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NeueHealth Reports Fourth Quarter and Full Year 2024 Results

NEUE

  • Delivered strongest financial performance to date in 2024, resulting from continued success of value-driven, consumer-centric care model
  • Drove positive Adjusted EBITDA for the fourth consecutive quarter in 2024, establishing the foundation for continued strong performance in 2025 and beyond
  • Generated significant growth to start 2025, serving 717,000 consumers, an increase of 48% compared to 2024

NeueHealth, Inc. (“NeueHealth” or the “Company”) (NYSE: NEUE), the value-driven healthcare company, today reported financial results for its fourth quarter and full year ended December 31, 2024.

“In 2024, we delivered our strongest financial performance to date, demonstrating the power of our value-driven, consumer-centric care model,” said Mike Mikan, President and CEO of NeueHealth. “We have established a strong foundation to drive strategic growth in 2025 with a focus on serving more consumers in new and existing markets and building on the relationships we have formed with payors and providers across the industry. I am excited for the future of our company and believe we are well-positioned to continue to bring a seamless, more coordinated care experience to all in 2025 and beyond.”

Key Metrics

As of December 31,

2024

2023

Consumer and Patient Metrics

Value-Based Consumers served

360,000

355,000

Enablement Services Lives

123,000

106,000

Three Months Ended

Years Ended

($ in thousands)

December 31,

December 31,

2024

2023

2024

2023

Financial Metrics

Revenue

$

232,638

$

292,871

$

936,657

$

1,160,802

Net Income (Loss)

$

2,523

$

(460,572

)

$

(99,717

)

$

(1,265,808

)

Net Loss from Continuing Operations

$

(42,480

)

$

(62,827

)

$

(102,058

)

$

(627,742

)

Adjusted EBITDA (non-GAAP)

$

5,482

$

(10,356

)

$

22,496

$

(8,480

)

See the table at the end of this release for additional information and a reconciliation of the non-GAAP measures used in the table above. See table at the end of this release for more detail.

Earnings Conference Call

As previously announced, NeueHealth will discuss the Company’s results, strategy, and outlook on a conference call with investors at 8:00 a.m. Eastern Time today. NeueHealth will host a live webcast of this conference call which can be accessed from the Investor Relations page of the Company’s website (investors.neuethealth.com). Following the call, a webcast replay will be available on the same site. This earnings release and the Form 8-K filed March 20, 2025 can be accessed on the Investor Relations page of the Company’s website. We routinely post important information on our website, including corporate and investor presentations and financial information. We intend to use our website as a means of disclosing material, non-public information and for complying with our disclosure obligations under Regulation FD. Such disclosures will be included in the Investor Relations section of our website. Accordingly, investors should monitor this portion of our website, in addition to following our press releases, U.S. Securities and Exchange Commission (“SEC”) filings and public conference calls and webcasts.

About NeueHealth

NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, NeueHealth helps to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid. NeueHealth delivers high-quality clinical care to over 500,000 health consumers through owned clinics and unique partnerships with over 3,000 affiliated providers. We also enable independent providers and medical groups to thrive in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. We believe our value-driven, consumer-centric care model can transform the healthcare experience and maximize value across the healthcare system. For more information, visit: www.neuehealth.com.

Additional Information and Where to Find It

On December 23, 2024, the Company entered into an Agreement and Plan of Merger (the “Merger Agreement”) with NH Holdings 2025, Inc. ("Parent"), pursuant to which, if all applicable conditions are satisfied or waived, the Company will become a wholly owned subsidiary of Parent (the “Transaction”). Parent is indirectly controlled by private investment funds affiliated with New Enterprise Associates, Inc. ("NEA").

