory changes affecting the overall pool of MA eligible beneficiaries; and difficulties growing our provider networks and contracting with providers and medical facilities on competitive terms.
We use machine learning and artificial intelligence ("AI") technologies as part of our Clover Assistant platform, and we are making investments in expanding our artificial intelligence capabilities in our products, services, and tools, including ongoing deployment and improvement of existing machine learning and AI technologies, as well as developing new product features using AI technologies, including, for example, generative AI.
We use machine learning and artificial intelligence technologies as part of our Clover Assistant platform, and we are making investments in expanding our artificial intelligence capabilities in our products, services, and tools, including ongoing deployment and improvement of existing machine learning and AI technologies, as well as developing new product features using AI technologies, including, for example, generative AI.
The preparation of financial statements in conformity with accounting principles generally accepted in the United States ("GAAP") and our key metrics require management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes and amounts reported in our key metrics.
The preparation of the consolidated financial statements in conformity with accounting principles generally accepted in the United States ("GAAP") and our key metrics require management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes and amounts reported in our key metrics.
However, we cannot ensure that these contractual measures and other safeguards will adequately protect us from the risks associated with the storage and transmission of such information on our behalf by our subcontractors.
However, we cannot ensure that these contractual measures and other safeguards will adequately protect us from the risks associated with the storage and transmission of such information by our subcontractors on our behalf.
Sales of a substantial number of shares of our Class A common stock into the public market, particularly sales by our directors, executive officers, principal stockholders and their respective affiliates, or the perception that these sales might occur, could cause the market price of our common stock to decline and may make it more difficult for our other stockholders to sell their shares of common stock at a time and price that they deem appropriate.
Sales of a substantial number of shares of our Class A common stock into the public market, particularly sales by our directors, executive officers, principal stockholders and their respective affiliates, or the perception that these sales might occur, could cause the market price of our Class A common stock to decline and may make it more difficult for our other stockholders to sell their shares of common stock at a time and price that they deem appropriate.
In addition, the government may assert that a claim including items or services resulting from a violation of the federal Anti-Kickback Statute constitutes a false or fraudulent claim for purposes of the FCA; the federal physician self-referral law, commonly referred to as the Stark Law, which, subject to limited exceptions, prohibits physicians from referring Medicare or Medicaid patients to an entity for the provision of certain "designated health services" if the physician or a member of such physician's immediate family has a direct or indirect financial relationship (including an ownership interest or a compensation arrangement) with the entity, and prohibits the entity from billing Medicare or Medicaid for such designated health services; the administrative simplification provisions of the HIPAA as amended by the Health Information Technology for Economic and Clinical Health Act ("HITECH") which impose a number of obligations on issuers of health insurance coverage and health benefit plan sponsors with respect to the privacy and security of health information and data standards regulation; the criminal healthcare fraud provisions of HIPAA and related rules that prohibit knowingly and willfully executing a scheme or artifice to defraud any healthcare benefit program or falsifying, concealing or covering up a material fact or making any material false, fictitious or fraudulent statement in connection with the delivery of or payment for healthcare benefits, items or services.
In addition, the government may assert that a claim including items or services resulting from a violation of the federal Anti-Kickback Statute constitutes a false or fraudulent claim for purposes of the FCA; the federal physician self-referral law, commonly referred to as the Stark Law, which, subject to limited exceptions, prohibits physicians from referring Medicare or Medicaid patients to an entity for the provision of certain "designated health services" if the physician or a member of such physician's immediate family has a direct or indirect financial relationship (including an ownership interest or a compensation arrangement) with the entity, and prohibits the entity from billing Medicare or Medicaid for such designated health services; the administrative simplification provisions of the HIPAA as amended by the Health Information Technology for Economic and Clinical Health Act of 2009 ("HITECH") which impose a number of obligations on issuers of health insurance coverage and health benefit plan sponsors with respect to the privacy and security of health information and data standards regulation; the criminal healthcare fraud provisions of HIPAA and related rules that prohibit knowingly and willfully executing a scheme or artifice to defraud any healthcare benefit program or falsifying, concealing or covering up a material fact or making any material false, fictitious or fraudulent statement in connection with the delivery of or payment for healthcare benefits, items or services.
Any actions or publications by stockholder advisory firms or institutional investors critical of our corporate governance practices or capital structure could also adversely affect the value of our Class A common stock. Our ability to use our net operating losses to offset future taxable income may be subject to certain limitations. In general, under Section 382 of the U.S.
Any actions or publications by stockholder advisory firms or institutional investors critical of our corporate governance practices or capital structure could also adversely affect the value of our Class A common stock. 52 Our ability to use our net operating losses to offset future taxable income may be subject to certain limitations. In general, under Section 382 of the U.S.
Suits filed under the FCA, known as qui tam actions, can be brought by any individual on behalf of the government and such individuals, commonly known as "whistleblowers," may share in any amounts paid by the entity to the government in fines or settlement; state insurance holding company laws and regulations pertaining to licensing and plan solvency requirements; reassignment of payment rules that prohibit certain types of billing and collection practices in connection with claims payable by the Medicare or Medicaid programs; similar state law provisions pertaining to anti-kickback, self-referral, and false claims issues, some of which may apply to items or services reimbursed by any third-party payer; state laws that prohibit general business corporations, such as us, from engaging in the corporate practice of medicine, controlling physicians' medical decisions or engaging in some practices such as splitting fees with physicians; the provision of the Affordable Care Act that requires MA plans to spend at least 85% of premium dollars on medical care; federal and state laws that govern our relationships with pharmaceutical manufacturers, wholesalers, pharmacies, beneficiaries, and consumers; federal and state legislative proposals and/or regulatory activity that could adversely affect pharmacy benefit industry practices, including the management and breadth of provider networks; the regulation of the development and use of drug formularies and/or maximum allowable cost list pricing; and regulations or regulatory activity increasing the regulation of prescription drug pricing, imposing additional rights to access to drugs for individuals enrolled in healthcare benefit plans or reducing the cost of such drugs to those individuals, imposing requirements relating to the receipt or required disclosure of rebates from pharmaceutical manufacturers, and restricting the use of average wholesale prices; laws that regulate debt collection practices; a provision of the Social Security Act that imposes civil and criminal penalties on healthcare providers who fail to disclose or refund known overpayments; and federal and state laws that prohibit providers from billing and receiving payment from Medicare and Medicaid for services unless the services are medically necessary, adequately and accurately documented, and billed using codes that accurately reflect the type and level of services rendered; federal and state laws and policies that require healthcare providers to maintain licensure, certification or accreditation to enroll and participate in the Medicare and Medicaid programs, and to report certain changes in their operations to the agencies that administer these programs; federal and state laws governing the ways in which we communicate with beneficiaries and market our services, including the Telephone Consumer Protection Act, the Controlling the Assault of Non-Solicited Pornography, and the Marketing Act; with respect to our non-U.S. operations, we are subject to regulation in the jurisdictions in which those operations are organized or in which we conduct business as well as U.S. laws that regulate the conduct and activities of U.S. based businesses operating abroad, such as the export controls laws or the FCPA.
Suits filed under the FCA, known as qui tam actions, can be brought by any individual on behalf of the government and such individuals, commonly known as "whistleblowers," may share in any amounts paid by the entity to the government in fines or settlement; state insurance holding company laws and regulations pertaining to licensing and plan solvency requirements; 43 reassignment of payment rules that prohibit certain types of billing and collection practices in connection with claims payable by the Medicare or Medicaid programs; similar state law provisions pertaining to anti-kickback, self-referral, and false claims issues, some of which may apply to items or services reimbursed by any third-party payer; state laws that prohibit general business corporations, such as us, from engaging in the corporate practice of medicine, controlling physicians' medical decisions or engaging in some practices such as splitting fees with physicians; the provision of the ACA that requires MA plans to spend at least 85% of premium dollars on medical care; federal and state laws that govern our relationships with pharmaceutical manufacturers, wholesalers, pharmacies, members, and consumers; federal and state legislative proposals and/or regulatory activity that could adversely affect pharmacy benefit industry practices, including the management and breadth of provider networks; the regulation of the development and use of drug formularies and/or maximum allowable cost list pricing; and regulations or regulatory activity increasing the regulation of prescription drug pricing, imposing additional rights to access to drugs for individuals enrolled in healthcare benefit plans or reducing the cost of such drugs to those individuals, imposing requirements relating to the receipt or required disclosure of rebates from pharmaceutical manufacturers, and restricting the use of average wholesale prices; laws that regulate debt collection practices; a provision of the Social Security Act that imposes civil and criminal penalties on healthcare providers who fail to disclose or refund known overpayments; and federal and state laws that prohibit providers from billing and receiving payment from Medicare and Medicaid for services unless the services are medically necessary, adequately and accurately documented, and billed using codes that accurately reflect the type and level of services rendered; federal and state laws and policies that require healthcare providers to maintain licensure, certification or accreditation to enroll and participate in the Medicare and Medicaid programs, and to report certain changes in their operations to the agencies that administer these programs; federal and state laws governing the ways in which we communicate with members and market our services, including the Telephone Consumer Protection Act, the Controlling the Assault of Non-Solicited Pornography, and Marketing Act; with respect to our non-U.S. operations, we are subject to regulation in the jurisdictions in which those operations are organized or in which we conduct business as well as U.S. laws that regulate the conduct and activities of U.S. based businesses operating abroad, such as the export controls laws or the FCPA.
If we fail to drive adoption of Clover Assistant by our Providers or fail to accurately identify beneficiaries at high risk for near-term hospitalization for our complex care management program, we could fail to drive significant reductions in MCR for our members, which would have a material and adverse effect on our business, financial condition, and results of operation.
If we fail to drive adoption of Clover Assistant by our Providers or fail to accurately identify members at high risk for near-term hospitalization for our complex care management program, we could fail to drive significant reductions in MCR for our members, which would have a material and adverse effect on our business, financial condition, and results of operation.
Business models for market participants involved in the financing and supply of pharmaceutical products rely on certain benchmarks and 22 practices (e.g., pricing based on Average Wholesale Price, or the use of Maximum Allowable Cost lists). It is uncertain how these business models will evolve and whether other pricing benchmarks will be introduced and widely adopted.
Business models for market participants involved in the financing and supply of pharmaceutical products rely on certain benchmarks and practices (e.g., pricing based on Average Wholesale Price, or the use of Maximum Allowable Cost lists). It is uncertain how these business models will evolve and whether other pricing benchmarks will be introduced and widely adopted.
Food and Drug Administration (the "FDA"); and 43 Because of the breadth of these laws and the narrowness of the statutory exceptions and safe harbors available, it is possible that some of our business activities could be subject to scrutiny or challenge under one or more of such laws. Achieving and sustaining compliance with these laws may also prove costly.
Food and Drug Administration (the "FDA"); Because of the breadth of these laws and the narrowness of the statutory exceptions and safe harbors available, it is possible that some of our business activities could be subject to scrutiny or challenge under one or more of such laws. Achieving and sustaining compliance with these laws may also prove costly.
