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S-1 Filing
agilon health (AGL) S-1IPO registration
Filed: 30 Aug 21, 4:03pm
Delaware | 8090 | 37-1915147 | ||
(State or Other Jurisdiction of Incorporation or Organization) | (Primary Standard Industrial Classification Code Number) | (I.R.S. Employer Identification Number) |
Paul M. Rodel, Esq. Debevoise & Plimpton LLP 919 Third Avenue New York, New York 10022 (212) 909-6000 | William V. Fogg, Esq. Michael E. Mariani, Esq. Cravath, Swaine & Moore LLP 825 Eighth Avenue New York, New York 10019 (212) 474-1000 |
Large accelerated filer | ☐ | Accelerated filer | ☐ | |||
Non-accelerated filer | ☒ | Smaller reporting company | ☐ | |||
Emerging growth company | ☐ |
Title of Each Class of Securities to be Registered | Proposed Maximum Aggregate Offering Price(1)(2) | Amount of Registration Fee | ||
Common Stock, par value $0.01 per share | $100,000,000 | $10,910 | ||
(1) | Estimated solely for the purpose of calculating the registration fee in accordance with Rule 457(o) of the Securities Act of 1933, as amended. |
(2) | Includes shares of common stock subject to the underwriters’ option to purchase additional shares. |
Per Share | Total | |||||||
Public offering price | $ | $ | ||||||
Underwriting discounts and commissions (1) | $ | $ | ||||||
Proceeds, before expenses, to the selling stockholders | $ | $ |
(1) | See “Underwriting” for a description of the compensation payable to the underwriters. |
J.P. Morgan | Goldman Sachs & Co. LLC |
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F-1 |
i |
• | “We,” “us,” “our,” “agilon” and the “Company” mean agilon health, inc., a Delaware corporation and its consolidated subsidiaries, unless the context refers only to agilon health, inc., as a corporate entity (which we refer to as “agilon health”). |
• | ���Anchor geography” means the geographies in which our anchor physician groups operate. |
• | “Anchor physician groups” means the physician groups with which we have long-term contractual arrangements, typically including joint governance, operations and leadership, and surplus sharing, and does not include physicians in our Hawaii geography. |
• | “Capitation” means a payment arrangement in which a set amount for each enrolled beneficiary is paid to a provider or entity during an agreed upon period, regardless of whether or not such beneficiary seeks medical services or treatment. |
• | “CMS” means the Centers for Medicare & Medicaid Services. |
• | “CMS Innovation Center” means the Center for Medicare & Medicaid Innovation. |
• | “DCE” means a Direct Contracting Entity participating in the CMS Innovation Center Direct Contracting Model. |
• | “FFS” means fee-for-service. |
• | “Independent physicians” means physicians not employed by health systems or insurance providers. |
• | “Live,” when referring to a physician partner or a geography, means implementation of our platform with the physician partner or in the geography is complete, and we are generating revenue and assuming financial risk pursuant to agreements with payors. |
• | “MA” means Medicare Advantage. |
• | “Members” means the MA patients who are attributed to our PCPs (as defined below) by our payors (as defined below). |
• | “Payors” means health insurance providers. |
• | “Our PCPs” means PCPs contracted by our anchor physician groups and our network of contracted physicians. |
• | “PCP” means primary care physician. |
• | “Physician partners” means our anchor physician groups and all other physicians with whom we have contractual arrangements. |
• | “PMPM” means per member per month. |
• | “RBE” means a risk-bearing entity. |
• | “STAR rating” means annual ratings awarded by CMS to health plans which measure the quality of health services received by beneficiaries enrolled in MA based on various calculated quality metrics. |
• | “Total Care Model” means a PCP-led global capitation reimbursement model in which physicians receive a monthly payment from health plans to manage the total healthcare needs of their attributed patients. |
ii |
iii |
• | Unsustainably high and rising costs characterized by waste, unnecessary variation in care and poor patient experience and health outcomes; |
• | FFS reimbursement model focused on units of service rather than a coordinated approach to meet the unique needs of individual patients; |
• | The Medicare population is projected to grow from approximately 62 million in 2020 to more than 70 million individuals in 2025 with a total spend of approximately $1.25 trillion, and MA enrollment is projected to comprise 47% of total Medicare enrollment (which we refer to as the “MA penetration rate”); and |
• | PCPs are positioned—but not currently empowered or incentivized—to act as the quarterback for healthcare delivery, with their decisions estimated to influence up to 90% of total healthcare spending according to a 2017 study. |
• | Implemented the first MA multi-payor, globally capitated risk model with a community-based physician group in all of our diverse geographies in which our anchor physician groups operate (“anchor geographies”); |
• | Exported the Total Care Model from one to 17 geographies ranging from communities as small as Zanesville, Ohio to large and rapidly growing communities such as Austin, Texas; |
• | Grew from approximately 24,000 patients attributed to our PCPs by our payors (“members”) to approximately 230,700 MA members on our platform; |
• | Expanded from two payors to 15 payors on our platform; and |
• | Began participating in the Direct Contracting Model, with over 50,000 Medicare FFS beneficiaries served by our existing PCPs contracted through our five currently approved DCEs. |
• | agilon’s platform, which is holistic in enabling the rapid transformation to risk, is comprised of an integrated set of capabilities designed to continuously improve, and is delivered to our anchor physician groups through an aligned long-term partnership model; |
• | agilon’s long-term physician partnership approach with community-based physician groups, which is designed to move healthcare closer to the physician, be outcome-centric and optimize the long-term sticky relationship between a patient and their existing physician; and |
• | agilon’s network of leading community-based physician partners, functioning as a collaborative group which can share best practices, influence the development of the platform, compare notes on the transition to a Total Care Model and learn from one another. |
(1) | 2020 Medicare spend for total Medicare beneficiaries is based on CMS spend per beneficiary. |
(2) | 2025 Medicare spend for total Medicare beneficiaries, beneficiaries attributed to independent PCPs and agilon total addressable market is based on CMS projected Medicare enrollment and spending per beneficiary growth rates. |
• | PCPs lack the incentive structure to reorganize the healthcare delivery system. |
• | PCPs lack the infrastructure to participate in a multi-payor model. |
• | PCPs lack the breadth of capabilities and resources necessary to transition to a Total Care Model. |
• | PCP groups are highly fragmented and lack the benefits of scale. |
• | Limited long-term, deep collaboration between payors and physicians. |
• | Payor Engagement |
• | Direct Contracting Model |
• | Data Integration and Management |
• | Clinical Programs and Product Development |
• | Quality (Clinical and Experience) |
• | Growth 60-64 year-old patients, to enable their patients to make educated healthcare choices. These patients represent an embedded growth opportunity. |
• | Performance Management Analytics peer-to-peer |
• | Financial Management |
• | National Policy |
• | Long-term partnership model that allows both agilon and physicians to take the long-term view and benefit from the maturity of a growing number of members on the platform; |
• | Shared governance and co-location of staff to manage our local partnerships; |
• | Local dyad leadership structure that includes a medical director from the local anchor physician group; |
• | Local brand which reflects the local anchor physician group or geography; |
• | Capital from agilon to support value-based care infrastructure supporting the delivery of high-quality healthcare, and 100% downside protection, which removes a major obstacle to physicians making the leap to a Total Care Model; |
• | Operating leverage created by amortizing centralized investments in the platform infrastructure across a growing number of physician partners; and |
• | Surplus dollars generated locally due to improvements in quality of care and healthcare costs are shared with the local anchor physician group. |
• | empower PCPs to act as the quarterback for healthcare delivery; |
• | enable PCPs to define a tailored patient experience across multiple payors; |
• | create an operating partnership and economic model built around improved health outcomes instead of a transaction-based model; and |
• | align the physician business model with the strength of their long-term patient relationships enabling the long-term growth of independent, community-based physician groups. |
• | Rapid creation of a Medicare Total Care Model that enables our PCPs to take a long-term view of their relationships with their patients and allocate resources to meet individual member health needs. |
• | Sustainable long-term business model alongside commercial and Medicare FFS. |
• | Provides access to network of like-minded partners. |
• | Improved economics. |
• | Improving the physician experience. |
• | Improving the patient experience. |
• | Supporting superior health outcomes. |
• | We believe we have the ability to generate significant, recurring and growing medical margin in concert with our physician partners over the course of our long-term partnerships and the inherently sticky physician-patient relationship. |
• | Our physician partnerships are typically 20 years. |
• | Average physician tenure within our anchor physician groups is 13 years. |
• | Patients 65 years of age and older remain with their PCP for an average of 10 years, according to a 2004 study. |
• | Embedded same-geography, long-term organic membership growth resulting from our physician partners’ existing patients who age into Medicare and elect to enroll in MA or who elect to convert from Medicare FFS to MA over the life of our long-term partnership. |
1 | Includes COPC, certain private investment funds and our physician partners with whom we have physician partner group equity agreements. |