In connection with the Transaction, the Company has filed with the SEC a preliminary proxy statement on Schedule 14A (as amended, the “Proxy Statement”), the definitive version of which will be sent or provided to Company stockholders. The Company, affiliates of the Company and affiliates of NEA intend to jointly file a transaction statement on Schedule 13E-3 (the “Schedule 13E-3”) with the SEC. The Company may also file other documents with the SEC regarding the transaction. This Current Report on Form 8-K is not a substitute for the Proxy Statement, the Schedule 13E-3 or any other document which the Company may file with the SEC. INVESTORS AND SECURITY HOLDERS ARE URGED TO READ THE PROXY STATEMENT, THE SCHEDULE 13E-3 AND ANY OTHER RELEVANT DOCUMENTS THAT ARE FILED OR WILL BE FILED WITH THE SEC, AS WELL AS ANY AMENDMENTS OR SUPPLEMENTS TO THESE DOCUMENTS, CAREFULLY AND IN THEIR ENTIRETY BEFORE MAKING ANY VOTING OR INVESTMENT DECISION WITH RESPECT TO THE COMPANY OR THE TRANSACTION BECAUSE THESE DOCUMENTS CONTAIN OR WILL CONTAIN IMPORTANT INFORMATION ABOUT THE TRANSACTION AND RELATED MATTERS. Investors and security holders may obtain free copies of the Proxy Statement, the Schedule 13E-3 and other documents that are filed or will be filed with the SEC by the Company, when such documents become available, through the website maintained by the SEC at www.sec.gov or through the Company’s website at https://investors.neuehealth.com/home/default.aspx.

The Transaction will be implemented solely pursuant to the Merger Agreement, which contains the full terms and conditions of the transaction.

Participants in the Solicitation

The Company and certain of its directors, executive officers and employees may be deemed to be participants in the solicitation of proxies from stockholders of the Company in connection with the proposed transaction. Information regarding the Company’s directors and executive officers is available in the definitive proxy statement for the 2024 annual meeting of stockholders of the Company, which was filed by the Company with the SEC on April 1, 2024 (the “Annual Meeting Proxy Statement”), and is available in the Proxy Statement. Please refer to the sections captioned “Executive Compensation,” “Director Compensation,” and “Security Ownership of Certain Beneficial Owners and Management” in the Annual Meeting Proxy Statement and the section captioned "Security Ownership of Certain Beneficial Owners and Management" in the Proxy Statement. Holdings of the Company’s securities by certain of the Company’s employees, and any changes in the holdings of the Company’s securities by the Company’s directors or executive officers from the amounts described in the Proxy Statement, have been reflected in the following Statements of Change in Ownership on Form 4 filed with the SEC: Form 4, filed by George Lawrence Mikan III on March 17, 2025; Form 4, filed by Jay Matushak on March 17, 2025; Form 4, filed by Tomas Orozco on March 17, 2025; Form 4, filed by Jeffery Michael Craig on March 17, 2025; and Form 4, filed by Jeffrey J. Scherman on March 17, 2025. Other information regarding the participants in the proxy solicitation and a description of their direct and indirect interests, by security holdings or otherwise, will be contained in the Proxy Statement and other relevant materials to be filed with the SEC in connection with the proposed Transaction when they become available. Free copies of the Proxy Statement and such other materials may be obtained as described in the preceding paragraph.