If our trademarks are successfully challenged, we could be forced to rebrand our platform, which would result in loss of brand recognition and would require us to devote resources to advertising and marketing new brands. 47 We could incur substantial costs as a result of any claim of infringement of another party's intellectual property rights.
If our trademarks are successfully challenged, we could be forced to rebrand our platform, which would result in loss of brand recognition and would require us to devote resources to advertising and marketing new brands. We could incur substantial costs as a result of any claim of infringement of another party's intellectual property rights.
Changes in laws, regulations, and guidelines governing health insurance may also be incompatible with various aspects of our business and require that we make significant modifications to our existing technology or practices. This may be costly and time-consuming to implement and could also harm our business, operating results, and financial condition.
Proposed changes in laws, regulations, and guidelines governing health insurance may also be incompatible with various aspects of our business and require that we make significant modifications to our existing technology or practices. This may be costly and time-consuming to implement and could also harm our business, operating results, and financial condition.
These requirements may also inhibit our ability to acquire an insurance company should we wish to do so in the future. Certain provisions in our corporate charter documents and under Delaware law may prevent or hinder attempts by our stockholders to change our management or to acquire a controlling interest in us.
These requirements may also inhibit our ability to acquire an insurance company should we wish to do so in the future. 54 Certain provisions in our corporate charter documents and under Delaware law may prevent or hinder attempts by our stockholders to change our management or to acquire a controlling interest in us.
If we do not comply with existing or new laws and regulations related to PHI, we could be subject to criminal or civil sanctions. 45 Because of the extreme sensitivity of the personal information, including PHI, that we store and transmit, the security features of our technology platform are very important.
If we do not comply with existing or new laws and regulations related to PHI, we could be subject to criminal or civil sanctions. Because of the extreme sensitivity of personal information, including PHI, that we store and transmit, the security features of our technology platform are very important.
Because some patent applications may not be public for a period of time, there is also a risk that we could adopt a technology without knowledge of a pending patent application; that technology would infringe a third-party patent once that patent is issued. We also rely on unpatented internally-developed technology.
Because some patent applications may not be public for a period of time, there is also a risk that we could adopt a technology without knowledge of a pending patent application; that technology would infringe a third-party patent once that patent is issued. 47 We also rely on unpatented internally-developed technology.
The U.S. federal government and other governments may reduce funding for health care or other programs or make changes that adversely affect the number of persons eligible for certain programs, the services provided to enrollees in such programs and premiums we can charge.
In addition, the U.S. federal government and other governments may reduce funding for health care or other programs or make changes that adversely affect the number of persons eligible for certain programs, the services provided to enrollees in such programs and premiums we can charge.
In any case, our available funds could be materially reduced, which could harm our ability to implement our business strategies. 44 Our use and disclosure of personally identifiable information, including health information, is subject to federal and state privacy and security regulations.
In any case, our available funds could be materially reduced, which could harm our ability to implement our business strategies. Our use and disclosure of personally identifiable information, including health information, is subject to federal and state privacy and security regulations.
Breaches of our security measures or those of our third-party service providers or other cyber security incidents could result in unauthorized access to our sites, networks, systems, and accounts; unauthorized access to, and misappropriation of, individuals' personal identifying information, personal health information, or other confidential or proprietary information of ourselves, our beneficiaries, or other third parties; viruses, worms, spyware, or other malware being served from our platform, networks, or systems; deletion or modification of content or the display of unauthorized content on our platform; the loss of access to critical data or systems through ransomware, destructive attacks or other means; and business delays, service or system disruptions or denials of service.
Breaches of our security measures or those of our third-party service providers or other cyber security incidents could result in unauthorized access to our sites, networks, systems, and accounts; unauthorized access to, and misappropriation of, individuals' personal identifying information, personal health information, or other confidential or proprietary information of ourselves, our members, or other third parties; viruses, worms, spyware, or other malware being served from our platform, networks, or systems; deletion or modification of content or the display of unauthorized content on our platform; the loss of access to critical data or systems through ransomware, destructive attacks or other means; and business delays, service or system disruptions or denials of service.
If we are unable to continue to grow and enhance our product and service offerings to our provider users and beneficiaries, develop and deliver innovative and potentially disruptive products and services to satisfy evolving market demands, or develop and recruit qualified physicians and other provider specialists, we may not remain competitive, and we risk inability to maintain or increase our Lives under Clover Management, lack of adoption of our products and services by beneficiaries and provider users, and loss of current market share to existing competitors and disruptive new market entrants.
If we are unable to continue to grow and enhance our product and service offerings to our provider users and members, develop and deliver innovative and potentially disruptive products and services to satisfy evolving market demands, or develop and recruit qualified physicians and other provider specialists, we may not remain competitive, and we risk inability to maintain or increase our lives under Clover management, lack of adoption of our products and services by members and provider users, and loss of current market share to existing competitors and disruptive new market entrants.
Any of these factors could have a material adverse effect on our business, financial condition, and results of operations. We may be unable to effectively manage our growth, which could have a material adverse effect on our business, financial condition, and results of operation.
Any of these factors could have a material adverse effect on our business, financial condition, and results of operations. We may be unable to effectively manage our growth, which could have a material adverse effect on our business, financial condition, and results of operations.
In addition to the financial impact of having fewer beneficiaries than we anticipated, if we do not grow our Lives under Clover Management, we could find it difficult to retain or increase our contracted providers at favorable rates, which could jeopardize both our ability to provide plans in our current markets or expand into new markets and also our ability to do so in a cost-efficient manner.
In addition to the financial impact of having fewer members than we anticipated, if we do not grow our lives under Clover management, we could find it difficult to retain or increase our contracted providers at favorable rates, which could jeopardize both our ability to provide plans in our current markets or expand into new markets and also our ability to do so in a cost-efficient manner.
If an unexpected reduction in payments, inadequate government funding, significantly delayed payments for Medicare programs or similar events were to occur, our business, results of operations, and financial condition could be adversely affected. Our business also depends upon the public and private sector of the U.S. insurance system, which is subject to a changing regulatory environment.
If an unexpected reduction in payments, inadequate government funding, significantly delayed payments for Medicare programs or similar events were to occur, our business, results of operations, and financial condition could be materially and adversely affected. 41 Our business also depends upon the public and private sector of the U.S. insurance system, which is subject to a changing regulatory environment.
Through our HMO subsidiary, we employ providers and other clinical staff to provide medical services to medically complex beneficiaries enrolled in our in-home primary care program, which does not charge any additional fees for the services provided. We believe our health services operations comply with applicable state law regarding the corporate practice of medicine and fee-splitting and similar issues.
Through our HMO subsidiary, we employ providers and other clinical staff to provide medical services to medically complex members enrolled in our in-home primary care program, which does not charge any additional fees for the services provided. We believe our health services operations comply with applicable state law regarding the corporate practice of medicine and fee-splitting and similar issues.
Such organizations or provider groups may compete directly with us, which could adversely affect our growth. The failure to maintain or to secure new cost-effective provider contracts may make it more difficult to increase adoption of Clover Assistant by providers as well as lead to higher costs, healthcare provider network disruptions and less attractive options for our beneficiaries.
Such organizations or provider groups may compete directly with us, which could adversely affect our growth. The failure to maintain or to secure new cost-effective provider contracts may make it more difficult to increase adoption of Clover Assistant by providers as well as lead to higher costs, healthcare provider network disruptions and less attractive options for our members.
As such, we believe that quarter-to-quarter and year-to-year comparisons of our operating results may not be meaningful and should not be relied upon as an indication of our future performance. 31 Market, regulatory and political conditions, including global economic conditions, rates of inflation and political developments in the United States and abroad, may have adverse consequences on our business, financial condition and share price.
As such, we believe that quarter-to-quarter and year-to-year comparisons of our operating results may not be meaningful and should not be relied upon as an indication of our future performance. 33 Market, regulatory and political conditions, including global economic conditions, rates of inflation and political developments in the United States and abroad, may have adverse consequences on our business, financial condition and share price.
Any such errors, failures, vulnerabilities, or bugs may not be found until after new features, integrations, or capabilities have been released. 29 Furthermore, we will need to ensure that our platform can scale to meet the evolving needs of users, particularly as we expand our business and provider user base.
Any such errors, failures, vulnerabilities, or bugs may not be found until after new features, integrations, or capabilities have been released. 31 Furthermore, we will need to ensure that our platform can scale to meet the evolving needs of users, particularly as we expand our business and provider user base.
See "— We may require additional capital to support business growth, and this capital might not be available on acceptable terms, or at all." If we are unable to successfully address these risks and challenges as we encounter them, our business may be harmed, which could negatively affect the value of our common stock.
See the section entitled "— We may require additional capital to support business growth, and this capital might not be available on acceptable terms, or at all." If we are unable to successfully address these risks and challenges as we encounter them, our business may be harmed, which could negatively affect the value of our common stock.
New competitors or alliances may emerge that have greater market share, a larger beneficiary base, a stronger and larger provider network, more widely adopted proprietary technologies, greater ability to care for their beneficiaries, greater marketing expertise, or greater financial resources and larger sales forces than we have, which could put us at a competitive disadvantage.
New competitors or alliances may emerge that have greater market share, a larger member base, a stronger and larger provider network, more widely adopted proprietary technologies, greater ability to care for their beneficiaries, greater marketing expertise, or greater financial resources and larger sales forces than we have, which could put us at a competitive disadvantage.
Any of these events could have a material adverse effect on our business, brand, reputation, and results of operations. Furthermore, certain legislative authorities have in recent years discussed or proposed legislation that would restrict outsourcing of certain services. In addition, we may be held accountable for any failure of performance by our vendors.
Any of these events could have a material adverse effect on our business, brands, reputation, and results of operations. Furthermore, certain legislative authorities have in recent years discussed or proposed legislation that would restrict outsourcing of certain services. In addition, we may be held accountable for any failure of performance by our vendors.
The market for healthcare in the United States is in the early stages of structural change and is rapidly evolving toward a more value-based care model. Our success depends on our ability to keep pace with technological developments, satisfy increasingly sophisticated beneficiary and provider user requirements, and sustain and grow market acceptance.
The market for healthcare in the United States is in the early stages of structural change and is rapidly evolving toward a more value-based care model. Our success depends on our ability to keep pace with technological developments, satisfy increasingly sophisticated member and provider user requirements, and sustain and grow market acceptance.
Our competitors may develop products and services that may appeal more to our beneficiaries and/or providers. As a result, we must continue to invest significant resources in research and development in order to enhance our existing platform and introduce new high-quality products and features that our beneficiaries and providers will want, while offering our MA plans at competitive prices.