2 | Includes indebtedness related to the 2021 Credit Facilities (as defined herein), including term loan indebtedness, revolver indebtedness and letters of credit. On February 18, 2021, we, through agilon health management, inc. (“agilon management”), entered in the 2021 Secured Credit Agreement (as defined herein) to refinance our outstanding indebtedness under the Credit Facilities (as defined herein). See “Description of Certain Indebtedness.” |
3 | Operating subsidiaries include wholly-owned RBEs, independent practice associations and other immaterial subsidiaries, which have been omitted from this chart for convenience. |
4 | Ownership percentages assume no exercise of the underwriters option to purchase up to additional shares of common stock in the offering, and are determined as described in “—The Offering.” |
• | our history of net losses and the expectation that our expenses will increase in the future; |
• | failure to identify and develop successful new geographies, physician partners and payors or execute upon our growth initiatives; |
• | success in executing our operating strategies or achieving results consistent with our historical performance; |
• | significant reductions in membership; |
• | challenges for our physician partners in the transition to a Total Care Model; |
• | inaccuracies in the estimates and assumptions we use to project the size, revenue or medical expense amounts of our target geographies, our members’ risk adjustment factors, medical services expense, incurred but not reported claims and earnings pursuant to payor contracts; |
• | the spread of, and response to, the novel coronavirus, or COVID-19, and the inability to predict the ultimate impact on us; |
• | dependence on a limited number of key payors, including for membership attribution and assignment, data and reporting accuracy and claims payment; |
• | dependence on physician partners and other providers to effectively manage the quality and cost of care and perform obligations under payor contracts, which contracts generally provide that if the cost of care exceeds the corresponding capitation revenue we receive from payors in respect of attributed members we may realize operating deficits, which are typically not capped, and could lead to substantial losses; |
• | dependence on physician partners to accurately, timely and sufficiently document their services and potential False Claims Act or other liability if any diagnosis information or encounter data are inaccurate or incorrect; |
• | reductions in reimbursement rates or methodology applied to derive reimbursement from, or discontinuation of, federal government healthcare programs, from which we drive substantially all of our total revenue; |
• | statutory or regulatory changes, administrative rulings, interpretations of policy and determinations by intermediaries and governmental funding restrictions, and any impact on government funding, program coverage and reimbursements; |
• | the impact on our revenue of CMS modifying the methodology used to determine the revenue associated with MA members; |
• | ability to comply with federal, state and local regulations and laws we are subject to, or to adapt to changes in or new regulations or laws, including as such regulations and laws that relate to our physician alignment strategies with our physician partners or the corporate practice of medicine; |
• | our physician partners’ compliance with federal and state healthcare fraud and abuse laws and regulations; and |
• | the influence of the CD&R Investor and our status as a “controlled company.” |
Common stock offered by the selling stockholders | shares. |
Common stock to be outstanding after this offering | 390,882,560 shares. |
Option to purchase additional shares | The underwriters also may purchase up to additional shares from the selling stockholders at the initial offering price less the underwriting discounts and commissions, within 30 days from the date of this prospectus. |
Use of proceeds | We will not receive any of the proceeds from the sale of our common stock by the selling stockholders in this offering, including any shares the selling stockholders may sell pursuant to the underwriters’ option to purchase additional shares of our common stock. |
Dividend policy | We do not currently anticipate paying dividends on our common stock for the foreseeable future. Any future determination to pay dividends on our common stock will be subject to the discretion of our board of directors and depend upon various factors. See “Dividend Policy.” |
Risk Factors | Our business is subject to a number of risks that you should consider before making a decision to invest in our common stock. See “Risk Factors.” |
NYSE symbol | “AGL”. |
• | 41,197,388 shares of common stock issuable upon exercise of options outstanding as of June 30, 2021 at a weighted average exercise price of $4.40 per share; |
• | 28,453,653 shares of common stock reserved for future issuance under our Omnibus Incentive Plan and ESPP; and |
• | 1,112,131 shares of our common stock subject to outstanding unvested RSUs granted to directors and employees. |
Six Months Ended June 30, | Three Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
( dollars in thousands | 2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | |||||||||||||||||||||
Consolidated Statement of Operations Data: | ||||||||||||||||||||||||||||
Revenues: | ||||||||||||||||||||||||||||
Medical services revenue | $ | 910,090 | $ | 582,309 | $ | 497,678 | $ | 292,495 | $ | 1,214,270 | $ | 788,566 | $ | 466,612 | ||||||||||||||
Other operating revenue | 1,970 | 2,333 | 1,278 | 1,099 | 4,063 | 5,845 | 8,215 | |||||||||||||||||||||
Total revenues | 912,060 | 584,642 | 498,956 | 293,594 | 1,218,333 | 794,411 | 474,827 | |||||||||||||||||||||
Expenses: | ||||||||||||||||||||||||||||
Medical services expense | 802,837 | 468,016 | 442,483 | 220,363 | 1,021,877 | 725,374 | 412,669 | |||||||||||||||||||||
Other medical expenses | 57,355 | 53,187 | 33,694 | 34,761 | 102,306 | 40,526 | 34,092 | |||||||||||||||||||||
General and administrative | 79,318 | 60,832 | 43,013 | 34,248 | 137,292 | 122,832 | 88,745 | |||||||||||||||||||||
Stock-based compensation expense (1) | 276,020 | 3,176 | 274,548 | 2,155 | ||||||||||||||||||||||||
Depreciation and amortization | 7,008 | 6,517 | 3,581 | 3,319 | 13,531 | 12,253 | 11,385 | |||||||||||||||||||||
Total expenses | 1,222,538 | 591,728 | 797,319 | 294,846 | 1,275,006 | 900,985 | 546,891 | |||||||||||||||||||||
Income (loss) from operations | (310,478 | ) | (7,086 | ) | (298,363 | ) | (1,252 | ) | (56,673 | ) | (106,574 | ) | (72,064 | ) | ||||||||||||||
Other income (expense): | ||||||||||||||||||||||||||||
Other income (expense), net | 4,303 | 48 | 2,967 | (74 | ) | 2,465 | 955 | 611 | ||||||||||||||||||||
Interest expense | (4,439 | ) | (4,229 | ) | (1,498 | ) | (2,080 | ) | (8,135 | ) | (9,068 | ) | (9,839 | ) | ||||||||||||||
Income (loss) before income taxes | (310,614 | ) | (11,267 | ) | (296,894 | ) | (3,406 | ) | (62,343 | ) | (114,687 | ) | (81,292 | ) | ||||||||||||||
Income tax benefit (expense) | (451 | ) | (39 | ) | (435 | ) | (39 | ) | (865 | ) | 232 | 113 | ||||||||||||||||
Income (loss) from continuing operations | (311,065 | ) | (11,306 | ) | (297,329 | ) | (3,445 | ) | (63,208 | ) | (114,455 | ) | (81,179 | ) | ||||||||||||||
Discontinued operations: | ||||||||||||||||||||||||||||
Income (loss) before impairments, gain (loss) on sales and income taxes | (2,898 | ) | (12,429 | ) | (1,547 | ) | (4,340 | ) | (20,049 | ) | (86,108 | ) | (32,132 | ) | ||||||||||||||
Impairments | — | — | — | — | — | (98,343 | ) | (40,794 | ) | |||||||||||||||||||
Gain (loss) on sales of assets, net | — | — | — | — | 20,401 | — | — | |||||||||||||||||||||
Income tax benefit (expense) | (129 | ) | (275 | ) | (65 | ) | (126 | ) | 2,804 | 16,166 | 7,588 | |||||||||||||||||
Total discontinued operations | (3,027 | ) | (12,704 | ) | (1,612 | ) | (4,466 | ) | 3,156 | (168,285 | ) | (65,338 | ) | |||||||||||||||
Net income (loss) | (314,092 | ) | (24,010 | ) | (298,941 | ) | (7,911 | ) | (60,052 | ) | (282,740 | ) | (146,517 | ) | ||||||||||||||
Noncontrolling interests’ share in (earnings) loss | 169 | — | 96 | — | — | 152 | (409 | ) | ||||||||||||||||||||
Net income (loss) attributable to common shares | $ | (313,923 | ) | $ | (24,010 | ) | $ | (298,845 | ) | $ | (7,911 | ) | $ | (60,052 | ) | $ | (282,588 | ) | $ | (146,926 | ) | |||||||
(1) | For annual periods prior to 2021, stock-based compensation expense is included in general and administrative expenses. |
June 30, 2021 | December 31, 2020 | December 31, 2019 | ||||||||||
Consolidated Balance Sheet Data (at period end): | ||||||||||||
Cash and cash equivalents | $ | 1,109,372 | $ | 106,795 | $ | 123,633 | ||||||
Total assets | 1,701,734 | 446,361 | 402,794 | |||||||||
Total liabilities | 551,456 | 421,591 | 353,822 | |||||||||
Contingently redeemable common stock | — | 309,500 | 281,000 | |||||||||
Total stockholders’ equity (deficit) | 1,150,278 | (284,730 | ) | (232,028 | ) |
Six Months Ended June 30, | Year Ended December 31, | |||||||||||||||||||
( dollars in thousands | 2021 | 2020 | 2020 | 2019 | 2018 | |||||||||||||||
Consolidated Statement of Cash Flows Data: | ||||||||||||||||||||
Cash flows from: | ||||||||||||||||||||
Operating activities | $ | (80,119 | ) | $ | (35,498 | ) | $ | (53,204 | ) | $ | (103,861 | ) | $ | (67,531 | ) | |||||
Investing activities | (76,338 | ) | (2,351 | ) | $ | 22,066 | $ | (5,060 | ) | $ | (7,970 | ) | ||||||||
Financing activities | 1,143,077 | 31,522 | $ | 24,621 | $ | 176,298 | $ | 84,743 |
Six Months Ended June 30, | Three Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
( dollars in thousands | 2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | |||||||||||||||||||||
Other Financial Data: | ||||||||||||||||||||||||||||
Medical margin (1) | $ | 107,253 | $ | 114,293 | $ | 55,195 | $ | 72,132 | $ | 192,393 | $ | 63,192 | $ | 53,943 | ||||||||||||||
Network contribution (2) | 54,436 | 63,250 | 24,294 | 38,510 | 99,016 | 25,598 | 22,083 | |||||||||||||||||||||
Adjusted EBITDA (3) | 2,088 | 16,888 | (1,674 | ) | 14,311 | 5,827 | (56,711 | ) | (32,240 | ) |
(1) | Medical margin represents medical services revenue after deducting medical services expense. |