Forward-Looking Statements

Statements made in this release that are not statements of historical fact, including statements about our beliefs and expectations, are forward-looking statements and should be evaluated as such. Forward-looking statements include information concerning possible or assumed future results of operations, including descriptions of our business plan and strategies. These statements often include words such as “anticipate,” “expect,” “plan,” “believe,” “intend,” “project,” “forecast,” “estimates,” “projections,” “outlook,” “ensure,” and other similar expressions. These forward-looking statements include any statements regarding our plans and expectations. Such forward-looking statements are subject to various risks, uncertainties and assumptions. Accordingly, there are or will be important factors that could cause actual outcomes or results to differ materially from those indicated in these statements. Factors that might materially affect such forward-looking statements include: the failure to complete the Transaction on the anticipated terms and within the anticipated timeframe, including as a result of failure to obtain required stockholder or regulatory approvals or to satisfy other closing conditions; potential litigation relating to the Transaction that could be instituted against NEA, the Company or their respective affiliates, directors, managers, officers or employees, and the effects of any outcomes related thereto; potential adverse reactions or changes to our business relationships or operating results resulting from the announcement, pendency or completion of the transaction; the risk that our stock price may decline significantly if the Transaction is not consummated; certain restrictions during the pendency of the Transaction that may impact our ability to pursue certain business opportunities or strategic transactions; costs associated with the Transaction, which may be significant; the occurrence of events, changes or other circumstances that could give rise to the termination of the Merger Agreement, including in circumstances requiring us to pay a termination fee; our ability to continue as a going concern; expectations and outcomes related to the NEA Merger Agreement; our ability to comply with the terms of our credit facilities or any credit facility into which we enter in the future; our ability to receive the remaining proceeds from the sale of our Medicare Advantage (“MA”) business in California in a timely manner; our ability to obtain any short or long term debt or equity financing needed to operate our business; our ability to quickly and efficiently complete the wind down of our remaining Individual and Family Plan (“IFP”) businesses and MA businesses outside of California, including by satisfying liabilities of those businesses when due and payable; potential disruptions to our business due to the Transaction or corporate restructuring and any resulting headcount reduction; our ability to accurately estimate and effectively manage the costs relating to changes in our business offerings and models; a delay or inability to withdraw regulated capital from our subsidiaries; a lack of acceptance or slow adoption of our business model; our ability to retain existing consumers and expand consumer enrollment; our and our Care Partner’s abilities to obtain and accurately assess, code, and report risk adjustment factor scores; our ability to contract with care providers and arrange for the provision of quality care; our ability to accurately estimate medical expenses; our ability to obtain claims information timely and accurately; the impact of any pandemic or epidemic on our business and results of operations; the risks associated with our reliance on third-party providers to operate our business; the impact of modifications or changes to the U.S. health insurance markets; the impact of changes to federal funding for government healthcare programs; our ability to manage any growth of our business; our ability to operate, update or implement our technology platform and other information technology systems; our ability to retain key executives; our ability to successfully pursue acquisitions and integrate acquired businesses and divest businesses as needed; the occurrence of severe weather events, catastrophic health events, natural or man-made disasters, and social and political conditions or civil unrest; our ability to prevent and contain data security incidents and the impact of data security incidents on our members, patients, employees and financial results; our ability to comply with requirements to maintain effective internal controls; the outcome of threatened or pending litigation and risks of future legal disputes; the impacts resulting from new (or change to existing) laws, regulations and executive actions; our ability to mitigate risks associated with our ACO REACH and related businesses, including any unanticipated market, legislative or regulatory developments; and the other factors set forth under the heading “Risk Factors” in the Company’s reports on Form 10-K, Form 10-Q, and Form 8-K (including all amendments to those reports) and our other filings with the SEC. Except as required by law, we undertake no obligation to update publicly any forward-looking statements for any reason after the date of this release to conform these statements to actual results or changes in our expectations.

NeueHealth, Inc. and Subsidiaries

Consolidated Balance Sheets

(in thousands, except share and per share data)

(Unaudited)

December 31, 2024

December 31, 2023

Assets

Current assets:

Cash and cash equivalents

$

83,295

$

87,299

Short-term investments

9,871

6,265

Accounts receivable, net of allowance of $27 and $14,023, respectively

36,594

39,084

ACO REACH performance year receivable

95,075

115,878

Current assets of discontinued operations

173,006

822,570

Prepaids and other current assets

36,807

17,831

Total current assets

434,648

1,088,927

Other assets:

Property, equipment and capitalized software, net

11,240

14,499

Intangible assets, net

71,064

93,238

Other non-current assets

27,431

28,816

Total other assets

109,735

136,553

Total assets

$

544,383

$

1,225,480

Liabilities, Redeemable Noncontrolling Interest, Redeemable Preferred Stock and Shareholders’ Equity (Deficit)

Current liabilities:

Medical costs payable

$

124,360

$

157,903

Accounts payable

6,298

11,841

Short-term borrowings

2,000

303,947

Current liabilities of discontinued operations

344,651

699,758

Risk share payable to deconsolidated entity

123,981

123,981

Warrant liability

29,738

13,971

Other current liabilities

79,200

79,856

Total current liabilities

710,228

1,391,257

Long-term borrowings

202,614

66,400

Other liabilities

17,649

22,441

Total liabilities

930,491

1,480,098

Commitments and contingencies

Redeemable noncontrolling interests

48,580

88,908

Redeemable Series A preferred stock, 0.0001 par value; 750,000 shares authorized in 2024 and 2023; 750,000 shares issued and outstanding in 2024 and 2023