Our competitors may develop products and services that may appeal more to our members and/or providers. As a result, we must continue to invest significant resources in research and development in order to enhance our existing platform and introduce new high-quality products and features that our members and providers will want, while offering our MA plans at competitive prices.
Regardless of whether the other states in which we operate adopt risk-based capital requirements, the state departments of insurance can require our regulated insurance subsidiaries to maintain minimum levels of statutory capital in excess of amounts required under the applicable state laws if they determine that maintaining additional statutory capital is in the best interests of our beneficiaries.
Regardless of whether the other states in which we operate adopt risk-based capital requirements, the state departments of insurance can require our regulated insurance subsidiaries to maintain minimum levels of statutory capital in excess of amounts required under the applicable state laws if they determine that maintaining additional statutory capital is in the best interests of our members.
Additionally, multiple claims against us could render it difficult or costly to obtain insurance for our affiliated professional entities, which could negatively impact our ability to staff our clinical programs and other operations. 32 Our international operations pose certain risks to our business that may be different from risks associated with our domestic operations.
Additionally, multiple claims against us could render it difficult or costly to obtain insurance for our affiliated professional entities, which could negatively impact our ability to staff our clinical programs and other operations. 34 Our international operations pose certain risks to our business that may be different from risks associated with our domestic operations.
If we do complete acquisitions, we may not ultimately strengthen our competitive position or achieve the goals of such acquisition, and any acquisitions we complete could be viewed negatively by providers, beneficiaries, or investors. We may encounter difficult or unforeseen expenditures in integrating an acquisition, particularly if we cannot retain the key personnel of the acquired company.
If we do complete acquisitions, we may not ultimately strengthen our competitive position or achieve the goals of such acquisition, and any acquisitions we complete could be viewed negatively by providers, members, or investors. We may encounter difficult or unforeseen expenditures in integrating an acquisition, particularly if we cannot retain the key personnel of the acquired company.
As a result, Medicare Advantage and Part D plans that achieve higher Star Ratings may have a competitive advantage over plans with lower Star Ratings. 41 The Star Ratings system considers various measures adopted by CMS, including, among others, quality of care, preventative services, chronic illness management and member satisfaction.
As a result, Medicare Advantage and Part D plans that achieve higher Star Ratings may have a competitive advantage over plans with lower Star Ratings. 42 The Star Ratings system considers various measures adopted by CMS, including, among others, quality of care, preventative services, chronic illness management and member satisfaction.
Thus, our future performance is heavily dependent on our ability to utilize Clover Assistant to drive down the medical care ratios for our beneficiaries. By doing so, we aim to drive per member per month ("PMPM") medical expense savings and generate more accurate risk adjustment data over time.
Thus, our future performance is heavily dependent on our ability to utilize Clover Assistant to drive down the medical care ratios for our members. By doing so, we aim to drive per member per month ("PMPM") medical expense savings and generate more accurate risk adjustment data over time.
Failure to maintain satisfactory quality and performance measures may negatively affect our premium rates, subject us to penalties, limit or reduce our number of beneficiaries, impede our ability to compete for new business in existing or new markets or result in the termination of our contracts, or affect our ability to establish new health plans or expand current health plans.
Failure to maintain satisfactory quality and performance measures may negatively affect our premium rates, subject us to penalties, limit or reduce our number of members, impede our ability to compete for new business in existing or new markets or result in the termination of our contracts, or affect our ability to establish new health plans or expand current health plans.
As we rely in part on brand names and trademark protection to enforce our intellectual property rights, efforts by third parties to limit use of our brand names or trademarks and barriers to the registration of brand names and trademarks in various countries may restrict our ability to promote and maintain a cohesive brand throughout our key markets.
As we rely in part on brand names and trademark protection to enforce our intellectual property rights, efforts by third parties to limit use of our brand names or trademarks and barriers to the registration of brand names and trademarks in various countries may restrict our ability to promote and maintain cohesive brands throughout our key markets.
Any one of these competitive pressures in our market, or our failure to compete effectively, may result in fewer plans being offered; a reduction in plan benefits; reduced services; a loss of existing beneficiaries or inability to grow our number of beneficiaries; fewer provider users; reduced revenues; lower gross margins; and loss of market share.
Any one of these competitive pressures in our market, or our failure to compete effectively, may result in fewer plans being offered; a reduction in plan benefits; reduced services; a loss of existing members or inability to grow our number of members; fewer provider users; reduced revenues; lower gross margins; and loss of market share.
Our market opportunity is also based on the assumption that our existing and future offerings will be more attractive to our beneficiaries and providers and potential beneficiaries and providers than competing MA plans. If these assumptions prove inaccurate, our business, financial condition, and results of operations could be adversely affected.
Our market opportunity is also based on the assumption that our existing and future offerings will be more attractive to our members and providers and potential members and providers than competing MA plans. If these assumptions prove inaccurate, our business, financial condition, and results of operations could be adversely affected.
Furthermore, our higher concentration of minority members and members residing in socioeconomically disadvantaged neighborhoods generally may make it more difficult for us to achieve and maintain high Star Ratings as compared to our competitors, given the well-documented health disparities among different minority and socioeconomic groups.
For example, our higher concentration of minority members and members residing in socioeconomically disadvantaged neighborhoods generally may make it more difficult for us to achieve and maintain high Star Ratings as compared to our competitors, given the well-documented health disparities among different minority and socioeconomic groups.
If Clover Assistant is not adopted as quickly as we anticipate in the markets in which we operate, we may be unable to collect and provide valuable actionable data to providers treating our beneficiaries in such markets, which could prevent us from driving significant reductions in MCR for our beneficiaries in such markets.
If Clover Assistant is not adopted as quickly as we anticipate in the markets in which we operate, we may be unable to collect and provide valuable actionable data to providers treating our members in such markets, which could prevent us from driving significant reductions in MCR for our members in such markets.
We depend on third parties for certain of our customer service operations. If we or our vendors fail to provide service that meets our beneficiaries' expectations, we may have difficulty retaining our Lives under Clover Management, which could adversely affect our business, financial condition, and results of operations.
We depend on third parties for certain of our customer service operations. If we or our vendors fail to provide service that meets our members' expectations, we may have difficulty retaining our lives under Clover management, which could adversely affect our business, financial condition, and results of operations.
As a result, our costs may increase, we would not realize the anticipated benefits of our agreements for PBM services, we could become overly dependent on such agreements, which could cause us to lose core competencies and we may not be able to meet the full demands of our beneficiaries.
As a result, our costs may increase, we would not realize the anticipated benefits of our agreements for PBM services, we could become overly dependent on such agreements, which could cause us to lose core competencies and we may not be able to meet the full demands of our members.
Any failure or perceived failure by us to maintain posted privacy policies that are accurate, comprehensive and fully implemented, and any violation or perceived violation of our privacy-, data protection-, or information security obligations to providers, beneficiaries, or other third parties could result in claims of deceptive practices brought against us.
Any failure or perceived failure by us to maintain posted privacy policies that are accurate, comprehensive and fully implemented, and any violation or perceived violation of our privacy-, data protection-, or information security obligations to providers, members, or other third parties could result in claims of deceptive practices brought against us.
Accordingly, healthcare providers may not utilize Clover Assistant until there is enough evidence to convince them to alter their current approach or until the number of Clover beneficiaries that they see expands to a point where they feel it is necessary to do so.
Accordingly, healthcare providers may not utilize Clover Assistant until there is enough evidence to convince them to alter their current approach or until the number of Clover members that they see expands to a point where they feel it is necessary to do so.
Our failure to successfully manage our international operations and the associated risks effectively could limit the future growth of our business. 33 We conduct business in various jurisdictions and we are subject to significant expenses and risks related to compliance with state licensure requirements, which could impact our business and results of operations.
Our failure to successfully manage our international operations and the associated risks effectively could limit the future growth of our business. 35 We conduct business in various jurisdictions and we are subject to significant expenses and risks related to compliance with state licensure requirements, which could impact our business and results of operations.
If we issue a significant amount of equity securities in connection with future acquisitions, existing stockholders' ownership would be diluted. 37 If our estimates or judgments relating to our critical accounting policies prove to be incorrect, our results of operations could be adversely affected.
If we issue a significant amount of equity securities in connection with future acquisitions, existing stockholders' ownership would be diluted. 39 If our estimates or judgments relating to our critical accounting policies prove to be incorrect, our results of operations could be adversely affected.
Fraud, waste, and abuse prohibitions encompass a wide range of activities, including kickbacks for referral of beneficiaries or federally reimbursable healthcare products or services, fraudulent coding practices, billing for unnecessary medical and/or other covered services, improper marketing and violations of patient privacy rights.
Fraud, waste, and abuse prohibitions encompass a wide range of activities, including kickbacks for referral of members or federally reimbursable healthcare products or services, fraudulent coding practices, billing for unnecessary medical and/or other covered services, improper marketing and violations of patient privacy rights.
Our business activities are highly regulated, and new and proposed government regulation or legislative reforms could increase our cost of doing business and reduce our number of beneficiaries, profitability, and liquidity. The healthcare industry is heavily regulated and closely scrutinized by federal, state and local governments.
Our business activities are highly regulated, and new and proposed government regulation or legislative reforms could increase our cost of doing business and reduce our number of members, profitability, and liquidity. The healthcare industry is heavily regulated and closely scrutinized by federal, state and local governments.
Our results of operations have in the past and could in the future vary significantly from quarter-to-quarter and year-to-year and may fail to match our past performance, our projections, or the expectations of securities analysts because of a variety of factors, many of which are outside of our control.
Our results of operations have in the past and could in the future vary significantly from quarter-to-quarter and year-to-year and may fail to match our past performance or the expectations of investors and securities analysts because of a variety of factors, many of which are outside of our control.
See the section entitled "— Our business activities are highly regulated, and new and proposed government regulation or legislative reforms could increase our cost of doing business and reduce our number of beneficiaries, profitability, and liquidity." Litigation and audits, investigations or reviews by governmental authorities or regulators may result in substantial costs and may divert management's attention and resources, which may substantially harm our business, financial condition, and results of operations.
See the section entitled "— Our business activities are highly regulated, and new and proposed government regulation or legislative reforms could increase our cost of doing business and reduce our number of members, profitability, and liquidity." 40 Litigation and audits, investigations or reviews by governmental authorities or regulators may result in substantial costs and may divert management's attention and resources, which may substantially harm our business, financial condition, and results of operations.
Of particular importance are: the U.S. federal Anti-Kickback Statute, which prohibits the knowing and willful offer, payment, solicitation or receipt of any bribe, kickback, rebate or other remuneration for referring an individual, in return for ordering, leasing, purchasing or recommending or arranging for or to induce the referral of an individual or the ordering, purchasing or leasing of items or services covered, in whole or in part, by any federal healthcare program, such as Medicare and Medicaid.