(2) | Network contribution is a non-GAAP financial measure. Network contribution represents medical services revenue less the sum of: (i) medical services expense and (ii) other medical expenses excluding costs incurred in implementing geographies. Income (loss) from operations is the most directly comparable U.S. generally accepted accounting principles (“GAAP”) measure to network contribution. See “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Non-GAAP Financial Measures” for more information regarding network contribution and a reconciliation to income (loss) from operations. |
(3) | Adjusted EBITDA is a non-GAAP financial measure. We define Adjusted EBITDA as net income (loss) adjusted to exclude: (i) income (loss) from discontinued operations, net of income taxes, (ii) interest expense, (iii) income tax expense (benefit), (iv) depreciation and amortization expense, (v) geography entry costs, (vi) share-based compensation expense, (vii) severance and related costs and (viii) certain other items that are not considered by us in the evaluation of ongoing operating performance. Net income (loss) is the most directly comparable GAAP measure to Adjusted EBITDA. See “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Non-GAAP Financial Measures” for more information regarding Adjusted EBITDA and a reconciliation to net income (loss). |
• | Changes to the Medicare fee schedule or other rate schedules which serve as the basis for payments issued to hospitals, specialty and ancillary physicians and other providers; |
• | Contractual rates paid to hospitals, specialty and ancillary physicians and other providers; |
• | The utilization rates of healthcare services, including inpatient hospitalization, by our members; |
• | Changes to member benefit levels established annually by payors; and |
• | The utilization rate and cost of pharmaceuticals or specialty drugs utilized by our members. |
• | failure to obtain new physician partners or members or to retain existing physician partners or members; |
• | decision by a payor to not renew the existing contractual agreement upon termination of such contract; |
• | low quality of care by our physician partners, including as a result of our failure to provide tools and information to deliver high-quality care; |
• | alternative care opportunities that are more attractive than those provided by our physician partners; |
• | premium increases, benefit revisions or other similar changes, which cause our current payor relationships to be less attractive to members than other alternatives, including traditional Medicare or MA plans with which we do not maintain a relationship; |
• | negative publicity, through social media, news coverage or otherwise, related to us, our physician partners, payors or MA; |
• | failure of our payors to maintain their annual ratings awarded by CMS to health plans which measure the quality of health services received by beneficiaries enrolled in MA based on various calculated quality metrics (“STAR ratings”), which leads to members disenrolling from such payors; and |
• | federal and state regulatory changes. |
• | damage from fire, power loss, natural disasters and other events outside our control; |
• | communications failures; |
• | software and hardware errors, failures and crashes; |
• | data security breaches, ransomware attacks, computer viruses, hacking, denial-of-service |
• | other potential interruptions. |
• | requiring us to change our platform and services; |
• | increasing the regulatory, including compliance, burdens under which we operate, which, in turn, may negatively impact the manner in which we provide services and increase our costs; |
• | adversely affecting our ability to market our services through the imposition of further regulatory restrictions regarding the manner in which plans market to MA enrollees; or |
• | adversely affecting our ability to attract and retain physician partners and have patients attributed to those physician partners. |
• | Federal and state laws, and related regulations, including the False Claims Act and the Civil Monetary Penalties Law (“CMPL”), which impose civil and criminal liability on individuals or entities that knowingly submit false or fraudulent claims for payment, or knowingly make, or cause to be made, a false statement in order to have a false claim paid, including qui tam |
• | Federal and state anti-kickback laws, and related regulations, which generally prohibit transactions intended to induce or reward referrals for items or services reimbursable by a federal healthcare program; |
• | Federal and state physician self-referral prohibition statutes, and related regulations, which generally prohibit physicians from referring a patient to an entity providing designated health services (“DHS”) if the physician (or his/her immediate family member) has a financial relationship with that entity; |
• | Provisions of, and regulations enacted pursuant to, HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act of 2009 (the “HITECH Act”) and the American Recovery and Reinvestment Act of 2009, as well as similar or more stringent state laws, regarding the collection, use and disclosure of health information; |
• | Provisions of, and regulations enacted pursuant to, the 21 st Century Cures Act, regarding interoperability and prohibitions against information blocking; |
• | Federal laws and regulations that require providers to enroll in the Medicare program before submitting any claims for services, to promptly report certain changes in operations to the agencies that administer these programs, and to re-enroll in these programs when changes in direct or indirect ownership occur or in response to revalidation requests from Medicare; |
• | Federal and state laws that govern managed care organizations, such as our payors, and downstream contracted entities, such as our RBEs, including laws governing timely payment of claims, quality assurance, utilization review, credentialing, financial solvency, downstream transfers of risk and payor-provider contractual relationships; |
• | State laws that govern the activities of third-party administrators and utilization review agents; and |
• | State laws that prohibit general business entities from practicing medicine, controlling physicians’ medical decisions or engaging in certain practices, such as splitting fees with physicians. |
• | suspension or termination of our participation in federal healthcare programs; |
• | criminal or civil liability, fines, damages or monetary penalties for violations of healthcare fraud and abuse laws, including the federal False Claims Act, CMPL, Anti-Kickback Statute and Stark Law; |
• | enforcement actions by governmental agencies or claims for monetary damages by patients under federal or state patient privacy laws, including HIPAA; |
• | enforcement actions by governmental agencies or monetary penalties for violations of the 21 st Century Cures Act; |
• | repayment of amounts received in violation of law or applicable payment program requirements, and related monetary penalties; |
• | mandated changes to our practices or procedures that materially increase operating expenses; |
• | imposition of corporate integrity agreements that could subject us to ongoing audits and reporting requirements as well as increased scrutiny of our billing and business practices; |
• | termination of various relationships or contracts related to our business; and |
• | harm to our reputation which could negatively affect our business relationships, decrease our ability to attract or retain patients and physicians, decrease access to new business opportunities and impact our ability to obtain financing, among other things. |
• | our ability to obtain additional financing for working capital, capital expenditures, acquisitions, debt service requirements, pay dividends and make other distributions or to purchase, redeem or retire capital stock or for general corporate purposes and our ability to satisfy our obligations with respect to our indebtedness may be impaired in the future; |
• | a large portion of our cash flow from operations must be dedicated to the payment of principal and interest on our indebtedness, thereby reducing the funds available to us for other purposes; |
• | we are exposed to the risk of increased interest rates because a significant portion of our borrowings are at variable rates of interest; |
• | it may be more difficult for us to satisfy our obligations to our creditors, resulting in possible defaults on, and acceleration of, such indebtedness; |
• | we may be more vulnerable to general adverse economic and industry conditions; |
• | we may be at a competitive disadvantage compared to our competitors with proportionately less indebtedness or with comparable indebtedness on more favorable terms and, as a result, they may be better positioned to withstand economic downturns; |
• | our ability to refinance indebtedness may be limited or the associated costs may increase; |
• | our flexibility to adjust to changing market conditions and ability to withstand competitive pressures could be limited; |
• | our ability to pay dividends and make other distributions or to purchase, redeem or retire capital stock may be limited; and |
• | we may be prevented from carrying out capital spending and restructurings that are necessary or important to our growth strategy and efforts to improve our operating margins. |
• | incur additional indebtedness and create liens; |
• | pay dividends and make other distributions or to purchase, redeem or retire capital stock; |
• | purchase, redeem or retire certain junior indebtedness; |
• | make loans and investments; |
• | enter into agreements that limit agilon management’s or its subsidiaries’ ability to pledge assets or to make distributions or loans to us or transfer assets to us; |
• | sell assets; |
• | enter into certain types of transactions with affiliates; |
• | consolidate, merge or sell substantially all assets; |
• | make voluntary payments or modifications of junior indebtedness; and |
• | enter into lines of business. |
• | industry, regulatory or general market conditions; |
• | domestic and international economic factors unrelated to our performance; |
• | changes in our physician partners’ or their patients’ preferences; |
• | new regulatory pronouncements and changes in regulatory guidelines; |
• | lawsuits, enforcement actions and other claims by third parties or governmental authorities; |
• | actual or anticipated fluctuations in our quarterly operating results; |
• | lack of research coverage and reports by industry analysts or changes in any securities analysts’ estimates of our financial performance; |
• | action by institutional stockholders or other large stockholders, including future sales of our common stock; |