747,481

747,481

Redeemable Series B preferred stock, 0.0001 par value; 175,000 shares authorized in 2024 and 2023; 175,000 shares issued and outstanding in 2024 and 2023

172,936

172,936

Shareholders’ equity (deficit):

Common stock, 0.0001 par value; 3,000,000,000 shares authorized in 2024 and 2023; 8,320,959 and 8,053,576 shares issued and outstanding in 2024 and 2023, respectively

1

1

Additional paid-in capital

3,099,423

3,056,027

Accumulated deficit

(4,442,529

)

(4,307,849

)

Accumulated other comprehensive loss

(122

)

Treasury stock, at cost, 31,526 shares at December 31, 2024 and 2023

(12,000

)

(12,000

)

Total shareholders’ equity (deficit)

(1,355,105

)

(1,263,943

)

Total liabilities, redeemable noncontrolling interests, redeemable preferred stock and shareholders’ equity (deficit)

$

544,383

$

1,225,480

NeueHealth, Inc. and Subsidiaries

Consolidated Statements of Income (Loss)

(in thousands, except share and per share data)

(Unaudited)

Three Months Ended December 31,

Years Ended December 31,

2024

2023

2024

2023

Revenue:

Capitated revenue

$

63,076

$

60,091

$

259,881

$

219,774

ACO REACH revenue

154,249

219,659

625,339

896,504

Service revenue

15,036

13,051

50,393

44,438

Investment income (loss)

277

70

1,044

86

Total revenue

232,638

292,871

936,657

1,160,802

Operating expenses:

Medical costs

184,892

264,864

742,140

996,582

Operating costs

72,786

65,441

273,900

287,138

Bad debt expense

4,353

14

27,407

Restructuring charges

775

123

956

6,990

Goodwill impairment

401,385

Intangible assets impairment

11,411

Depreciation and amortization

3,602

4,025

15,646

18,296

Total operating expenses

262,055

338,806

1,044,067

1,737,798

Operating loss

(29,417

)

(45,935

)

(107,410

)

(576,996

)

Interest expense

6,248

11,205

18,701

38,203

Warrant expense

7,487

4,097

3,661

13,971

Gain on troubled debt restructuring

(30,311

)

Loss from continuing operations before income taxes

(43,152

)

(61,237

)

(99,461

)

(629,170

)

Income tax (benefit) expense

(672

)

1,590

2,597

(1,428

)

Net loss from continuing operations

(42,480

)

(62,827

)

(102,058

)

(627,742

)

Gain (Loss) from discontinued operations, net of tax

45,003

(397,745

)

2,341

(638,066

)

Net Income (Loss)

2,523

(460,572

)

(99,717

)

(1,265,808

)

Net earnings from continuing operations attributable to noncontrolling interests

(5,245

)

230,856

(34,963

)

114,354

Series A preferred stock dividend accrued

(10,801

)

(10,305

)

(42,184

)

(40,139

)

Series B preferred stock dividend accrued

(2,424

)

(2,311

)

(9,466

)

(9,006

)

Net loss attributable to NeueHealth, Inc. common shareholders

$

(15,947

)

$

(242,332

)

$

(186,330

)

$

(1,200,599

)

Basic and diluted (loss) income per share attributable to NeueHealth, Inc. common shareholders

Continuing operations

$

(7.41

)

$

19.54

$

(22.93

)

$

(70.72

)

Discontinued operations

5.47

(50.01

)

0.28

(80.22

)

Basic and diluted loss per share

(1.94

)

(30.47

)

(22.65

)

(150.94

)

Basic and diluted weighted-average common shares outstanding

8,226

7,954

8,226

7,954

NeueHealth, Inc. and Subsidiaries

Consolidated Statements of Cash Flows

(in thousands)

(Unaudited)

Years Ended December 31,

2024

2023

Cash flows from operating activities:

Net loss

$

(99,717

)

$

(1,265,808

)

Adjustments to reconcile net loss to net cash provided by operating activities:

Depreciation and amortization

15,646

24,167

Impairment of intangible assets

11,411

Impairment of goodwill

587,535

Share-based compensation

70,207

83,692

Payment-In-Kind (“PIK”) Interest

17,005

Deferred income taxes

(3,063

)

Gain on troubled debt restructuring

(30,311

)

Net accretion of investments

(229

)

(17,986

)

Loss on disposal of property, equipment, and capitalized software

709

6,418

Gain on sale of California MA business

(65,210

)

Other, net

5,135

1,858

Changes in assets and liabilities, net of acquired assets and liabilities:

Accounts receivable

(2,001

)

(7,756

)

ACO REACH performance year receivable

20,803

(16,697

)

Other assets

(10,162

)

191,441

Medical cost payable

(55,254

)

(635,616

)

Risk adjustment payable

(14,311

)

(1,652,744

)

Accounts payable and other liabilities

(3,941

)

(149,325

)

Unearned revenue

79

(10,614

)

Warrant liability

16,924

13,971

Risk share payable to deconsolidated entity

123,981

Net cash (used in) provided by operating activities

(123,217

)

(2,726,546

)

Cash flows from investing activities:

Purchases of investments

(14,963

)

(837,074

)

Proceeds from sales, paydown, and maturities of investments

7,069

1,960,283

Purchases of property and equipment

(2,333

)

(2,897

)

Proceeds from sale of business, net

197,121

(682

)

Net cash provided by (used in) investing activities

186,894

1,119,630

Cash flows from financing activities:

Proceeds from long-term borrowings

119,804

66,400

Proceeds from short-term borrowings

2,000

Repayments of short-term borrowings

(273,636

)

Purchase of non-controlling interests

(93,950

)

Distributions to noncontrolling interest holders

(7,770

)

(16,494

)

Net cash (used in) provided by financing activities

(253,552

)

49,906

Net increase (decrease) in cash and cash equivalents

(189,875

)

(1,557,010

)

Cash and cash equivalents – beginning of year

$

375,280

$

1,932,290

Cash and cash equivalents – end of period

$

185,405

$

375,280

NeueHealth, Inc. and Subsidiaries

Segment Information

(in thousands)

(Unaudited)

NeueCare

($ in thousands)

Three Months Ended
December 31,

Years Ended
December 31,

Statement of income (loss) and operating data:

2024

2023

2024

2023

Revenue:

Capitated revenue

$

63,076

$

60,091

$

259,881

$

219,774

Service revenue

12,213

11,848

40,646

41,559

Investment income

225

711

Total unaffiliated revenue

75,514

71,939

301,238

261,333

Affiliated revenue

3,738

(611

)

12,489

5,876

Total segment revenue

79,252

71,328

313,727

267,209

Operating expenses

Medical Costs

38,706

33,158

131,541

97,483

Operating Costs

28,536

26,896

128,672

119,922

Goodwill impairment

401,385

Intangible assets impairment

11,411

Bad debt expense

4,345

4,984

Restructuring charges

130

Depreciation and amortization

2,785

3,181

12,538

12,651

Total operating expenses

70,027

67,580

284,162

636,555

Operating income (loss)

$

9,225

$

3,748

$

29,565

$

(369,346

)

NeueSolutions

($ in thousands)

Three Months Ended
December 31,

Years Ended
December 31,

Statement of income (loss) and operating data:

2024

2023

2024

2023

Revenue:

ACO REACH revenue

$

154,249

$

219,659

$

625,339

896,504

Service revenue

2,823

1,203

9,747

2,879

Total segment revenue

157,072

220,862

635,086

899,383

Operating expenses

Medical Costs

149,926

231,095

623,089

904,986

Operating Costs

4,041

4,391

17,243

14,474

Bad debt expense

1

8

17

22,423

Total operating expenses

153,968

235,494

640,349

941,883

Operating income (loss)

$

3,104

$

(14,632

)

$

(5,263

)

$

(42,500

)