Regulations of particular importance include: the U.S. federal Anti-Kickback Statute, which prohibits the knowing and willful offer, payment, solicitation or receipt of any bribe, kickback, rebate or other remuneration for referring an individual, in return for ordering, leasing, purchasing or recommending or arranging for or to induce the referral of an individual or the ordering, purchasing or leasing of items or services covered, in whole or in part, by any federal healthcare program, such as Medicare and Medicaid.
While we believe that our risk adjustment data collection efforts and relationships with providers, including those related to Clover Assistant, comply with applicable laws, we are and may be subject to audits, reviews and investigation of our practices and arrangements, and the federal government might conclude that they violate the FCA, the Anti-Kickback Statute and/or other federal and state laws governing fraud and abuse.
While we believe that our risk adjustment data collection efforts and relationships with providers, including those related to Clover Assistant, comply with applicable laws, we and our Counterpart Health customers are and may be subject to audits, reviews and investigation of our practices and arrangements, and the federal government might conclude that they violate the FCA, the Anti-Kickback Statute and/or other federal and state laws governing fraud and abuse.
Risks Related to Our Intellectual Property Failure to protect or enforce our intellectual property rights could impair our ability to protect our internally-developed technology and our brand, and our business may be adversely affected. Our success is dependent, in part, upon protecting our intellectual property rights, internally-developed technology, and other proprietary information.
Risks Related to Our Intellectual Property Failure to protect or enforce our intellectual property rights could impair our ability to protect our internally-developed technology and our brands, and our business may be adversely affected. Our success is dependent, in part, upon protecting our intellectual property rights, internally-developed technology, and other proprietary information.
Our future financial performance will depend in part on our growth in this market and on our ability to adapt to emerging market demands, including adapting to the ways our beneficiaries access and use our MA plans and clinical care programs, and the ways our providers use Clover Assistant.
Our future financial performance will depend in part on our growth in this market and on our ability to adapt to emerging market demands, including adapting to the ways our members access and use our MA plans and clinical care programs, and the ways our providers use Clover Assistant.
Compliance with applicable U.S. and foreign laws and regulations, such as import and export requirements, anti-corruption laws, tax laws, foreign exchange controls, data privacy and data localization requirements, labor laws, and anti-competition regulations, increases the costs of doing business in foreign jurisdictions.
Compliance with applicable U.S. and foreign laws and regulations, such as import and export requirements, anti-corruption laws, tax laws, foreign exchange controls, data privacy and data localization and data transfer restriction requirements, labor laws, and anti-competition regulations, increases the costs of doing business in foreign jurisdictions.
Any other changes in these requirements could materially increase our statutory capital requirements. In addition, as we continue to expand our plan offerings in new states, add new beneficiaries, or pursue new business opportunities, we may be required to maintain additional statutory capital.
Any other changes in these requirements could materially increase our statutory capital requirements. In addition, as we continue to expand our plan offerings in new states, add new members, or pursue new business opportunities, we may be required to maintain additional statutory capital.
Internal Revenue Code of 1986, as amended, or the Code, a corporation that undergoes an "ownership change" is subject to limitations on its ability to utilize its pre-change net operating losses, or NOLs, to offset future taxable income.
Internal Revenue Code of 1986, as amended, or the Code, a corporation that undergoes an "ownership change" is subject to limitations on its ability to utilize its pre-change net operating losses, or ("NOL"), to offset future taxable income.
If our professional employees fail to maintain their required licenses or comply with state licensing laws related to the practice of medicine or provision of other healthcare services, it could disrupt the provision of in-home care services and/or result in negative publicity and loss of confidence in our services which could damage our brand, and our business, results of operations, and financial condition could be negatively impacted. 34 We rely on third-party providers for computing infrastructure, network connectivity, and other technology-related services needed to deliver our technology platform and products.
If our professional employees fail to maintain their required licenses or comply with state licensing laws related to the practice of medicine or provision of other healthcare services, it could disrupt the provision of in-home care services and/or result in negative publicity and loss of confidence in our services which could damage our brands, and our business, results of operations, and financial condition could be negatively impacted. 36 We rely on third-party providers for computing infrastructure, network connectivity, and other technology-related services needed to deliver our technology platform and products.
Furthermore, the Federal Trade Commission and many state attorneys general continue to enforce federal and state consumer protection laws against companies for online collection, use, dissemination, and security practices that appear to be unfair or deceptive.
Furthermore, the Federal Trade Commission and many state attorneys general continue to enforce federal and state consumer protection laws against companies for online data collection, use, dissemination, and security and privacy practices that appear to be unfair or deceptive.
A vulnerability in such service providers’ software or systems, a failure in their safeguards, policies or procedures, or a cyber-attack or other data security incident affecting any of these third parties result in harm our business.
A vulnerability in such service providers’ software or systems, a failure in their safeguards, policies or procedures, or a cyber-attack or other data security incident affecting any of these third parties would result in harm to our business.
Even if the allegations in any regulatory or other action against us are proven false, any surrounding negative publicity could harm consumer, marketing partner or carrier confidence in us, which could significantly damage our brand.
Even if the allegations in any regulatory or other action against us are proven false, any surrounding negative publicity could harm consumer, marketing partner or carrier confidence in us, which could significantly damage our brands.
Our business relies on the availability of our platform and products for our beneficiaries and provider users, and we may lose beneficiaries and provider users if they are not able to access our platform or encounter difficulties in doing so.
Our business relies on the availability of our platform and products for our members and provider users, and we may lose members and provider users if they are not able to access our platform or encounter difficulties in doing so.
We have entered into agreements with our PBM services suppliers to provide us and certain of our beneficiaries with certain PBM services, such as claims processing, mail pharmacy services, specialty pharmacy services, retail network pharmacy network services, participating pharmacy audit services, reporting, and formulary services.
We have entered into agreements with our PBM services suppliers to provide us and certain of our members with certain PBM services, such as claims processing, mail pharmacy services, specialty pharmacy services, retail network pharmacy network services, participating pharmacy audit services, reporting, and formulary services.
If the services become unavailable or are not adequately performed, our operations and business strategies could be significantly disrupted which could have a material adverse effect on our business, brand, reputation, and results of operations.
If the services become unavailable or are not adequately performed, our operations and business strategies could be significantly disrupted which could have a material adverse effect on our business, brands, reputation, and results of operations.
Comprehensive statutes and regulations govern the manner in which we are compensated for providing coverage for our members and Non-Insurance Beneficiaries, our contractual relationships with our providers, vendors and beneficiaries, our marketing activities and other aspects of our operations.
Comprehensive statutes and regulations govern the manner in which we are compensated for providing coverage for our members, our contractual relationships with our providers, vendors and beneficiaries, our marketing activities and other aspects of our operations.
This will require us to invest in and commit significant financial, operational, and management resources to grow and change in these areas which may disrupt our operations and performance and adversely affect our business, financial condition, and results of operation. 25 We operate in a competitive industry, and if we are not able to compete effectively, our business, financial condition, and results of operations will be harmed.
This will require us to invest in and commit significant financial, operational, and management resources to grow and change in these areas which may disrupt our operations and performance and adversely affect our business, financial condition, and results of operations. 27 We operate in a competitive industry, and if we are not able to compete effectively, our business, financial condition, and results of operations will be harmed.
Any such volatility and disruptions, or a general sustained economic downturn or other developments, may have adverse consequences on us or on our third party relationships (including relationships with vendors and health care providers).
Any such volatility or disruption, or a general sustained economic downturn or other developments, may have adverse consequences on us or on our third party relationships (including relationships with vendors and health care providers).
We also contract with third parties for important aspects of the storage and transmission of beneficiary information, and thus rely on those third parties to manage functions that have material cyber-security risks.
We also contract with third parties for important aspects of the storage and transmission of member information, and thus rely on those third parties to manage functions that have material cyber-security risks.
In addition, in order to retain our members and Non-Insurance Beneficiaries and attract additional beneficiaries, our provider networks, including those providers participating in Medicare and willing to see our beneficiaries but who we have not contracted with, must be not only adequate, but attractive, providing Medicare-eligible beneficiaries access to the providers and facilities that they want.
In addition, in order to retain our members and attract additional members, our provider networks, including those providers participating in Medicare and willing to see our members but who we have not contracted with, must be not only adequate, but attractive, providing Medicare-eligible members access to the providers and facilities that they want.
As a result, any negative perception of our senior management by our current or prospective investors, beneficiaries, or providers, or any negative press stories about our senior management, may harm our reputation and damage our business prospects.
As a result, any negative perception of our senior management by our current or prospective investors, members, or providers, or any negative press stories about our senior management, may harm our reputation and damage our business prospects.
In recent years, the DOJ and the Department of Health and Human Services Office of Inspector General (the "OIG") have increased their scrutiny of healthcare payers and providers, and Medicare Advantage insurers, under the federal FCA, in particular. There have been a number of investigations, prosecutions, convictions, and settlements in the healthcare industry.
In recent years, the DOJ and the Department of Health and Human Services Office of Inspector General (the "OIG") have increased their scrutiny of healthcare payers and providers, and Medicare Advantage insurers, under the Federal False Claims Act ("FCA"), in particular. There have been a number of investigations, prosecutions, convictions, and settlements in the healthcare industry.
See the section entitled "—If we fail to estimate, price for and manage medical expenses in an effective manner, the profitability of our Insurance and Non-Insurance businesses could decline, which could materially and adversely affect our results of operations, financial condition, and cash flows." Our future performance also depends on utilizing our clinical care capabilities to improve the quality of care for our members so that they remain members.
See the section entitled "—If we fail to estimate, price for and manage medical expenses in an effective manner, the profitability of our business could decline, which could materially and adversely affect our results of operations, financial condition, and cash flows." Our future performance also depends on utilizing our clinical care capabilities to improve the quality of care for our members so that they remain members.
Any such events could adversely affect our business, financial condition, and results of operations. 26 Our failure to estimate incurred but not reported claims accurately would affect our results of operations.
Any such events could adversely affect our business, financial condition, and results of operations. 28 Our failure to estimate incurred but not reported claims accurately would affect our results of operations.
We believe that developing widespread brand recognition and maintaining and enhancing our reputation is critical to our relationships with existing providers and beneficiaries, and to our ability to attract new providers and beneficiaries to our platform and offerings.
We believe that developing widespread brand recognition and maintaining and enhancing our reputation is critical to our relationships with existing providers and members, and to our ability to attract new providers and members to our platform and offerings.
Accordingly, the future financial performance of our business will depend in part on our ability to adapt to regulatory developments, including changes in laws and regulations or changes to interpretations of such laws or regulations, especially laws and regulations governing Medicare. For example, in March 2010, the Affordable Care Act ("ACA") became law.
Accordingly, the future financial performance of our business will depend in part on our ability to adapt to regulatory developments, including changes in laws and regulations or changes to interpretations of such laws or regulations, especially laws and regulations governing Medicare. For example, in March 2010, the ACA became law.