• | failure to meet any guidance given by us or any change in any guidance given by us, or changes by us in our guidance practices; |
• | announcements by us of significant impairment charges; |
• | speculation in the press or investment community; |
• | investor perception of us and our industry; |
• | changes in market valuations or earnings of similar companies; |
• | the impact of short selling or the impact of a potential “short squeeze” resulting from a sudden increase in demand for our common stock; |
• | announcements by us or our competitors of significant contracts, acquisitions, dispositions or strategic partnerships; |
• | war, terrorist acts and epidemic disease, including COVID-19; |
• | any future sales of our common stock or other securities; |
• | additions or departures of key personnel; and |
• | misconduct or other improper actions of our employees. |
• | authorize the issuance of “blank check” preferred stock that could be issued by our board of directors to thwart a takeover attempt; |
• | provide for a classified board of directors, which divides our board of directors into three classes, with members of each class serving staggered three-year terms, which prevents stockholders from electing an entirely new board of directors at an annual meeting; |
• | limit the ability of stockholders to remove directors if the CD&R Investor ceases to beneficially own at least 40% of the outstanding shares of our common stock; |
• | provide that vacancies on our board of directors, including vacancies resulting from an enlargement of our board of directors, may be filled only by a majority vote of directors then in office; |
• | prohibit stockholders from calling special meetings of stockholders if the CD&R Investor ceases to beneficially own at least 40% of the outstanding shares of our common stock; |
• | prohibit stockholder action by written consent, thereby requiring all actions to be taken at a meeting of the stockholders, if the CD&R Investor ceases to beneficially own at least 40% of the outstanding shares of our common stock; |
• | opt out of Section 203 of the DGCL, which prohibits a publicly-held Delaware corporation from engaging in a “business combination” with an “interested stockholder” for a period of three years following the time the person became an interested stockholder, until the CD&R Investor ceases to beneficially own at least 5% of the outstanding shares of our common stock; |
• | establish advance notice requirements for nominations of candidates for election as directors or to bring other business before an annual meeting of our stockholders; and |
• | require the approval of holders of at least 66 2/3% of the outstanding shares of our common stock to amend our By-laws and certain provisions of our Certificate of Incorporation if the CD&R Investor ceases to beneficially own at least 40% of the outstanding shares of our common stock. |
• | the requirement that a majority of the board of directors consist of independent directors; |
• | the requirement that our Nominating and Governance Committee be composed entirely of independent directors with a written charter addressing the committee’s purpose and responsibilities; |
• | the requirement that we have a Compensation Committee that is composed entirely of independent directors with a written charter addressing the committee’s purpose and responsibilities; and |
• | the requirement for an annual performance evaluation of the Nominating and Governance and Compensation Committees. |
• | our history of net losses, and our ability to achieve or maintain profitability in an environment of increasing expenses; |
• | our ability to identify and develop successful new geographies, physician partners and payors, or to execute upon our growth initiatives; |
• | our ability to execute our operation strategies or to achieve results consistent with our historical performance; |
• | our expectation that our expenses will increase in the future and the risk that medical expenses incurred on behalf of members may exceed the amount of medical revenues we receive; |
• | our ability to secure contracts with MA payors or to secure MA at favorable financial terms; |
• | our ability to recover startup costs incurred during the initial stages of development of our physician partner relationships and program initiatives; |
• | our ability to obtain additional capital needed to support our business; |
• | significant reductions in our membership; |
• | challenges for our physician partners in the transition to a Total Care Model; |
• | inaccuracies in the estimates and assumptions we use to project the size, revenue or medical expense amounts of our target market; |
• | the spread of, and response to, the novel coronavirus, or COVID-19, and the inability to predict the ultimate impact on us; |
• | inaccuracies in the estimates and assumptions we use to project our members’ risk adjustment factors, medical services expense, incurred but not reported claims and earnings pursuant to payor contracts; |
• | the impact of restrictive or exclusivity clauses in some of our contracts with physician partners that may prohibit us from establishing new RBEs within certain geographies in the future; |
• | the impact of restrictive or exclusivity clauses in some of our contracts with physician partners that may subject us to investigations or litigation; |
• | our ability to retain our management team and key employees or attract qualified personnel in the future; |
• | our ability to realize the full value of our intangible assets and any impairment charges we have or may record; |
• | adverse determinations of tax matters; |
• | security breaches, loss of data or other disruptions to our data platforms; |
• | our reliance on third parties for internet infrastructure and bandwidth to operate our business and provide services to our members and physician partners; |
• | our ability to protect the confidentiality of our know-how and other proprietary and internally developed information; |
• | the impact of devoting significant attention and resources to the provision of certain transition services in connection with the disposition of our California operations; |
• | our subsidiaries’ lack of performance or ability to fund their operations, which could require us to fund such losses; |
• | our dependence on a limited number of key payors; |
• | the limited terms of our contracts with payors and that they may not be renewed upon their expiration; |
• | our reliance on our payors for membership attribution and assignment, data and reporting accuracy and claims payment; |
• | our dependence on physician partners and other providers to effectively manage the quality and cost of care and perform obligations under payor contracts; |
• | difficulties in obtaining accurate and complete diagnosis data; |
• | our dependence on physician partners to accurately, timely and sufficiently document their services and potential False Claims Act or other liability if any diagnosis information or encounter data are inaccurate or incorrect; |
• | our reliance on third-party software and data to operate our business and provide services to our members and physician partners; |
• | the impact of consolidation in the healthcare industry; |
• | reductions in reimbursement rates or methodology applied to derive reimbursement from, or discontinuation of, federal government healthcare programs, from which we derive substantially all of our total revenue; |
• | uncertain or adverse economic conditions, including a downturn or decrease in government expenditures; |
• | our ability to compete in our competitive industry; |
• | the impact of government performance standards and benchmarks on our compensation and reputation; |
• | statutory or regulatory changes, administrative rulings, interpretations of policy and determinations by intermediaries and governmental funding restrictions, and their impact on government funding, program coverage and reimbursements; |
• | regulatory proposals directed at containing or lowering the cost of healthcare and our participation in such proposed models; |
• | we, our physician partners or affiliates being subject to federal or state investigations, audits and enforcement actions; |
• | regulatory inquiries and corrective action plans imposed by our payors; |
• | repayment obligations arising out of payor audits; |
• | the impact on our revenue of CMS modifying the methodology used to determine the revenue associated with MA members; |
• | negative publicity regarding the managed healthcare industry; |
• | the extensive regulation of the healthcare industry at the federal, state and local levels; |
• | our substantial indebtedness and the potential that we may incur additional indebtedness; |
• | our ability to sustain an active, liquid trading market for our common stock; |
• | the significant influence the CD&R Investor has over us; and |
• | risks related to other factors discussed under “Risk Factors” in this prospectus. |
June 30, 2021 | ||||
(dollars in thousands, except share and per share amounts) | ||||
Cash and cash equivalents (1) | $ | 1,109,372 | ||
Long-term debt (1)(2) | 49,612 | |||
Mezzanine and Stockholders’ Equity: | ||||
Common stock, $0.01 par value (3) | 3,909 | |||
Additional paid-in capital (3) | 2,011,651 | |||
Accumulated deficit | (865,113 | ) | ||
Noncontrolling interests | (169 | ) | ||
Total stockholders’ equity (deficit) | 1,150,278 | |||
Total capitalization | $ | 1,199,890 | ||
(1) | In connection with our IPO, on April 26, 2021 we made a mandatory prepayment of $50.0 million of the 2021 Secured Term Loan Facility as a result of the gross proceeds from the IPO exceeding $1.0 billion. |
(2) | As of June 30, 2021, we had availability under the 2021 Secured Revolving Facility totaling $64.4 million and outstanding letters of credit totaling $35.6 million, of which $14.0 million was for the DCEs. See “Description of Certain Indebtedness” included elsewhere in this prospectus. |
(3) | As of June 30, 2021, we had 390,882,560 shares of common stock issued and outstanding. The shares of common stock outstanding exclude: |
• | 41,197,388 shares of common stock issuable upon exercise of options outstanding as of June 30, 2021 at a weighted average exercise price of $4.40 per share; |
• | 28,453,653 shares of common stock reserved for future issuance under our Omnibus Incentive Plan and ESPP; and |
• | 1,112,131 shares of our common stock subject to outstanding unvested RSUs granted to directors and employees. |
Per Share | ||||