Non-GAAP Financial Measures

We use the non-GAAP financial measures Adjusted EBITDA and Adjusted Operating Cost Ratio. We define Adjusted EBITDA as Net Loss excluding (income) loss from discontinued operations, interest expense, income taxes, transaction related costs, depreciation and amortization, share-based and long-term compensation expense, restructuring and contract termination costs, impairment of goodwill and intangible assets, losses related to the bankruptcy of one of our ACO REACH partners, changes in the fair value of equity securities and derivatives, changes in the fair value of contingent consideration. We define Adjusted Operating Cost Ratio as Operating Cost Ratio excluding share-based compensation expense. These non-GAAP measures have been presented in this quarterly Earnings Release or in the earnings conference call and related materials as supplemental measures of financial performance that are not required by or presented in accordance with GAAP because we believe they assist management and investors in comparing our operating performance across reporting periods on a consistent basis by excluding and including items that we do not believe are indicative of our core operating performance. Management believes these measures are useful to investors in highlighting trends in our operating performance, while other measures can differ significantly depending on long-term strategic decisions regarding capital structure, the tax jurisdictions in which we operate and capital investments. Management uses Adjusted EBITDA and Adjusted Operating Cost Ratio to supplement GAAP measures of performance in the evaluation of the effectiveness of our business strategies, to make budgeting decisions, to establish discretionary annual incentive compensation and to compare our performance against that of other peer companies using similar measures. Management supplements GAAP results with non-GAAP financial measures to provide a more complete understanding of the factors and trends affecting the business than GAAP results alone.

Adjusted EBITDA is not a recognized term under GAAP and should not be considered as an alternative to Net Income (Loss) as a measure of financial performance or any other performance measure derived in accordance with GAAP. Additionally, Adjusted EBITDA is not intended to be a measure of free cash flow available for management’s discretionary use as it does not consider certain cash requirements such as interest payments, tax payments and debt service requirements. The presentation of Adjusted EBITDA has limitations as an analytical tool and should not be considered in isolation or as a substitute for analysis of our results as reported under GAAP. Because not all companies use identical calculations, the presentation of these measures may not be comparable to other similarly titled measures of other companies and can differ significantly from company to company.

Adjusted Operating Cost Ratio is not a recognized term under GAAP and should not be considered as an alternative to Operating Cost Ratio as a measure of financial performance or any other performance measure derived in accordance with GAAP. The presentation of Adjusted Operating Cost Ratio has limitations as an analytical tool and should not be considered in isolation or as a substitute for analysis of our results as reported under GAAP. Because not all companies use identical calculations, the presentation of these measures may not be comparable to other similarly titled measures of other companies and can differ significantly from company to company.

The following table provides a reconciliation of net loss to Adjusted EBITDA for the periods presented:

Three Months Ended
December 31,

Years Ended
December 31,

($ in thousands)

2024

2023

2024

2023

Net Income (Loss)

$

2,523

$

(460,572

)

$

(99,717

)

$

(1,265,808

)

Loss from Discontinued Operations

(45,003

)

397,745

(2,341

)

638,066

EBITDA adjustments from continuing operations

Interest expense

6,248

11,206

18,701

38,203

Income tax (benefit) expense

(672

)

1,591

2,597

(1,428

)

Transaction related costs (a)

16,122

4,363

19,301

23,252

Depreciation and amortization (h)

3,603

4,024

14,658

18,296

Share-based compensation and other long-term incentive compensation expense (b)

12,577

18,081

68,824

83,692

Restructuring and contract termination costs (e)

775

122

956

6,990

Impairment of goodwill and long-lived assets (h)

2,749

274

2,880

401,659

ACO REACH care partner bankruptcy (g)

8,713

3,475

36,454

Change in fair value of warrant liability (d)

7,486

4,097

3,661

13,971

Change in fair value of contingent consideration (i)

(1,827

)

Held-for-sale operations (f)

(926

)

19,812

Gain on troubled debt restructuring (c)

(30,311

)

EBITDA adjustments from continuing operations

$

47,962

$

52,471

$

124,554

$

619,262

Adjusted EBITDA

$

5,482

$

(10,356

)

$

22,496

$

(8,480

)

(a)

Transaction related costs include accounting, tax, valuation, consulting, legal and investment banking fees directly relating to financing initiatives and acquisitions or dispositions. These costs can vary from period to period and impact comparability, and we do not believe such transaction costs reflect the ongoing performance of our business. Included within transaction costs is $14.2 million of compensation expense that was recognized in relation to the purchase of the minority interest in Centrum for the three and twelve months ended December 31, 2024. There was no compensation expense included within transaction costs for the three and twelve months ended December 31, 2023.