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Item 1C. Cybersecurity

Cybersecurity — threats and controls disclosure

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Biggest changeThe cybersecurity program seeks to protect the enterprise against threats from cybersecurity risks, to comply with applicable laws and regulations, and to establish and enhance our processes for responding to cybersecurity events. 55 Among other things, the program includes the following components: security event monitoring and detection; extended detection and response; vulnerability scanning; security awareness and privacy training for personnel; phishing simulations; and a cybersecurity incident response team.
Biggest changeThe cybersecurity program seeks to protect the enterprise against threats from cybersecurity risks, to comply with applicable laws and regulations, and to establish and enhance our processes for responding to cybersecurity events.
The Company’s CISO is responsible for developing and managing the cybersecurity program, including security incident response, remediation, and setting security policy and standards required by applicable law or regulation. The CISO holds a dual-accredited Executive MBA, and Certified Information Security Manager (CISM), Certified Information Systems Auditor (CISA), Certified Data Privacy Solutions Engineer (CDPSE) certifications.
The Company’s CISO is responsible for developing and managing the cybersecurity program, including security incident response, remediation, and setting security policy and standards required by applicable law or regulation. The CISO holds a dual-accredited Executive MBA, and Certified Information Security Manager ("CISM"), Certified Information Systems Auditor ("CISA") and Certified Data Privacy Solutions Engineer ("CDPSE") certifications.
The Audit Committee reviews the adequacy and effectiveness of the Company’s cybersecurity policies and internal controls regarding information and cybersecurity, and together with the full Board, regularly receives reports from our and our subsidiaries’ management, including our Chief Information Security Officer (the “CISO”) on cybersecurity matters, including, but not limited to: Security Awareness, Internal Risk, Third-Party Risk, IR / DR Readiness, Access Control IAM/PAM, HIPAA Security Rule Compliance, Phishing, Security Monitoring, Vulnerability Management, Application Security, Governance, Data Security, and Cloud Security.
The Audit Committee reviews the adequacy and effectiveness of the Company’s cybersecurity policies and internal controls regarding information and cybersecurity, and together with the full Board, regularly receives reports from our management, including our Chief Information Security Officer (the “CISO”) on cybersecurity matters, including, but not limited to: AI Security, Security Awareness, Internal Risk, Third-Party Risk, IR / DR Readiness, Access Control IAM/PAM, HIPAA Security Rule Compliance, Phishing, Security Monitoring, Vulnerability Management, Application Security, Governance, Data Security, and Cloud Security.
For additional information related to risks from cybersecurity threats, please refer to Item 1.A. “Risks Related to Our Business and Industry Our failure to protect our sites, networks, and systems against security breaches, or otherwise to protect our confidential or health information or the confidential or health information of our beneficiaries, providers, or other third parties, would damage our reputation and brand, and substantially harm our business and results of operations. Governance The Company’s Board of Directors (the “Board”) oversees the Company’s overall risk management program, and has assigned oversight of cybersecurity risk management to its Audit Committee.
For additional information related to risks from cybersecurity threats, please refer to Item 1.A. “Risks Related to Our Business and Industry Our failure to protect our sites, networks, and systems against security breaches, or otherwise to protect our confidential or health information or the confidential or health information of our members, providers, or other third parties, could damage our reputation and brands, and substantially harm our business and results of operations. Governance The Company’s Board of Directors (the “Board”) oversees the Company’s overall risk management program, and has assigned oversight of cybersecurity risk management to its Audit Committee.
The program includes a dedicated third-party risk assessor, security risk reports, and formal business owner risk response. During the period covered by this report, the Company has not identified any risks from cybersecurity threats that have materially affected or are reasonably likely to materially affect the Company, including its business strategy, results of operations, or financial condition.
During the period covered by this report, the Company has not identified any risks from cybersecurity threats that have materially affected or are reasonably likely to materially affect the Company, including its business strategy, results of operations, or financial condition.
Depending on the circumstances, information regarding cybersecurity risks and incidents may be elevated from the CISO and his team through a variety of different channels, including risk response forms as part of our formal security risk process, discussions with the Audit Committee and reports to the Board on a quarterly basis. Item 2. Properties. Not applicable.
The cybersecurity team is made aware of security risks and incidents by various means including our SIEM, assessments, audit, threat feeds, and security team connections and network. 56 Depending on the circumstances, information regarding cybersecurity risks and incidents may be elevated from the CISO and his team through a variety of different channels, including risk response forms as part of our formal security risk process, discussions with the Audit Committee and reports to the Board on a quarterly basis.
The Company also engages third-party vendors and consultants, respectively, to perform audits and penetration tests. The Company and its subsidiaries’ third-party service providers collect, process, and store certain information, including PII, PHI, or other confidential and proprietary information. We maintain a third-party vendor security risk management program to assess the cybersecurity risk and measures taken by such service providers.
The Company and its subsidiaries’ third-party service providers collect, process, and store certain information, including PII, PHI, or other confidential and proprietary information. We maintain a third-party vendor security risk management program to assess the cybersecurity risk and measures taken by such service providers. The program includes a third-party risk assessor, security risk reports, and formal business owner risk response.
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The cybersecurity team is made aware of security risks and incidents by various means including our SIEM, assessments, audit, threat feeds, and security team connections and network.
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Among other things, the program includes the following components: • security event monitoring and detection; • extended detection and response; • vulnerability scanning; • security awareness and privacy training for personnel; • phishing simulations; and • a cybersecurity incident response team. The Company also engages third-party vendors and consultants, respectively, to perform audits and penetration tests.

Item 3. Legal Proceedings

Legal Proceedings — active lawsuits and investigations

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Biggest changeInformation concerning legal proceedings can be found in Note 19 (Commitments and Contingencies) to the consolidated financial statements included in Part II, Item 8 of this Form 10-K, which information is incorporated by reference into this item. 56 Item 4. Mine Safety Disclosures Not applicable. 57 Part II
Biggest changeInformation concerning legal proceedings can be found in Note 13 "Commitments and Contingencies" to the consolidated financial statements included in Part II, Item 8 of this Form 10-K, which information is incorporated by reference into this item. Item 4. Mine Safety Disclosures. Not applicable. 57 Part II

Item 5. Market for Registrant's Common Equity

Market for Common Equity — stock, dividends, buybacks

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Biggest changeIssuer Purchases of Equity Securities We did not purchase any shares of our common stock during the year ended December 31, 2023. Unregistered Sales of Equity Securities and Use of Proceeds None. Performance Graph Item 6. [Reserved.] 58
Biggest changeAs of December 31, 2024, there was $18.2 million available for repurchase. The Company had no share repurchases during the three months ended December 31, 2024. Unregistered Sales of Equity Securities and Use of Proceeds None. 58 Performance Graph Item 6. [Reserved.] 59
Item 5. Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities. Common Stock Our Class A common stock is listed on The Nasdaq Stock Market under the ticker symbol "CLOV." Our Class B common stock is not listed on any securities exchange.
Item 5. Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities. Common Stock Our Class A common stock is listed on NASDAQ under the ticker symbol "CLOV." Our Class B common stock is not listed on any securities exchange.
Holders At March 5, 2024 , there were 334 holders of record of our Class A common stock and 308 holders of record of our Class B common stock. Such figures do not include beneficial owners holding our securities through nominee names.
Holders At February 24, 2025, there were 340 holders of record of our Class A common stock and 309 holders of record of our Class B common stock. Such figures do not include beneficial owners holding our securities through nominee names.
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Issuer Purchases of Equity Securities On May 6, 2024, our Board authorized the repurchase of up to $20.0 million in shares of our Class A common stock over a two year period. The timing, manner, price and amount of any repurchases are determined by the discretion of management, depending on market conditions and other factors.
Added
Repurchases may be made through open market purchases or accelerated share repurchases. The exact number of shares to be repurchased by the Company, if any, is not guaranteed. Depending on market conditions and other factors, these repurchases may be commenced or suspended at any time or periodically without prior notice.