Assumed public offering price per share (1) | $ | |||
Net tangible book value per share as of June 30, 2021 | ||||
Dilution of net tangible book value per share to new investors | $ | |||
(1) | Based upon the last reported sale price of our common stock on , 2021 of $ per share on the NYSE. |
Shares Purchased | Total Consideration | Average Price Per Share | ||||||||||||||||||
Number | Percent | Amount | Percent | |||||||||||||||||
Existing stockholders | % | $ | % | $ | ||||||||||||||||
New investors | % | $ | % | $ | ||||||||||||||||
Total | % | $ | % | $ |
• | Adding new physician partnerships through the expansion into new geographies, |
• | Growth in membership in existing geographies as a result of: |
• | Patients who are attributed to our physician partners who (a) age into Medicare and elect to enroll in MA or (b) elect to convert from Medicare FFS to MA, and |
• | Growth in the number of PCPs at existing physician partners, expanding our physician partners’ capacity to care for a greater membership population. |
MA Membership | ||||||||||||||||||||
Geography Go-Live | December 31, 2017 | December 31, 2018 | December 31, 2019 | December 31 2020 | CAGR | |||||||||||||||
2017 & Prior | 28,900 | 31,400 | 33,700 | 36,700 | 8 | % | ||||||||||||||
2018 | — | 25,100 | 29,700 | 35,500 | 19 | % | ||||||||||||||
2019 | — | — | 26,800 | 33,000 | 23 | % | ||||||||||||||
2020 | — | — | — | 25,800 | ||||||||||||||||
28,900 | 56,500 | 90,200 | 131,000 | 65 | % | |||||||||||||||
• | Patients who are attributed to our physician partners who age-in to Medicare and elect to enroll in MA or otherwise transition to MA. |
• | Growth in the number of PCPs at existing physician partners, expanding our physician partners’ capacity to care for a greater membership population. |
• | Affiliated physician groups recruiting new PCPs. |
• | Affiliated physician groups acquiring other physician groups. |
• | Contract with additional local physicians and physician groups by leveraging our local infrastructure and existing subscription-like PMPM agreements with payors. |
Year Ended | Three Months Ended June 30 | Six Months Ended June 30, | ||||||||||||||||||||||||||
2018 | 2019 | 2020 | 2020 | 2021 | 2020 | 2021 | ||||||||||||||||||||||
Platform support costs | $ | 62,739 | $ | 89,266 | $ | 99,943 | $ | 25,233 | $ | 30,667 | $ | 48,743 | $ | 59,075 | ||||||||||||||
% of Revenue | 13 | % | 11 | % | 8 | % | 9 | % | 6 | % | 8 | % | 6 | % | ||||||||||||||
Note: Represents costs to support our live geographies and enterprise functions, which are included in general and administrative expenses. |
• | Growth in New Membership—While new members are attributed to our platform throughout the year, our largest amount of growth typically occurs in January of each year. Operations in our new geographies generally begin on January 1, at which time our MA payors attribute members from our new physician partners to our platform as our agreements with those payors in those geographies become effective. This coincides with the beginning of the Medicare program year. Similarly, our same market growth within a given year is typically greatest in January, as a result of the outcome of the Medicare Open Enrollment Period (sometimes called Annual Election Period or AEP), which runs each year from October 15 to December 7. |
• | Per Member Revenue—Our revenue is a function of the percent of premium we have negotiated with our payors as well as our ability to accurately and appropriately document the acuity of a member’s total health status. We experience an element of seasonality with respect to our average per member revenue as it generally declines over the course of a given year. This results from the monthly cycle of (i) attributed members aging into Medicare, who typically have lower acuity profiles (and, therefore, lower average per member revenue rates) and (ii) older members with more severe acuity profiles (and, therefore, higher per member revenue rates) expiring. Additionally, in January of each year, CMS resets county-level benchmark rates, the risk adjustment factor for each member based upon health conditions documented in the prior year, and other components of premium revenue. The collective impact of these revisions has historically led to an increase in our average per member revenue. |
• | Medical Expense—Medical expense is driven by utilization of healthcare services by attributed membership. There are seasonal factors that can influence healthcare utilization, such as the flu season or the number of calendar or working days in a given period. |
As of and For the Three Months Ended June 30, | As of and For the Six Months Ended June 30, | As of and for the Year Ended December 31, | ||||||||||||||||||||||||||||||
2021 | 2020 | % Change | 2021 | 2020 | 2020 | 2019 | 2018 | |||||||||||||||||||||||||
MA members | 181,700 | 125,400 | 45 | % | 181,700 | 125,400 | 131,000 | 90,200 | 56,500 | |||||||||||||||||||||||
Medical services revenue | $ | 497,678 | $ | 292,495 | 70 | % | $ | 910,090 | $ | 582,309 | $ | 1,214,270 | $ | 788,566 | $ | 466,612 | ||||||||||||||||
Medical margin | $ | 55,195 | $ | 72,132 | (23 | )% | $ | 107,253 | $ | 114,293 | $ | 192,393 | $ | 63,192 | $ | 53,943 | ||||||||||||||||
Platform support costs | $ | 30,667 | $ | 25,223 | 22 | % | $ | 59,075 | $ | 48,743 | $ | 99,943 | $ | 89,266 | $ | 62,739 | | |||||||||||||||
Network contribution (1) | $ | 24,294 | $ | 38,510 | (37 | )% | $ | 54,436 | $ | 63,250 | $ | 99,016 | $ | 25,598 | $ | 22,083 | ||||||||||||||||
Adjusted EBITDA (1) | $ | (1,674 | ) | $ | 14,311 | (112 | )% | $ | 2,088 | $ | 16,888 | $ | 5,827 | $ | (56,711 | ) | $ | (32,240 | ) |
(1) | Network contribution and Adjusted EBITDA are non-GAAP financial measures. See“—Non-GAAP Financial Measures” for additional information, including reconciliations to the most directly comparable GAAP measures. |
Three Months Ended June 30, | Six Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | ||||||||||||||||||||||
Medical services revenue | $ | 497,678 | $ | 292,495 | $ | 910,090 | $ | 582,309 | $ | 1,214,270 | $ | 788,566 | $ | 466,612 | ||||||||||||||
Medical services expense | (442,483 | ) | (220,363 | ) | (802,837 | ) | (468,016 | ) | (1,021,877 | ) | (725,374 | ) | (412,669 | ) | ||||||||||||||
Medical margin | $ | 55,195 | $ | 72,132 | $ | 107,253 | $ | 114,293 | $ | 192,393 | $ | 63,192 | $ | 53,943 | ||||||||||||||
Three Months Ended June 30, | Six Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | ||||||||||||||||||||||
Medical services revenue | $ | 497,678 | $ | 292,495 | $ | 910,090 | $ | 582,309 | $ | 1,214,270 | $ | 788,566 | $ | 466,612 | ||||||||||||||
Medical services expense | (442,483 | ) | (220,363 | ) | (802,837 | ) | (468,016 | ) | (1,021,877 | ) | (725,374 | ) | (412,669 | ) | ||||||||||||||
Other medical expenses—live geographies (1) | (30,901 | ) | (33,622 | ) | (52,817 | ) | (51,043 | ) | (93,377 | ) | (37,594 | ) | (31,860 | ) | ||||||||||||||
Network contribution | $ | 24,294 | $ | 38,510 | $ | 54,436 | $ | 63,250 | $ | 99,016 | $ | 25,598 | $ | 22,083 | ||||||||||||||
(1) | Represents physician incentive expense related to surplus sharing and other direct medical expenses incurred to improve care for our members in our live geographies. Excludes costs in geographies that are in implementation and are not yet generating revenue. For the three months ended June 30, 2021 and 2020, costs incurred in implementing geographies were $2.8 million and $1.1 million, respectively. For the years ended December 31, 2020, 2019, and 2018, costs incurred in implementing geographies were $8.9 million, $2.9 million and $2.2 million, respectively. |
• | Interest income, which consists primarily of interest earned on our cash and cash equivalents and restricted cash and cash equivalents; and |
• | Equity income (loss) from unconsolidated joint ventures. |
Three Months Ended June 30, | Six Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | ||||||||||||||||||||||
(dollars in thousands) | ||||||||||||||||||||||||||||
Revenues: | ||||||||||||||||||||||||||||
Medical services revenue | $ | 497,678 | $ | 292,495 | $ | 910,090 | $ | 582,309 | $ | 1,214,270 | $ | 788,566 | $ | 466,612 | ||||||||||||||
Other operating revenue | 1,278 | 1,099 | 1,970 | 2,333 | 4,063 | 5,845 | 8,215 | |||||||||||||||||||||
Total revenues | 498,956 | 293,594 | 912,060 | 584,642 | 1,218,333 | 794,411 | 474,827 | |||||||||||||||||||||
Expenses: | ||||||||||||||||||||||||||||
Medical services expense | 442,483 | 220,363 | 802,837 | 468,016 | 1,021,877 | 725,374 | 412,669 | |||||||||||||||||||||
Other medical expenses | 33,694 | 34,761 | 57,355 | 53,187 | 102,306 | 40,526 | 34,092 | |||||||||||||||||||||
General and administrative | 43,013 | 34,248 | 79,318 | 60,832 | 137,292 | 122,832 | 88,745 | |||||||||||||||||||||
Stock-based compensation expense (1) | 274,548 | 2,155 | 276,020 | 3,176 | ||||||||||||||||||||||||
Depreciation and amortization | 3,581 | 3,319 | 7,008 | 6,517 | 13,531 | 12,253 | 11,385 | |||||||||||||||||||||
Total expenses | 797,319 | 294,846 | 1,222,538 | 591,728 | 1,275,006 | 900,985 | 546,891 | |||||||||||||||||||||
(1) | For annual periods prior to 2021, stock-based compensation expense is included in general and administrative expenses. |
Three Months Ended June 30, | Six Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | ||||||||||||||||||||||
(dollars in thousands) | ||||||||||||||||||||||||||||
Income (loss) from operations | (298,363 | ) | (1,252 | ) | (310,478 | ) | (7,086 | ) | (56,673 | ) | (106,574 | ) | (72,064 | ) | ||||||||||||||
Other income (expense): | ||||||||||||||||||||||||||||
Other income (expense), net | 2,967 | (74 | ) | 4,303 | 48 | 2,465 | 955 | 611 | ||||||||||||||||||||
Interest expense | (1,498 | ) | (2,080 | ) | (4,439 | ) | (4,229 | ) | (8,135 | ) | (9,068 | ) | (9,839 | ) | ||||||||||||||
Income (loss) before income taxes | (296,894 | ) | (3,406 | ) | (310,614 | ) | (11,267 | ) | (62,343 | ) | (114,687 | ) | (81,292 | ) | ||||||||||||||
Income tax benefit (expense) | (435 | ) | (39 | ) | (451 | ) | (39 | ) | (865 | ) | 232 | 113 | ||||||||||||||||
Income (loss) from continuing operations | (297,329 | ) | (3,445 | ) | (311,065 | ) | (11,306 | ) | (63,208 | ) | (114,455 | ) | (81,179 | ) | ||||||||||||||
Discontinued operations: | ||||||||||||||||||||||||||||
Income (loss) before impairments, gain (loss) on sales and income taxes | (1,547 | ) | (4,340 | ) | (2,898 | ) | (12,429 | ) | (20,049 | ) | (86,108 | ) | (32,132 | ) | ||||||||||||||
Impairments | — | (98,343 | ) | (40,794 | ) | |||||||||||||||||||||||