(b)

Represents non-cash compensation expense related to stock option and restricted stock unit award grants, which can vary from period to period based on several factors, including the timing, quantity and grant date fair value of the awards. Also includes estimated compensation expense that the Company has the option to pay in cash or shares of $1.0 million and $6.4 million for the three and twelve months ended December 31, 2024, which is a 2024-only deviation from the long-term incentive award program.

(c)

Beginning in the first quarter of 2024, Adjusted EBITDA excludes the impact of gains on troubled debt restructuring. The comparable periods in 2023 have been recast to exclude these impacts.

(d)

Represents the non-cash change in the fair value of the warrant liability established for warrants included in our financing arrangements, which are remeasured at fair value each reporting period.

(e)

Restructuring and contract termination costs represent severance costs as part of a workforce reduction, amounts paid for early termination of leases, and impairment of certain long-lived assets primarily relating to our decision to exit the Commercial business for the 2023 plan year.

(f)

Beginning in the second quarter of 2024, Adjusted EBITDA excludes the impact of our operations classified as held- for-sale. For the three and twelve months ended December 31, 2024, no intangible asset impairment expense and $11.4 million of intangible asset impairment expense was incurred, respectively, as a result of classifying operations as held-for-sale. The comparable periods in 2023 have been recast to exclude these impacts.

(g)

Represents the costs expected to be incurred as a result of one of our ACO REACH care partners filing for bankruptcy; includes the full allowance established for the outstanding receivable and ongoing costs incurred to manage and provide service to members attributed to the care partner that would have otherwise been reimbursed prior to the care partner’s bankruptcy.

(h)

Adjustment has been updated to remove the impact of our held-for-sale operations that are adjusted for in their entirety as described in (f).

(i)

Represents the change in fair value of contingent consideration from business combinations, which is remeasured at fair value each reporting period.

The following table provides a reconciliation of Adjusted Operating Cost Ratio for the periods presented:

Three Months Ended
December 31,

Years Ended
December 31,

2024

2023

2024

2023

Operating Cost Ratio

31.3%

22.3%

29.2%

24.7%

Impact of share-based and other long-term incentive compensation expense (a)

(5.4)%

(6.2)%

(7.3)%

(7.2)%

Impact of held-for-sale operations (b)

(0.6)%

(3.5)%

(2.3)%

(2.4)%

Impact of transaction related costs (c)

(6.9)%

(1.5)%

(2.1)%

(2.0)%

Adjusted Operating Cost Ratio

18.4%

11.1%

17.5%

13.1%

(a)

Represents non-cash compensation expense related to stock option and restricted stock unit award grants, which can vary from period to period based on several factors, including the timing, quantity and grant date fair value of the awards. Also includes estimated compensation expense that the Company has the option to pay in cash or shares of $1.0 million and $6.4 million for the three and twelve months ended December 31, 2024, which is a 2024-only deviation from the long-term incentive award program.

(b)

Represents the impact of revenue and operating costs related to our operations classified as held-for-sale during the year ended December 31, 2024. The comparable periods in 2023 have been recast to exclude these impacts.

(c)

Transaction related costs include accounting, tax, valuation, consulting, legal and investment banking fees directly relating to financing initiatives and acquisitions or dispositions. These costs can vary from period to period and impact comparability, and we do not believe such transaction costs reflect the ongoing performance of our business. Included within transaction costs is $14.2 million of compensation expense that was recognized in relation to the purchase of the minority interest in Centrum for the three and twelve months ended December 31, 2024. There was no compensation expense included within transaction costs for the year ended December 31, 2023.