Item 7. Management's Discussion & Analysis

Management's Discussion & Analysis (MD&A) — revenue / margin commentary

59 edited+30 added107 removed35 unchanged
Biggest changeYears ended December 31, 2023 2022 Total PMPM (1) Total PMPM (1) (Premium and expense amounts in thousands, except PMPM amounts) Insurance members at period end (#) 81,205 N/A 88,627 N/A Premiums earned, gross $ 1,236,213 $ 1,250 $ 1,085,339 $ 1,041 Premiums earned, net 1,235,769 1,250 1,084,869 1,041 Insurance medical claim expense incurred, gross 1,004,454 1,016 997,576 957 Insurance net medical claims incurred 1,003,683 1,015 996,410 956 Medical care ratio, gross (2) 81.3 % N/A 91.9 % N/A Medical care ratio, net 81.2 N/A 91.8 N/A (1) Calculated per member per month ("PMPM") figures are based on the applicable amount divided by member months in the given period.
Biggest changeWe seek to improve care and lower costs for our members by empowering providers with intuitive data-driven, personalized insights to support treatment of members through our software platform, Clover Assistant. 61 The following table presents key financial measures for the periods indicated: Year Ended December 31, 2024 2023 Total PMPM (1) Total PMPM (1) (amounts in thousands, except PMPM amounts) Insurance members at period end (#) 82,664 N/A 81,205 N/A Premiums earned, gross $ 1,345,280 $ 1,392 $ 1,236,213 $ 1,250 Premiums earned, net $ 1,344,881 $ 1,391 $ 1,235,769 $ 1,250 Insurance medical claim expense incurred, gross $ 1,012,905 $ 1,048 $ 1,004,454 $ 1,016 Insurance net medical claims incurred $ 1,010,289 $ 1,045 $ 1,003,683 $ 1,015 Medical care ratio, gross 75.3 % N/A 81.3 % N/A Medical care ratio, net 75.1 % N/A 81.2 % N/A Benefits expense ratio, gross 81.3 % N/A 86.5 % N/A Benefits expense ratio, net 81.2 % N/A 86.5 % N/A Adjusted SG&A $ 294,713 N/A $ 297,508 N/A Adjusted EBITDA $ 70,091 N/A $ (41,555) N/A Adjusted Net income (loss) from continuing operations $ 68,243 N/A $ (48,883) N/A (1) Calculated per member per month ("PMPM") figures are based on the applicable amount divided by member months in the given period.
Investing Activities Net cash provided by investing activities for the year ended December 31, 2023 of $140.0 million was primarily due to $316.2 million provided from the sale and maturity of investment securities. This was offset by $175.6 million used to purchase investments.
Net cash provided by investing activities for the year ended December 31, 2023, of $140.0 million was primarily due to $316.2 million provided from the sale and maturity of investment securities. This was offset by $175.6 million used to purchase investments.
Among plans with similar major characteristics, we offer most members in our MA plans (the "members") among the lowest average out-of-pocket costs for primary care provider and specialist co-pays in their markets. We strongly believe in providing our members provider choice, and we consider our PPO plan to be our flagship insurance product.
Among plans with similar major characteristics, we offer most members in our MA plans (the "members") among the lowest average out-of-pocket costs for primary care provider and specialist co-pays in their markets. We strongly believe in providing our members provider choice, and we consider our PPO plans to be our flagship insurance product.
We expect the cash required to meet these obligations to be primarily generated through cash, cash equivalents, restricted cash, short-term investments, and our current projections of cash flows from operations. Operating Activities Our largest source of operating cash flows is capitated payments from CMS.
We expect the cash required to meet these obligations to be primarily generated through cash, cash equivalents, restricted cash, short-term investments, and our current projections of cash flows from operations. Operating Activities from Continuing Operations Our largest source of operating cash flows is capitated payments from CMS.
Certain Business Transformation Initiatives On April 17, 2023, the Company announced it would implement certain business transformation initiatives, including an agreement to move its core plan operations to UST HealthProof’s integrated technology platform and additional corporate restructuring actions.
Restructuring costs On April 17, 2023, the Company announced it would implement certain business transformation initiatives, including an agreement to move its core plan operations to UST HealthProof’s integrated technology platform and additional corporate restructuring actions.
For further information, see Note 2 (Summary of Significant Accounting Policies) to the consolidated financial statements included in this Form 10-K. 68 Insurance Net Medical Claims Incurred Insurance net medical claims incurred is recognized in the period in which services are provided and includes paid claims and an estimate of the cost of services that have been incurred but not yet reported ("IBNR") and certain other unpaid claims and adjustments.
For further information, see Note 2 "Summary of Significant Accounting Policies" to the consolidated financial statements included in this Form 10-K. 70 Net Medical Claims Incurred Insurance net medical claims incurred is recognized in the period in which services are provided and includes paid claims and an estimate of the cost of services that have been incurred but not yet reported ("IBNR") and certain other unpaid claims and adjustments.
Because our reserving practice is to consistently recognize the actuarial best estimate using an assumption of moderately adverse conditions as required by actuarial standards, there is a reasonable possibility that there could be variances between actual completion factors and those assumed in our December 31, 2023 and 2022 unpaid claim estimates.
Because our reserving practice is to consistently recognize the actuarial best estimate using an assumption of moderately adverse conditions as required by actuarial standards, there is a reasonable possibility that there could be variances between actual completion factors and those assumed in our December 31, 2024 and 2023 unpaid claim estimates.
Premiums anticipated to be received within twelve months based on the documented diagnostic criteria of our members are estimated and included in revenues for the period, including the member months for which the payment is designated by CMS. 61 Premiums ceded is the amount of premiums earned, gross ceded to reinsurers.
Premiums anticipated to be received within twelve months based on the documented diagnostic criteria of our members are estimated and included in revenues for the period, including the member months for which the payment is designated by CMS. 62 Premiums ceded is the amount of premiums earned, gross ceded to reinsurers.
These commitments are associated with contracts that were enforceable and legally binding at December 31, 2023, and that specified all significant terms, including fixed or minimum serves to be used, fixed, minimum, or variable price provisions, and the approximate timing of the actions under the contracts.
These commitments are associated with contracts that were enforceable and legally binding at December 31, 2024, and that specified all significant terms, including fixed or minimum serves to be used, fixed, minimum, or variable price provisions, and the approximate timing of the actions under the contracts.
Recently Issued and Adopted Accounting Pronouncements See Note 2 (Summary of Significant Accounting Policies) to the consolidated financial statements included in this Form 10-K for a discussion of accounting pronouncements recently adopted and recently issued accounting pronouncements not yet adopted and their potential impact to our financial statements.
Recently Issued and Adopted Accounting Pronouncements See Note 2 "Summary of Significant Accounting Policies" in the accompanying notes to the consolidated financial statements included in this Form 10-K for a discussion of accounting pronouncements recently adopted and recently issued accounting pronouncements not yet adopted and their potential impact to our consolidated financial statements.
The discussion should be read in conjunction with the consolidated financial statements and notes thereto for the year ended December 31, 2023, contained in this Annual Report on Form 10-K (the "Form 10-K").
The discussion should be read in conjunction with the consolidated financial statements and notes thereto for the year ended December 31, 2024, contained in this Annual Report on Form 10-K (the "Form 10-K").
Management's Discussion and Analysis of Financial Condition and Results of Operations of our Annual Report on Form 10-K for the year ended December 31, 2022, filed with the SEC on March 1, 2023. This discussion contains forward-looking statements and involves numerous risks and uncertainties, including, but not limited to, those described in the "Risk Factors" section of this Form 10-K.
Management's Discussion and Analysis of Financial Condition and Results of Operations of our Annual Report on Form 10-K for the year ended December 31, 2023, filed with the SEC on March 14, 2024. This discussion contains forward-looking statements and involves numerous risks and uncertainties, including, but not limited to, those described in the "Risk Factors" section of this Form 10-K.
Our proprietary software platform, Clover Assistant, helps us execute this strategy by enabling physicians to detect, identify, and manage chronic diseases earlier than they otherwise could. This technology is a cloud-based software platform that provides physicians with access to data-driven and personalized insights for the patients they treat.
Our proprietary software platform, Clover Assistant (licensed externally as Counterpart Assistant), helps us execute this strategy by enabling physicians to detect, identify, and manage chronic diseases earlier than they otherwise could. This technology is a cloud-based software platform that provides physicians with access to data-driven and personalized insights for the patients they treat.
For a discussion of these items and comparison of our results of operations for the fiscal years ended December 31, 2022 and December 31, 2021, see Item 7.
For a discussion of these items and comparison of our results of operations for the fiscal years ended December 31, 2023 and December 31, 2022, see Item 7.
The following discussion and analysis does not include certain items related to the year ended December 31, 2022, including year-to-year comparisons between the year ended December 31, 2022 and the year ended December 31, 2021.
The following discussion and analysis does not include certain items related to the year ended December 31, 2023, including year-to-year comparisons between the year ended December 31, 2023 and the year ended December 31, 2022.
Overview At Clover Health, our vision is to empower Medicare physicians to identify and manage chronic diseases early. Our strategy is to improve the care of people with Medicare, develop wide physician networks, and provide technology to help empower physicians.
Overview At Clover Health, our vision is to empower every physician with the technology to identify, manage, and treat chronic diseases earlier. Our strategy is to improve the care of people with Medicare, develop wide physician networks, and provide technology to help empower physicians.
Premiums are earned in the period in which members are entitled to receive services, and are net of estimated uncollectible amounts, retroactive membership adjustments, and any adjustments to recognize rebates under the minimum benefit ratios required under the Patient Protection and Affordable Care Act. We earn premiums through our plans offered under contracts with CMS.
Premiums are earned in the period in which members are entitled to receive services, and are net of estimated uncollectible amounts, retroactive membership adjustments, and any adjustments to recognize rebates under the minimum benefit ratios required under the ACA. We earn premiums through our plans offered under contracts with CMS.
All other clinical services and all corporate overhead not included in the reportable segments are included within Corporate/Other. These segment groupings are consistent with the information used by our Chief Executive Officer (identified as our chief operating decision maker) to assess performance and allocate the Company's resources.
All other clinical services and all corporate overhead not included in the reportable segments are included in Corporate/Other. The segment grouping is consistent with the information used by our Chief Executive Officer (identified as our chief operating decision maker) ("CODM")) to assess performance and allocate the Company's resources.
As such, we may receive dividends and administrative expense reimbursements from our subsidiaries, two of which are subject to regulatory restrictions. We continue to maintain significant levels of aggregate excess statutory capital and surplus in our state-regulated insurance subsidiaries.
We operate as a holding company in a highly regulated industry. As such, we may receive dividends and administrative expense reimbursements from our subsidiaries, two of which are subject to regulatory restrictions. We continue to maintain significant levels of aggregate excess statutory capital and surplus in our state-regulated insurance subsidiaries.
Premiums earned, gross excludes the effects of premiums ceded to reinsurers, and therefore should not be used as a substitute for Premiums earned, net, Total revenues, or any other measure presented in accordance with generally accepted accounting principles in the United States ("GAAP"). Premiums earned, net.
Premiums earned, gross excludes the effects of premiums ceded to reinsurers, and therefore should not be used as a substitute for Premiums earned, net, Total revenues, or any other measure presented in accordance with GAAP. Premiums earned, net.
Our subsidiary, Clover Health Partners, LLC ("Health Partners"), participated as a Direct Contracting Entity ("DCE") in the Centers for Medicare and Medicaid Services ("CMS") Accountable Care Organization Realizing Equity, Access, and Community Health Model ("ACO REACH Model" or "ACO REACH").
ACO REACH We previously participated as a Direct Contracting Entity ("DCE") in the Centers for Medicare and Medicaid Services ("CMS") Accountable Care Organization Realizing Equity, Access, and Community Health Model ("ACO REACH Model" or "ACO REACH").
We continually forecast and manage our cash, investments, working capital balances, and capital structure to meet the short-term and long-term obligations of our businesses while seeking to maintain liquidity and financial flexibility.
Liquidity and Capital Resources We manage our liquidity and financial position in the context of our overall business strategy. We continually forecast and manage our cash, investments, working capital balances, and capital structure to meet the short-term and long-term obligations of our businesses while seeking to maintain liquidity and financial flexibility.
For the twelve months ended December 31, 2023 the Company recorded $9.9 million of restructuring charges related to these business transformation initiatives, which consisted of employee termination benefits, vendor related costs, and other costs. Refer to Note 23. Restructuring Costs of the notes to audited consolidated financial statements included in Part II, Item 8 of this Form 10-K.
For the year ended December 31, 2024 the Company recorded $0.3 million of restructuring charges related to these business transformation initiatives, which consisted of employee termination benefits, vendor related costs, and other costs. Refer to Note 15 "Restructuring Costs" of the notes to the consolidated financial statements included in Part II, Item 8 of this Form 10-K.
At December 31, 2023 and 2022, total restricted and unrestricted cash, cash equivalents, and investments were $417.3 million and $555.3 million, respectively. These totals consist of $228.6 million and $327.6 million at December 31, 2023 and 2022, respectively, that specifically related to available-for-sale and held-to-maturity investment securities.