Gain (loss) on sales of assets, net | — | — | — | — | 20,401 | — | — | |||||||||||||||||||||
Income tax benefit (expense) | (65 | ) | (126 | ) | (129 | ) | (275 | ) | 2,804 | 16,166 | 7,588 | |||||||||||||||||
Total discontinued operations | (1,612 | ) | (4,466 | ) | (3,027 | ) | (12,704 | ) | 3,156 | (168,285 | ) | (65,338 | ) | |||||||||||||||
Net income (loss) | (298,941 | ) | (7,911 | ) | (314,092 | ) | (24,010 | ) | (60,052 | ) | (282,740 | ) | (146,517 | ) | ||||||||||||||
Noncontrolling interests’ share in (earnings) loss | 96 | — | 169 | — | — | 152 | (409 | ) | ||||||||||||||||||||
Net income (loss) attributable to common shares | $ | (298,845 | ) | $ | (7,911 | ) | $ | (313,923 | ) | $ | (24,010 | ) | $ | (60,052 | ) | $ | (282,588 | ) | $ | (146,926 | ) | |||||||
Three Months Ended June 30, | Six Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | ||||||||||||||||||||||
Revenues: | ||||||||||||||||||||||||||||
Medical services revenue | 100 | % | 100 | % | 100 | % | 100 | % | 100 | % | 99 | % | 98 | % | ||||||||||||||
Other operating revenue | — | — | — | — | — | 1 | 2 | |||||||||||||||||||||
Total revenues | 100 | 100 | 100 | 100 | 100 | 100 | 100 | % | ||||||||||||||||||||
Expenses: | ||||||||||||||||||||||||||||
Medical services expense | 89 | 75 | 88 | 80 | 84 | 91 | 87 | |||||||||||||||||||||
Other medical expenses | 7 | 12 | 6 | 9 | 8 | 5 | 7 | |||||||||||||||||||||
General and administrative | 9 | 12 | 9 | 10 | 11 | 15 | 19 | |||||||||||||||||||||
Stock-based compensation expense (1) | 55 | 1 | 30 | 1 | ||||||||||||||||||||||||
Depreciation and amortization | 1 | 1 | 1 | 1 | 1 | 2 | 2 | |||||||||||||||||||||
Total expenses | 160 | 100 | 134 | 101 | 105 | 113 | 115 | |||||||||||||||||||||
(1) | For annual periods prior to 2021, stock-based compensation expense is included in general and administrative expenses. |
Three Months Ended June 30, | Six Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | ||||||||||||||||||||||
Income (loss) from operations | (60 | ) | — | (34 | ) | (1 | ) | (5 | ) | (13 | ) | (15 | ) | |||||||||||||||
Other income (expense): | ||||||||||||||||||||||||||||
Other income (expense), net | 1 | — | — | — | — | — | — | |||||||||||||||||||||
Interest expense | — | (1 | ) | — | (1 | ) | (1 | ) | (1 | ) | (2 | ) | ||||||||||||||||
Income (loss) before income taxes | (60 | ) | (1 | ) | (34 | ) | (2 | ) | (5 | ) | (14 | ) | (17 | ) | ||||||||||||||
Income tax benefit (expense) | — | — | — | — | — | — | — | |||||||||||||||||||||
Income (loss) from continuing operations | (60 | ) | (1 | ) | (34 | ) | (2 | ) | (5 | ) | (14 | ) | (17 | ) | ||||||||||||||
Discontinued operations: | ||||||||||||||||||||||||||||
Income (loss) before impairments, gain (loss) on sales and income taxes | — | (1 | ) | — | (2 | ) | (2 | ) | (11 | ) | (7 | ) | ||||||||||||||||
Impairments | — | (12 | ) | (9 | ) | |||||||||||||||||||||||
Gain (loss) on sales of assets, net | — | — | — | — | 2 | — | — | |||||||||||||||||||||
Income tax benefit (expense) | — | — | — | — | — | 2 | 2 | |||||||||||||||||||||
Total discontinued operations | — | (2 | ) | — | (2 | ) | — | (21 | ) | (14 | ) | |||||||||||||||||
Net income (loss) | (60 | ) | (3 | ) | (34 | ) | (4 | ) | (5 | ) | (36 | ) | (31 | ) | ||||||||||||||
Noncontrolling interests’ share in (earnings) loss | — | — | — | — | — | — | — | |||||||||||||||||||||
Net income (loss) attributable to common shares | (60 | )% | (3 | )% | (34 | )% | (4 | )% | (5 | )% | (36 | )% | (31 | )% | ||||||||||||||
Three Months Ended June 30, | Change | Six Months Ended June 30, | Change | |||||||||||||||||||||||||||||
(dollars in thousands) | 2021 | 2020 | $ | % | 2021 | 2020 | $ | % | ||||||||||||||||||||||||
Medical services revenue | $ | 497,678 | $ | 292,495 | $ | 205,183 | 70 | % | $ | 910,090 | $ | 582,309 | $ | 327,781 | 56 | % | ||||||||||||||||
% of total revenues | 100 | % | 100 | % | 100 | % | 100 | % |
Three Months Ended June 30, | Change | Six Months Ended June 30, | Change | |||||||||||||||||||||||||||||
(dollars in thousands) | 2021 | 2020 | $ | % | 2021 | 2020 | $ | % | ||||||||||||||||||||||||
Medical services expense | $ | 442,483 | $ | 220,363 | $ | 222,120 | 101 | % | $ | 802,837 | $ | 468,016 | $ | 334,821 | 72 | % | ||||||||||||||||
% of total revenues | 89 | % | 75 | % | 88 | % | 80 | % |
Three Months Ended June 30, | Change | Six Months Ended June 30, | Change | |||||||||||||||||||||||||||||
(dollars in thousands) | 2021 | 2020 | $ | % | 2021 | 2020 | $ | % | ||||||||||||||||||||||||
Other medical expenses | $ | 33,694 | $ | 34,761 | $ | (1,067 | ) | (3 | )% | $ | 57,355 | $ | 53,187 | $ | 4,168 | 8 | % | |||||||||||||||
% of total revenues | 7 | % | 12 | % | 6 | % | 9 | % |
Three Months Ended June 30, | Change | Six Months Ended June 30, | Change | |||||||||||||||||||||||||||||
(dollars in thousands) | 2021 | 2020 | $ | % | 2021 | 2020 | $ | % | ||||||||||||||||||||||||
General and administrative | $ | 43,013 | $ | 34,248 | $ | 8,765 | 26 | % | $ | 79,318 | $ | 60,832 | $ | 18,486 | 30 | % | ||||||||||||||||
% of total revenues | 9 | % | 12 | % | 9 | % | 10 | % |
Three Months Ended June 30, | Change | Six Months Ended June 30, | Change | |||||||||||||||||||||||||||||
(dollars in thousands) | 2021 | 2020 | $ | % | 2021 | 2020 | $ | % | ||||||||||||||||||||||||
Stock-based compensation expense | $ | 274,548 | $ | 2,155 | $ | 272,393 | 12640 | % | $ | 276,020 | $ | 3,176 | $ | 272,844 | 8591 | % | ||||||||||||||||
% of total revenues | 55 | % | 1 | % | 30 | % | 1 | % |
Three Months Ended June 30, | Change | Six Months Ended June 30, | Change | |||||||||||||||||||||||||||||
(dollars in thousands) | 2021 | 2020 | $ | % | 2021 | 2020 | $ | % | ||||||||||||||||||||||||
Total discontinued operations | $ | (1,612 | ) | $ | (4,466 | ) | $ | 2,854 | 64 | % | $ | (3,027 | ) | $ | (12,704 | ) | $ | 9,677 | 76 | % | ||||||||||||
% of total revenues | (0 | )% | (2 | )% | (0 | )% | (2 | )% |
Year Ended December 31, | Change | |||||||||||||||
2020 | 2019 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
Medical services revenue | $ | 1,214,270 | $ | 788,566 | $ | 425,704 | 54 | % | ||||||||
% of total revenues | 100 | % | 99 | % |
Year Ended December 31, | Change | |||||||||||||||
2020 | 2019 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
Medical services expense | $ | 1,021,877 | $ | 725,374 | $ | 296,503 | 41 | % | ||||||||
% of total revenues | 84 | % | 91 | % |
Year Ended December 31, | Change | |||||||||||||||
2020 | 2019 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
Other medical expenses | $ | 102,306 | $ | 40,526 | $ | 61,780 | 152 | % | ||||||||
% of total revenues | 8 | % | 5 | % |
Year Ended December 31, | Change | |||||||||||||||
2020 | 2019 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
General and administrative | $ | 137,292 | $ | 122,832 | $ | 14,460 | 12 | % | ||||||||
% of total revenues | 11 | % | 15 | % |
Year Ended December 31, | Change | |||||||||||||||
2020 | 2019 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
Total discontinued operations | $ | 3,156 | $ | (168,285 | ) | $ | 171,441 | 102 | % | |||||||
% of total revenues | 0 | % | (21 | )% |
Year Ended December 31, | Change | |||||||||||||||
2019 | 2018 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
Medical services revenue | $ | 788,566 | $ | 466,612 | $ | 321,954 | 69 | % | ||||||||
% of total revenues | 99 | % | 98 | % |
Year Ended December 31, | Change | |||||||||||||||
2019 | 2018 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
Medical services expense | $ | 725,374 | $ | 412,669 | $ | 312,705 | 76 | % | ||||||||
% of total revenues | 91 | % | 87 | % |
Year Ended December 31, | Change | |||||||||||||||
2019 | 2018 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
Other medical expenses | $ | 40,526 | $ | 34,092 | $ | 6,434 | 19 | % | ||||||||
% of total revenues | 5 | % | 7 | % |
Year Ended December 31, | Change | |||||||||||||||
2019 | 2018 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
General and administrative $ | 122,832 | $ | 88,745 | $ | 34,087 | 38 | % | |||||||||
% of total revenues | 15 | % | 19 | % |
Year Ended December 31, | Change | |||||||||||||||
2019 | 2018 | $ | % | |||||||||||||
(dollars in thousands) | ||||||||||||||||
Total discontinued operations | $ | (168,285 | ) | $ | (65,338 | ) | $ | (102,947 | ) | 158 | % | |||||
% of total revenues | (21 | )% | (14 | )% |
• | Adjusted EBITDA does not reflect changes in, or cash requirements for, working capital needs; |
• | Adjusted EBITDA does not reflect interest expense, or the requirements necessary to service interest or principal payments on debt; |
• | Adjusted EBITDA does not reflect income tax expense (benefit) or the cash requirements to pay taxes; |
• | Adjusted EBITDA does not reflect historical cash expenditures or future requirements for capital expenditures or contractual commitments; |
• | Although depreciation and amortization charges are non-cash charges, the assets being depreciated and amortized will often have to be replaced in the future, and Adjusted EBITDA does not reflect any cash requirements for such replacements; and |
• | The expenses and other items that we exclude in our calculation of Adjusted EBITDA may differ from the expenses and other items, if any, that other companies may exclude from similarly titled non-GAAP financial measures. |
Three Months Ended June 30, | Six Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | ||||||||||||||||||||||
Income (loss) from operations | $ | (298,363 | ) | $ | (1,252 | ) | $ | (310,478 | ) | $ | (7,086 | ) | $ | (56,673 | ) | $ | (106,574 | ) | $ | (72,064 | ) | |||||||
Other operating revenue | (1,278 | ) | (1,099 | ) | (1,970 | ) | (2,333 | ) | (4,063 | ) | (5,845 | ) | (8,215 | ) | ||||||||||||||
Other medical expenses | 33,694 | 34,761 | 57,355 | 53,187 | 102,306 | 40,526 | 34,092 | |||||||||||||||||||||
Other medical expenses (live geographies) (1) | (30,901 | ) | (33,622 | ) | (52,817 | ) | (51,043 | ) | (93,377 | ) | (37,594 | ) | (31,860 | ) | ||||||||||||||
General and administrative | 43,013 | 34,248 | 79,318 | 60,832 | 137,292 | 122,832 | 88,745 | |||||||||||||||||||||
Stock-based compensation expense (2) | 274,548 | 2,155 | 276,020 | 3,176 | ||||||||||||||||||||||||
Depreciation and amortization | 3,581 | 3,319 | 7,008 | 6,517 | 13,531 | 12,253 | 11,385 | |||||||||||||||||||||
Network contribution | $ | 24,294 | $ | 38,510 | $ | 54,436 | $ | 63,250 | $ | 99,016 | $ | 25,598 | $ | 22,083 | ||||||||||||||