At December 31, 2024 and 2023, total restricted and unrestricted cash, cash equivalents, and investments were $437.6 million and $417.3 million, respectively. These totals consist of $243.1 million and $228.6 million at December 31, 2024 and December 31, 2023, respectively, that specifically relate to available-for-sale and held-to-maturity investment securities.
There were no other material cash requirements from known contractual obligations and commitments at December 31, 2023. For additional information regarding our remaining estimated contractual obligations and commitments, see Note 13 (Leases), Note 19 (Commitments and Contingencies), and Note 20 (Non-Insurance) to the consolidated financial statements included in this Form 10-K.
There were no other material cash requirements from known contractual obligations and commitments at December 31, 2024. For additional information regarding our remaining estimated contractual obligations and commitments, see Note 13 "Commitments and Contingencies" and Note 22 "Discontinued Operations" in the accompanying notes to the consolidated financial statements included in this Form 10-K.
Net cash provided by investing activities for the year ended December 31, 2022, of $95.1 million was primarily due to $485.4 million provided from the sale and maturity of investment securities. This was offset by $369.4 million used to purchase investments.
Investing Activities Net cash provided by investing activities for the year ended December 31, 2024 of $0.6 million was primarily due to $203.4 million provided from the sale and maturity of investment securities. This was offset by $201.2 million used to purchase investments.
On December 1, 2023, the Company notified CMS that it will no longer participate as a REACH ACO in connection with the 2024 performance year.
On December 1, 2023, the Company notified CMS that it will no longer participate as a REACH ACO in connection with the 2024 performance year. The remaining activity recognized during 2024 directly relates to prior performance years with CMS.
For both of the Company's plans (PPO and HMO), CMS gave a rating of 3.0 Stars for measurement year 2022, which represents a 0.5 Star rating decrease for both plans from the 2021 measurement year. The 3.0 Star rating will impact the 2025 payment year.
For both of the Company's plans (PPO and HMO), CMS had awarded a rating of 3.0 Stars for the measurement year 2022, which represented a 0.5 Star rating decrease for both plans from the 2021 measurement year.
This software is used in both our Insurance segment and our Non-Insurance segment. We operate Preferred Provider Organization ("PPO") and Health Maintenance Organization ("HMO") Medicare Advantage ("MA") plans for Medicare-eligible individuals. We aim to provide high-quality, affordable healthcare for all Medicare beneficiaries.
We operate Preferred Provider Organization ("PPO") and Health Maintenance Organization ("HMO") Medicare Advantage ("MA") plans for Medicare-eligible individuals. We aim to provide high-quality, affordable healthcare for all Medicare beneficiaries.
IBNR represents a substantial portion of our unpaid claims, as reflected below: Years ended December 31, 2023 2022 Total % Total % (dollars in thousands) IBNR $ 121,961 89.0 % $ 124,165 90.4 % Other unpaid claims 10,261 7.5 8,255 6.0 Claims adjustment expense 4,878 3.5 4,974 3.6 Total unpaid claims and claims adjustment expense $ 137,100 100.0 % $ 137,394 100.0 % Management determines the unpaid claims and claims adjustment expense with a supplemental perspective provided by a third-party actuarial firm.
IBNR represents a substantial portion of our unpaid claims, as reflected below: Year ended December 31, 2024 2023 Total % Total % (dollars in thousands) IBNR $ 131,230 83.9 % $ 121,961 89.0 % Other unpaid claims 19,862 12.7 10,261 7.5 Claims adjustment expense 5,304 3.4 4,878 3.6 Total unpaid claims and claims adjustment expense $ 156,396 100.0 % $ 137,100 100.0 % Management determines the unpaid claims and claims adjustment expense with a supplemental perspective provided by a third-party actuarial firm.
An important feature of our MA product is wide network access. We believe the use of Clover Assistant and related data insights allows us to improve clinical decision-making through a highly scalable platform. At December 31, 2023, we operated our MA plans in eight states and 220 counties, with 81,205 members.
An important feature of our MA product is wide network access. We believe the use of Clover Assistant and related data insights allows us to improve clinical decision-making through a highly scalable platform.
For a detailed discussion of our regulatory requirements, including aggregate statutory capital and surplus as well as dividends paid from the subsidiaries to the parent, please refer to Notes 22 (Dividend Restrictions), 24 (Statutory Equity), and 25 (Regulatory Matters) to the consolidated financial statements included in this Form 10-K, as well as in Part I. 66 Cash Flows The following table summarizes our consolidated cash flows for the years ended December 31, 2023 and 2022.
For a detailed discussion of our regulatory requirements, including aggregate statutory capital and surplus as well as dividends paid from the subsidiaries to the parent, please refer to Notes 19 "Dividend Restrictions", 20 "Statutory Equity and Income", and 21 "Regulatory Matters" to the consolidated financial statements included in this Form 10-K, as well as in Part I.
We expect that our cash, cash equivalents, restricted cash, short-term investments, and our current projections of cash flows, taken together, will be sufficient to meet our projected operating and regulatory requirements for the next 12 months based on our current plans.
Historically, we have financed our operations primarily from the proceeds we received through premiums earned under our MA plans. We expect that our cash, cash equivalents, restricted cash, investments, and our current projections of cash flows, taken together, will be sufficient to meet our projected operating and regulatory requirements for the next 12 months based on our current plans.
We view our number of members and associated PMPM premiums earned and medical claim expenses, in the aggregate and on a PMPM basis, as useful metrics to assess our financial performance; Member growth and retention aligns with our mission, drives our Total revenues, expands brand awareness, deepens our market penetration, creates additional opportunities to inform our data-driven insights to improve care and decrease medical claim expenses, and generates additional data to continue to improve the functioning of Clover Assistant.
Member growth and retention aligns with our mission, drives our Total revenues, expands brand awareness, deepens our market penetration, creates additional opportunities to inform our data-driven insights to improve care and decrease medical claim expenses, and generates additional data to continue to improve the functioning of Clover Assistant.
Member months represents the number of months members are enrolled in a Clover Health plan in the period. (2) Defined as Insurance gross medical claims incurred divided by premiums earned, gross. Membership and associated premiums earned and medical claim expenses. We define new and returning members on a calendar year basis.
Member months represents the number of months members are enrolled in a Clover Health plan in the period. Membership and associated premiums earned and medical claim expenses. We define new and returning members on a calendar year basis. Any member who is active on July 1 of a given year is considered a returning member in the following year.
The increase was primarily attributable to an increase in net investment income, partially due to a higher interest rate environment as compared to the prior period. 64 Net medical claims incurred Net medical claims incurred for both Insurance and Non-Insurance decreased $1,677.6 million, or 48.6%, to $1,776.4 million for the year ended December 31, 2023, compared to the year ended December 31, 2022.
Other income Other income increased $1.5 million, or 6%, to $26.3 million for the year ended December 31, 2024, compared to the year ended December 31, 2023. The increase was primarily attributable to an increase in net investment income due to a higher interest rate environment as compared to the prior period.
Net cash provided by financing activities for the year ended December 31, 2022 of $77.5 million was primarily the result of $82.4 million provided by Change in restricted cash related to surety bonds, deposits, and escrow accounts, partially offset by the acquisition of $6.4 million in Treasury stock. 67 Financing Arrangements There have been no material changes to our financing arrangements at December 31, 2023.
Net cash used in financing activities for the year ended December 31, 2023 of $5.1 million was primarily the result of the acquisition of $6.2 million in Treasury stock. Financing Arrangements There have been no material changes to our financing arrangements at December 31, 2024.
Unregulated Entities At December 31, 2023 and December 31, 2022, total restricted and unrestricted cash, cash equivalents, and investments for the parent company, Clover Health Investments, Corp., and unregulated subsidiaries were $136.8 million and $331.7 million, respectively, with the decrease for December 31, 2023 primarily reflecting operating expenses. We operate as a holding company in a highly regulated industry.
Unregulated Entities At December 31, 2024 and December 31, 2023, total restricted and unrestricted cash, cash equivalents, and investments for the parent company, Clover Health Investments, Corp., and unregulated subsidiaries were $151.5 million and $136.8 million, respectively, with the increase at December 31, 2024 primarily reflecting cash provided by operating activities.
We review several key performance measures, discussed below, to evaluate our business and results, measure performance, identify trends, formulate plans, and make strategic decisions.
We review several key performance measures, discussed below, to evaluate our business and results, measure performance, identify trends, formulate plans, and make strategic decisions. We believe that the presentation of such metrics is useful to management and counterparties to model the performance of healthcare companies such as Clover.
Cash, cash equivalents, and investments at the parent company were $74.0 million and $238.0 million at December 31, 2023 and December 31, 2022, respectively. Our unregulated subsidiaries held $62.8 million and $93.7 million of cash, cash equivalents, restricted cash, and investments at December 31, 2023 and December 31, 2022, respectively.
Cash, cash equivalents, and investments at the parent company were $146.8 million and $74.0 million at December 31, 2024 and December 31, 2023, respectively.
Regulated Entities At December 31, 2023 and December 31, 2022 total cash, cash equivalents, restricted cash, and investments for our regulated subsidiaries were $280.5 million and $223.6 million, respectively. Additionally, our regulated insurance subsidiaries held $203.4 million and $191.1 million of available-for-sale and held-to-maturity investment securities at December 31, 2023 and December 31, 2022, respectively.
Our unregulated subsidiaries held $4.8 million and $62.8 million of cash, cash equivalents, restricted cash, and investments at December 31, 2024 and December 31, 2023, respectively. 68 Regulated Entities At December 31, 2024 and December 31, 2023 total cash, cash equivalents, restricted cash, and investments for our regulated subsidiaries were $286.1 million and $280.5 million, respectively.
Our use of operating cash derived from our unregulated subsidiaries is generally not restricted by departments of insurance (or comparable state regulatory agencies). Our regulated insurance subsidiaries have not paid dividends to the parent, and applicable insurance laws restrict the ability of our regulated insurance subsidiary to declare and pay dividends to the parent.
Our regulated insurance subsidiaries have not paid dividends to the parent, and applicable insurance laws restrict the ability of our regulated insurance subsidiary to declare and pay dividends to the parent.
General and administrative expenses General and administrative expenses decreased $20.3 million, or 9.8%, to $187.6 million for the year ended December 31, 2023, compared to the year ended December 31, 2022. The decrease was primarily driven by a decrease in deferred acquisition costs.
This decrease was primarily driven by a decrease in share-based compensation related costs. 67 General and administrative expenses General and administrative expenses decreased $6.6 million, or 4%, to $176.5 million for the year ended December 31, 2024, compared to the year ended December 31, 2023. The decrease was primarily driven by a decrease in legal, consulting and contractor related costs.
Our primary uses of cash from operating activities are payments for medical benefits and payments of operating expenses. For the year ended December 31, 2023, Net cash used in operating activities was $115.9 million, which reflects a Net loss of $213.4 million.
For the year ended December 31, 2023, Net cash used in operating activities was $35.1 million, which reflects a Net loss from continuing operations of $210.1 million.
Years ended December 31, 2023 2022 (in thousands) Cash Flows Data: Net cash used in operating activities $ (115,871) $ (286,348) Net cash provided by investing activities 140,013 95,133 Net cash (used in) provided by financing activities (33,861) 77,460 Decrease in cash, cash equivalents, and restricted cash $ (9,719) $ (113,755) Cash Requirements Our cash requirements within the next twelve months include medical claims payable, accounts payable and accrued liabilities, current liabilities, purchase commitments, and other obligations.
Year ended December 31, 2024 2023 (in thousands) Cash Flows Data: Net cash provided by (used in) operating activities from continuing operations $ 82,450 $ (35,148) Net cash provided by investing activities 565 140,013 Net cash used in financing activities (17,361) (5,070) Increase in cash, cash equivalents, and restricted cash from continuing operations $ 65,654 $ 99,795 Cash Requirements Our cash requirements within the next twelve months include medical claims payable, accounts payable and accrued liabilities, current liabilities, purchase commitments, and other obligations.
CMS Star Ratings Pursuant to CMS’s Medicare Advantage Star ratings system, CMS annually awards between 1.0 and 5.0 Stars to Medicare Advantage plans based on performance in several categories. CMS released the Company’s 2024 Star ratings in October 2023, related to the 2022 measurement year, which will impact the 2025 payment year.
Pursuant to CMS’s Medicare Advantage Star ratings system, CMS annually awards between 1.0 and 5.0 Stars to Medicare Advantage plans based on performance in several categories. In the calendar year 2024, the Company was paid on the basis of 3.5 Stars for both our PPO and HMO plans.
After the Company evaluated its ownership interest in Character Biosciences, it began applying the equity method of accounting during the three months ended March 31, 2022, and for the year ended December 31, 2022 recorded a gain on investment of $9.2 million, which is attributable to its proportionate share of the gain on equity of that entity during that period.
Loss on investment In February 2022, Character Biosciences completed a private capital transaction. After the Company evaluated its ownership interest in Character Biosciences, it began applying the equity method of accounting. From this point forward, the Company recognizes its proportionate share of the gain/loss on equity of that entity during the period.
The increase was primarily due to the increase in CMS premiums received as a result of the 3.0 to 3.5 star rating effective January 1, 2023 and an increase in risk adjustment revenue driving favorability as a result of the Company focusing on member retention.
Premiums earned, net Premiums earned, net increased $109.1 million, or 9%, to $1,344.9 million for the year ended December 31, 2024, compared to the year ended December 31, 2023. The increase was primarily due to an increase in our risk adjustment revenue driving favorability as a result of the Company focusing on member retention.
Any member who is active on July 1 of a given year is considered a returning member in the following year. Any member who joins a Clover plan after July 1 in a given year is considered a new member for the entirety of the following calendar year.
Any member who joins a Clover plan after July 1 in a given year is considered a new member for the entirety of the following calendar year. We view our number of members and associated PMPM premiums earned and medical claim expenses, in the aggregate and on a PMPM basis, as useful metrics to assess our financial performance.
Non-cash activities included a $140.9 million charge to Stock-based compensation expense, and $7.2 million of amortization of the 2023 Premium deficiency reserve. Payments due to CMS related to our Non-Insurance operations decreased by $106.6 million. For the year ended December 31, 2022, Net cash used in operating activities was $286.3 million, which reflects a Net loss of $339.6 million.
Our primary uses of cash from operating activities are payments for medical benefits and payments of operating expenses. For the year ended December 31, 2024, Net cash provided by operating activities was $82.5 million, which reflects a Net loss from continuing operations of $46.3 million. Non-cash activities primarily included a $114.3 million charge to Stock-based compensation expense.
Material cash requirements from known contractual obligations and commitments at December 31, 2023 include: (1) the recognition of a performance guarantee of $15.6 million in connection with the Company's participation in the ACO REACH Model and (2) operating lease obligations of $4.7 million.
Material cash requirements from known contractual obligations and commitments at December 31, 2024 include operating lease obligations of $2.3 million.
We believe that the presentation of such metrics is useful to management and counterparties to model the performance of healthcare companies such as Clover. 60 Insurance segment Through our Insurance segment, we provide PPO and HMO plans to members in several states.
Through our Insurance segment, we provide PPO and HMO plans to members in several states.
Non-cash activities included a $164.3 million charge to Stock-based compensation expense, $93.5 million amortization of the 2022 Premium deficiency reserve, and a $9.2 million Gain on investment related to the change in the equity structure of Clover Therapeutics. Payments due to CMS related to our Non-Insurance operations increased by $110.4 million.
Non-cash activities primarily included a $140.9 million charge to Stock-based compensation expense, $15.9 million Goodwill and intangible asset impairment, $7.2 million amortization of the 2022 Premium deficiency reserve, and a $4.7 million Loss on investment.
Key Performance Measures of Our Operating Segments Operating Segments We manage our operations based on two reportable operating segments: Insurance and Non-Insurance. Through our Insurance segment, we provide PPO and HMO plans to Medicare Advantage members in several states. Our Non-Insurance segment consists of our operations in connection with our participation in the ACO REACH Model.
Refer to Note 22 "Discontinued Operations" in the accompanying notes to the consolidated financial statements included in this Form 10-K for additional information. Key Performance Measures Starting in the first quarter of 2024, we manage our operations based on one reportable segment: Insurance. Through our Insurance segment, we provide PPO and HMO plans to Medicare Advantage members in several states.
Please refer to Note 8 "Goodwill and Other Intangibles" of the notes to audited consolidated financial statements included in Part II, Item 8 of this Form 10-K for additional information.
For the year ended December 31, 2024, the Company recognized $0.5 million in shared losses. Refer to Note 12 "Variable Interest Entity and Equity Method of Accounting" of the notes to the consolidated financial statements included in Part II, Item 8 of this Form 10-K.
Years ended December 31, Change between 2023 and 2022 2023 2022 ($) (%) (in thousands) Revenues Premiums earned, net (Net of ceded premiums of $444 and $470 for the years ended December 31, 2023 and 2022, respectively) $ 1,235,769 $ 1,084,869 $ 150,900 13.9 % Non-Insurance revenue 773,177 2,380,135 (1,606,958) (67.5) Other income 24,774 11,683 13,091 112.1 Total revenues 2,033,720 3,476,687 (1,442,967) (41.5) Operating expenses Net medical claims incurred 1,776,388 3,453,952 (1,677,564) (48.6) Salaries and benefits 257,157 278,725 (21,568) (7.7) General and administrative expenses 187,571 207,917 (20,346) (9.8) Impairment of goodwill and other intangible assets 15,945 15,945 * Premium deficiency reserve benefit (7,239) (93,517) 86,278 (92.3) Depreciation and amortization 2,509 1,187 1,322 111.4 Restructuring costs 9,931 9,931 * Other expense 70 (70) * Total operating expenses 2,242,262 3,848,334 (1,606,072) (41.7) Loss from operations (208,542) (371,647) 163,105 (43.9) Change in fair value of warrants 86 (900) 986 * Interest expense 7 1,333 (1,326) (99.5) Amortization of notes and securities discount 30 (30) * Gain on extinguishment of note payable (23,326) 23,326 * Loss (gain) on investment 4,726 (9,217) 13,943 * Net loss $ (213,361) $ (339,567) $ 126,206 (37.2) % * Not presented because the current or prior period amount is zero or the amount for the line item changed from a gain to a loss (or vice versa) and thus yields a result that is not meaningful.
Year ended December 31, Change between 2024 and 2023 2024 2023 ($) (%) (in thousands) Revenues Premiums earned, net (Net of ceded premiums of $399 and $444 for the years ended December 31, 2024 and 2023, respectively) $ 1,344,881 $ 1,235,769 $ 109,112 8.8 % Other income 26,250 24,774 1,476 6.0 Total revenues 1,371,131 1,260,543 110,588 8.8 Operating expenses Net medical claims incurred 1,006,327 1,004,590 1,737 0.2 Salaries and benefits 232,454 257,157 (24,703) (9.6) General and administrative expenses 176,480 183,089 (6,609) (3.6) Impairment of goodwill and other intangible assets 15,945 (15,945) * Premium deficiency reserve benefit (7,239) 7,239 * Depreciation and amortization 1,331 2,509 (1,178) (47.0) Restructuring costs 288 9,821 (9,533) (97.1) Total operating expenses 1,416,880 1,465,872 (48,992) (3.3) Loss from continuing operations (45,749) (205,329) 159,580 (77.7) Change in fair value of warrants 50 86 (36) (41.9) Interest expense 7 (7) * Loss on investment 467 4,726 (4,259) (90.1) Net loss from continuing operations $ (46,266) $ (210,148) $ 163,882 (78.0) % Net income (loss) from discontinued operations (Note 22 ) 3,257 (3,213) 6,470 * Net loss $ (43,009) $ (213,361) $ 170,352 (79.8) % * Not presented because the current or prior period amount is zero or the amount for the line item changed from a gain to a loss (or vice versa) and thus yields a result that is not meaningful.
For additional information regarding our investing activities, please refer to Note 3 (Investment Securities) to our consolidated financial statements included in this Form 10-K.
For additional information regarding our investing activities, please refer to Note 3 "Investment Securities" to our consolidated financial statements included in this Form 10-K. 69 Financing Activities Net cash used in financing activities for the year ended December 31, 2024 of $17.4 million was primarily the result of the acquisition of $16.5 million in Treasury stock and repurchases of $1.8 million of Class A Common stock.
As a direct result of not participating in the ACO REACH Program in 2024, Lives under Clover Management will include only our Insurance members at the beginning of 2024. 59 2023 Highlights Geographic Presence Beginning in 2024, our MA plans will be available in a total of 200 counties and 5 states.
The Company entered 2025 with over 100,000 members, approximately 95% of whom are enrolled in Clover’s flagship PPO plans. Geographic Presence Beginning in 2025, our MA plans will be available in a total of 200 counties and 5 states.
This represents a 0.5 Star rating decrease for both plans as compared to the 2024 payment year. In the calendar year 2024, the Company will be paid on the basis of 3.5 Stars for both our PPO and HMO plans, which ratings were previously awarded.
Subsequently, on June 14, 2024, the Company announced that CMS had recalculated the Company's 2024 Star ratings for its PPO Medicare Advantage plans for the 2025 payment year, and had increased such plans’ rating by 0.5 Star, to a revised rating of 3.5 Stars.
Removed
The Company’s exit from the ACO REACH Program was made after the Company determined that it is in its best interest to fully exit the ACO REACH Program, and follows the Company's November 2022 announcement of a strategic reduction in the number of ACO REACH participating physicians in 2023.
Added
At December 31, 2024, we operated our MA plans in five states and 200 counties, with 82,664 members. 2024 Highlights 2025 Annual Election Period Results On January 13, 2025, the Company announced a 27% year-over-year growth of its MA membership during the most recent Annual Election Period ("AEP").
Removed
At December 31, 2023, we partnered with providers to care for 131,734 Lives under Clover Management, which included 81,205 Insurance members and 50,529 aligned Non-Insurance beneficiaries.
Added
CMS Star Ratings In October 2023, CMS initially released the Company’s 2024 Star ratings, which related to the 2022 measurement year and would have impacted the 2025 payment year.
Removed
ACO REACH On December 1, 2023, the Company notified CMS that it will no longer participate as a REACH ACO in connection with the 2024 performance year.
Added
On October 10, 2024, the Company announced that CMS had increased the Star rating of its PPO Medicare Advantage plans to 4.0 Stars for 2025, which will affect payment year 2026.
Removed
The Company’s exit from the ACO REACH Program was made after the Company determined that it is in its best interest to fully exit the ACO REACH Program, and follows the Company's November 2022 announcement of a strategic reduction in the number of ACO REACH participating physicians in 2023.
Added
In payment year 2026, the Company expects to experience a general 5% quality bonus increase in benchmark rates as a result of its PPO contract being rated 4.0 Stars, in accordance with CMS regulations.
Removed
We seek to improve care and lower costs for our Insurance members by empowering providers with data-driven, personalized insights to support treatment of members through our software platform, Clover Assistant.
Added
Increased quality bonus payments enable the Company to further reinvest in more competitive benefits, which the Company believes will deliver greater value to its members while fueling continued membership growth. Additionally, CMS increased the rating of Clover’s HMO MA plan to 3.5 Stars.
Removed
Non-Insurance segment Our Non-Insurance segment consists of operations in connection with our participation in the Direct Contracting program through the ACO REACH Model. As part of our Non-Insurance operations, we empower providers with Clover Assistant and offer a variety of programs aimed at reducing expenditures and preserving or enhancing the quality of care for our Non-Insurance Beneficiaries.
Added
As discussed earlier, as of December 31, 2024, over 95% of the Company's insurance members are members of our PPO Medicare Advantage Plans. 60 Counterpart Health During the second quarter of 2024, the Company launched Counterpart Health, Inc., or ("Counterpart Health"), a subsidiary of the Company which houses a new software-as-a-service and tech enabled services solution to bring the power of Counterpart Assistant technology to external payors and providers serving the Medicare eligible population.
Removed
On December 1, 2023, the Company notified CMS that it will no longer participate as a REACH ACO in connection with the 2024 performance year.
Added
This external offering aims to equip clinician users with our already built, clinician-centric, and AI-powered care management platform. Strategically, Counterpart Health aims to extend the benefits of data-driven proven technology and personalized care to a wider audience, enabling enhanced patient outcomes and reduced healthcare costs across the nation.
Removed
Year ended December 31, 2023 2022 Total PBPM (1) Total PBPM (1) (Revenue and claims amounts in thousands, except PBPM amounts) Non-Insurance Beneficiaries at period end 50,529 N/A 164,887 N/A Non-Insurance revenue $ 773,177 $ 1,232 $ 2,380,135 $ 1,175 Non-Insurance net medical claims incurred 771,798 1,229 2,460,879 1,214 Non-Insurance MCR (2) 99.8 % N/A 103.4 % N/A (1) Calculated ("PBPM") figures are based on the applicable amount divided by beneficiary months in the given period.
Added
Counterpart Health is complementary to Clover Health, and enables the Company to deploy and expand the reach of its existing technology asset for new potential growth and high margin business opportunities, with low startup costs. Revenue from our Counterpart Health SaaS and tech enabled services is included within Other income on our consolidated statements of operations and comprehensive loss.
Removed
Beneficiary months represents the number of months beneficiaries are aligned to our ACO REACH Model in the period. (2) Defined as Non-Insurance net medical claims incurred divided by Non-Insurance revenues. Non-Insurance Beneficiaries.
Added
As of January 1, 2024, this line of business met the definition of discontinued operations, and prior period amounts have been updated to conform to the current period presentation. At December 31, 2024, the Company did not anticipate any further material activity related to its discontinued operations.
Removed
A Non-Insurance Beneficiary is defined as an eligible fee-for-service ("FFS") covered life that has been aligned to our ACO REACH, Clover Health Partners, via attribution to an ACO REACH-participant provider through alignment based on claims data or by beneficiary election through voluntary alignment.
Added
Non-GAAP Financial Measures We use non-GAAP measures in this Form 10-K, including Insurance BER, Adjusted SG&A and Adjusted EBITDA. These non-GAAP financial measures are provided to enhance the reader's understanding of Clover Health's past financial performance and our prospects for the future.
Removed
A beneficiary alignment is effective at the first of the month, for the full calendar month, regardless of whether eligibility is lost during the course of the month. 62 Non-Insurance revenue. Non-Insurance revenue represents CMS' total expense incurred for medical services provided on behalf of Non-Insurance Beneficiaries during months in which they were alignment eligible during the performance year.

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Item 7A. Quantitative and Qualitative Disclosures About Market Risk

Market Risk — interest-rate, FX, commodity exposure

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Biggest changeTreasury fixed maturity securities. At December 31, 2023, none of our fixed maturity securities portfolio was unrated or rated below investment grade. Inflation Risk The United States economy continues to be impacted by inflation.
Biggest changeTreasury fixed maturity securities. At December 31, 2024, none of our fixed maturity securities portfolio was unrated or rated below investment grade. 71 Inflation Risk The United States economy continues to be impacted by inflation.
We continue to monitor the potential impacts from inflation and are prepared to respond to inflationary pressures as necessary. 74
We continue to monitor the potential impacts from inflation and are prepared to respond to inflationary pressures as necessary. 72

Other CLOV 10-K year-over-year comparisons