(1) | Represents physician incentive expense related to surplus sharing and other direct medical expenses incurred to improve care for our members in our live geographies. Excludes costs in geographies that are in implementation and are not yet generating revenue. For the three months ended June 30, 2021 and 2020, costs incurred in implementing geographies were $2.8 million and $1.1 million, respectively. For the six months ended June 30, 2021 and 2020, costs incurred in implementing geographies were $4.5 million and $2.1 million, respectively. For the years ended December 31, 2020, 2019, and 2018, costs incurred in implementing geographies were $8.9 million, $2.9 million and $2.2 million, respectively. |
(2) | For annual periods prior to 2021, stock-based compensation expense is included in general and administrative expenses. |
Three Months Ended June 30, | Six Months Ended June 30, | Year Ended December 31, | ||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | 2020 | 2019 | 2018 | ||||||||||||||||||||||
Net income (loss) | $ | (298,941 | ) | $ | (7,911 | ) | $ | (314,092 | ) | $ | (24,010 | ) | $ | (60,052 | ) | $ | (282,588 | ) | $ | (146,926 | ) | |||||||
(Income) loss from discontinued operations, net of income taxes | 1,612 | 4,466 | 3,027 | 12,704 | (3,156 | ) | 168,285 | 65,338 | ||||||||||||||||||||
Interest expense | 1,498 | 2,080 | 4,439 | 4,229 | 8,135 | 9,068 | 9,839 | |||||||||||||||||||||
Income tax expense (benefit) | 435 | 39 | 451 | 39 | 865 | (232 | ) | (113 | ) | |||||||||||||||||||
Depreciation and amortization | 3,581 | 3,319 | 7,008 | 6,517 | 13,531 | 12,253 | 11,385 | |||||||||||||||||||||
Geography entry costs (1) | 9,578 | 4,865 | 14,545 | 6,523 | 27,100 | 9,787 | 4,918 | |||||||||||||||||||||
Severance and related costs | 3,788 | 2,689 | 4,242 | 2,691 | 4,009 | 3,675 | 3.036 | |||||||||||||||||||||
Management fees (2) | 58 | 353 | 433 | 683 | 1,530 | 1,885 | 1,755 | |||||||||||||||||||||
Stock-based compensation expense | 274,548 | 2,155 | 276,020 | 3,176 | 6,472 | 4,399 | 2,950 | |||||||||||||||||||||
EBITDA adjustment related to equity method investments | 652 | — | 652 | — | — | — | ||||||||||||||||||||||
Other (3) | 1,517 | 2,256 | 5,363 | 4,336 | 7,393 | 16,757 | 15,578 | |||||||||||||||||||||
Adjusted EBITDA | $ | (1,674 | ) | $ | 14,311 | $ | 2,088 | $ | 16,888 | $ | 5,827 | $ | (56,711 | ) | $ | (32,240 | ) | |||||||||||
(1) | Represents direct geography entry costs, including investments to develop and expand our platform, physician incentive expense, employee-related expenses and marketing. For the three months ended June 30, 2021 and 2020, (i) $2.8 million and $1.1 million, respectively, are included in other medical expenses and (ii) $6.8 million and $3.7 million, respectively, are included in general and administrative expenses. For the six months ended June 30, 2021 and 2020, (i) $4.5 million and $2.1 million, respectively, are included in other medical expenses and (ii) $10.0 million and $4.4 million, respectively, are included in general and administrative expenses. For the years ended December 31, 2020, 2019, and 2018, (i) $8.9 million, $2.9 million and $2.2 million, respectively, are included in other medical expenses and (ii) $17.9 million, $6.9 million, and $2.7 million, respectively, are included in general and administrative expenses. |
(2) | Represents management fees and other expenses paid to CD&R. In connection with our IPO, we terminated our consulting agreement with CD&R, effective April 16, 2021. We were not charged a fee in connection with the termination of this agreement. |
(3) | Includes changes in non-cash accruals for unasserted claims and contingent liabilities. |
Six Months Ended June 30, | Year Ended December 31, | |||||||||||||||||||||||
2021 | 2020 | Change | 2020 | 2019 | 2018 | |||||||||||||||||||
Net cash provided by (used in) operating activities | $ | (80,119 | ) | $ | (35,498 | ) | $ | (44,621 | ) | $ | (53,204 | ) | $ | (103,861 | ) | $ | (67,531 | ) | ||||||
Net cash provided by (used in) investing activities | (76,338 | ) | (2,351 | ) | (73,987 | ) | $ | 22,066 | $ | (5,060 | ) | (7,970 | ) | |||||||||||
Net cash provided by (used in) financing activities | 1,143,077 | 31,522 | 1,111,555 | $ | 24,621 | $ | 176,298 | 84,743 |
• | which activities most significantly impact the entity’s economic performance, and our ability to direct those activities; |
• | our form of ownership interest; |
• | our representation on the entity’s governing body; |
• | the size and seniority of our investment; |
• | our ability to manage our ownership interest relative to other interest holders; |
• | our ability and the rights of other parties to participate in policy making decisions; and |
• | our ability to liquidate the entity. |
• | Expected Term |
• | Expected Volatility |
• | Risk-Free Interest Rate |
• | Expected Dividend |
• | valuations of our common stock completed on a regular basis; |
• | our historical financial results and estimated trends and projections for our future operating and financial performance; |
• | likelihood of achieving a liquidity event, such as an initial public offering or sale of our company, given prevailing market conditions; |
• | the market performance of comparable, publicly-traded companies; and |
• | the overall economic and industry conditions and outlook. |
• | Unsustainably high and rising costs characterized by waste, unnecessary variation in care and poor patient experience and health outcomes; |
• | FFS reimbursement model focused on units of service rather than a coordinated approach to meet the unique needs of individual patients; |
• | High incidence of physician burnout driven by growing administrative burden and the FFS reimbursement model; |
• | An aging U.S. population, with the over 65 population projected to grow from approximately 49 million in 2016 to approximately 77 million in 2034, driving Medicare growth and pressuring the healthcare system as average reimbursement fails to keep pace with the rise in average patient complexity; |
• | Rapid patient adoption of MA plans, private health plans administering Medicare benefits, as seniors increasingly value supplemental benefits and low monthly premiums; |
• | The Medicare population is projected to grow from approximately 62 million in 2020 to more than 70 million individuals in 2025 with a total spend of approximately $1.25 trillion, and MA enrollment comprised 37% of total Medicare enrollment in 2019 and is projected to comprise 47% of total Medicare enrollment in 2025; |
• | PCPs are positioned—but not currently empowered or incentivized—to act as the quarterback for healthcare delivery, with their decisions estimated to influence up to 90% of total healthcare spending according to a 2017 study; and |
• | The United States spends only 5% to 7% of its total healthcare dollars on primary care in contrast to 14% among OECD nations on average. |
• | Implemented the first MA multi-payor, globally capitated risk model with a community-based physician group in all of our diverse anchor geographies; |
• | Exported the Total Care Model from one to 17 geographies ranging from communities as small as Zanesville, Ohio to large and rapidly growing communities such as Austin, Texas; |
• | Built strong local positions with established community-based physician group leaders who have intimate and trusted relationships with patients in their communities, such as Austin Regional Clinic in Austin, Texas, Buffalo Medical Group in Buffalo, New York, Central Ohio Primary Care in Columbus, Ohio, Preferred Primary Care Physicians in Pittsburgh, Pennsylvania and Wilmington Health in Wilmington, North Carolina; |
• | Grew from approximately 24,000 MA members to approximately 230,700 MA members on our platform; |
• | Expanded from two payors to 15 payors on our platform; and |
• | Began participating in the Direct Contracting Model, with over 50,000 Medicare FFS beneficiaries served by our existing PCPs contracted through our five currently approved DCEs. |
• | Payor Engagement |
• | Direct Contracting Model |
• | Data Integration and Management |
• | Clinical Programs and Product Development |
• | Quality (Clinical and Experience) |
• | Growth 60-64 year old patients, to enable their patients to make educated healthcare choices. These existing patients represent a large, growing and durable source of potential attributed member growth. |
• | Performance Management Analytics |
• | Financial Management |
• | National Policy |
(1) | 2020 Medicare spend for total Medicare beneficiaries is based on CMS spend per beneficiary. |
(2) | 2025 Medicare spend for total Medicare beneficiaries, beneficiaries attributed to independent PCPs and agilon total addressable market is based on CMS projected Medicare enrollment and spending per beneficiary growth rates. |
• | Payor Engagement |
program management and financial management. Under our multi-year contracts with payors, agilon receives a percentage of total premiums and is responsible for managing the cost of the total healthcare needs of patients attributed to our PCPs. In 2021, we anticipate working with 15 payors, nine of which were live in 2020 and five of which went live in 2021, across a total of approximately 40 local contracts. Five of our payors are national, and our relationships with them across geographies support the portability of the agilon platform. |
• | Direct Contracting Model |
• | Data Integration and Management |
• | Clinical Programs and Product Development co-developed with our physicians and can be deployed and seamlessly integrated across our network to drive improved health outcomes. Combining insights from evidence-based medicine and patient-level data, our medical leadership and local physician leaders develop high-value actionable playbooks for partner physicians to deliver quality care, which include operational plans, analytics and tracking metrics. |
• | Quality (Clinical and Experience) 4-STAR-rated or higher plans, compared to 77% of MA members nationally. More than 90% of our providers surveyed in our live anchor physician groups believed that the quality of care programs developed through the agilon network enabled our physician partners to provide better care to their patients. Based on data from most of our anchor partners, approximately 50% of total medical costs are driven by specialists, with the potential for wide variability in costs depending on the quality of the specialist providing care. |
• | Growth 60-64 year-old patients, to enable their patients to make educated healthcare choices. These existing patients represent a large, growing and durable source of potential attributed member growth. We believe many of these patients will enroll in MA plans and fuel our local attributed member growth over the coming years. During the year ended December 31, 2020, individuals whoaged-in to MA or transitioned to MA from traditional Medicare were the primary driver of our 17% same-geography growth in existing geographies. |
• | Performance Management Analytics peer-to-peer |
• | Financial Management |
• | National Policy |
and MA payment. We regularly meet with policymakers and policy shapers in Washington, D.C. to help inform the national dialogue and future policies governing these critical issues. |
• | Long-term partnership model that allows both agilon and physicians to take the long-term view and benefit from the maturity of a growing number of members on the platform; |
• | Shared governance and co-location of staff to manage our local partnerships; |
• | Local dyad leadership structure that includes a medical director from the local anchor physician group; |
• | Local brand which reflects the local anchor physician group or geography; |
• | Capital from agilon to support value-based care infrastructure supporting the delivery of high-quality healthcare, and 100% downside protection, which removes a major obstacle to physicians making the leap to a Total Care Model; |
• | Operating leverage created by amortizing centralized investments in the platform infrastructure across a growing number of physician partners; and |
• | Surplus dollars generated locally due to improvements in quality of care and healthcare costs are shared with the local anchor physician group. We believe this will allow physicians to unlock the value in their practices by moving to a membership-based model that is better aligned with the long-term physician-Medicare patient relationship. |
• | empower PCPs to act as the quarterback for healthcare delivery; |
• | enable PCPs to define a tailored patient experience across multiple payors; |
• | create an operating partnership and economic model built around improved health outcomes instead of a transaction-based model; and |
• | align the physician business model with the strength of their long-term patient relationships enabling the long-term growth of independent, community-based physician groups. |
• | Rapid creation of a Medicare Total Care Model . |
• | Sustainable long-term business model alongside commercial and Medicare FFS . |
• | Provides access to network of like-minded partners . know-how and best practices encourages success in a Total Care Model. |
• | Improved economics . |
• | Improving the physician experience. |
• | Improving the patient experience . |
• | Supporting superior health outcomes. know-how and best practices to be able to identify and close CMS quality of care gaps and improve their patients’ experience. Further, we believe our Total Care Model provides greater stability and predictability for CMS, the Medicare program and its beneficiaries in the communities our physician partners serve. For example, in 2019, 78% of our members attributed to our live anchor physician groups attended their wellness visits, compared to the FFS national average CMS Annual Wellness Visit completion rate of 35% in 2019, enabling our PCPs to comprehensively assess members’ overall health condition and appropriately manage their care. Additionally, in 2019, our members’ ER utilization was 42% lower than the local FFS benchmark, inpatient acute utilization was 47% lower than the local FFS benchmark, and hospitalre-admission rate was 26% lower than the local FFS benchmark. In 2020, approximately 90% of our members in live geographies are currently enrolled in4- and5-STAR-rated plans compared to 77% of the MA population nationally. |
• | We believe we have the ability to generate significant, recurring and growing medical margin in concert with our physician partners over the course of our long-term partnerships and the inherently sticky physician-patient relationship. These durable relationships allow physician partners to invest time and resources to support our members’ long-term health outcomes through preventative services and increased coordination across the entire care continuum. |
• | Our partnerships with our anchor physician groups are structured as long-term contractual relationships, typically for 20 years. |
• | Average physician tenure within our anchor physician groups is 13 years. |
• | Patients 65 years of age and older remain with their PCP for an average of 10 years, according to a 2004 study. |
• | Embedded same-geography, long-term organic membership growth resulting from our physician partners’ existing patients who age into Medicare and elect to enroll in MA or who elect to convert from Medicare FFS to MA over the life of our long-term partnership. Expanding this model to include patients enrolled in traditional Medicare through the Direct Contracting Model further increases the value of our long-term partnerships. |
• | allowed us to optimize the physician capacity already deeply integrated in local communities; |
• | increased our speed to scale, as reflected in our rapid expansion of geographies and physician partners on our platform; and |
• | allowed us to deploy our model across heterogeneous physician partners and geographies: |
• | our geographies range in total population from approximately 225,000 to approximately 3.2 million and total MA lives from approximately 20,000 to approximately 364,000; |
• | in 2020 our geographies range in MA penetration rate from 27% to 64% and five-year CAGR growth rate of 2% to 16%; |
• | the proportion of MA members that in 2020 selected a PPO insurance product as a percentage of total MA membership in our geographies ranges from 25% to 78%; and |
• | our anchor physician groups comprise both primary care and multi-specialty groups and in 2020 range in size from fewer than 25 to more than 200 PCPs. |
• | Physician partners: |
• | Members: |
• | Implement a cross-functional work team of management, physicians and staff to evaluate risks and ensure communication to all impacted stakeholders; |
• | Relocated the vast majority of our employees to home-based work settings; |
• | Discontinued employee travel unless supporting critical business needs; |
• | Coordinated with our physician partners to accelerate telehealth visit activity, increase the availability of same-day appointments and coordinateparking-lot clinic visits, in order to enable members to avoid emergency room or similar settings fornon-emergent conditions; |
• | Deployed usage of personal protective equipment to employees returning to a workplace setting, and to our physician partners; |
• | Coordinated daily huddles for physicians and team members on clinical and operational impacts of COVID-19, which included participation and clinical education by nationally-recognized experts in infectious disease and epidemiology, and enabled physician partners across the country to engage with one another on best practices; |
• | Sent more than 800,000 communications to members to ensure they were well informed regarding best practices for staying safe, and aware of available support resources during the pandemic; and |
• | Facilitated the conversion to mail-order prescriptions and mail-in screening tests for patients |
• | Partnership and Collaboration: We are One Team. We collaborate deeply. We embrace diversity. Together with our physician partners, we empower the care that our families and friends deserve. |
• | Innovation: We rapidly adapt to our changing world and embrace the creativity of our physician partners and each other. |
• | Quality and Service Excellence: We value results, not activity. We serve others with passion and humility. |
• | Continuous Improvement: We are agile and move fast. We actively seek out and share feedback. We learn and improve every day. |
• | Expertise: We are curious. We aspire to be experts and share our knowledge. |
• | Accountability and Integrity: We celebrate our successes. We take ownership in everything we do. |
Name | Age | Position | ||
Ron Williams | 71 | Chairman of the Board | ||
Ravi Sachdev | 45 | Vice Chairman of the Board | ||
Steven J. Sell | 54 | Director, Chief Executive Officer and President | ||
Michelle A. Gourdine, M.D. | 58 | Director | ||
Sharad Mansukani, M.D. | 52 | Director | ||
Clay Richards | 47 | Director | ||
Richard J. Schnall | 52 | Director | ||
Michael Smith | 73 | Director | ||
Derek L. Strum | 43 | Director | ||
William Wulf, M.D. | 61 | Director | ||
Karen McLoughlin | 56 | Director | ||
Timothy S. Bensley | 62 | Chief Financial Officer | ||
Theodore Halkias | 54 | Chief Business Officer | ||
Veeral Desai | 40 | Chief Strategy and Development Officer | ||
Lisa Dombro | 53 | Chief Experience & Innovation Officer | ||
Benjamin Kornitzer, M.D. | 43 | Chief Medical and Quality Officer | ||
Joan Danieley | 60 | Chief Administrative Officer | ||
Ben Shaker | 38 | Chief Markets Officer | ||
Girish Venkatachaliah | 48 | Chief Technology Officer |
• | Our Class I directors will be Richard J. Schnall, Sharad Mansukani, M.D., Michael Smith and Clay Richards, and their terms will expire at the annual meeting of stockholders to be held in 2022. |
• | Our Class II directors will be Derek L. Strum, Michelle A. Gourdine, M.D., Karen McLoughlin and Ron Williams, and their terms will expire at the annual meeting of stockholders to be held in 2023. |
• | Our Class III directors will be Ravi Sachdev, Steven J. Sell and William Wulf, M.D., and their terms will expire at the annual meeting of stockholders to be held in 2024. |
• | the requirement that a majority of the board of directors consist of independent directors; |
• | the requirement that our Nominating and Governance Committee be composed entirely of independent directors with a written charter addressing the committee’s purpose and responsibilities; |
• | the requirement that we have a Compensation Committee that is composed entirely of independent directors with a written charter addressing the committee’s purpose and responsibilities; and |
• | the requirement for an annual performance evaluation of the Nominating and Governance and Compensation Committees. |
• | Steven J. Sell, Chief Executive Officer and President (beginning June 1, 2020) |
• | Theodore Halkias, Chief Financial Officer |
• | Joan Danieley, Chief Administrative Officer |
• | Lisa Dombro, Chief Experience & Innovation Officer |
• | Benjamin Kornitzer, M.D., Chief Medical and Quality Officer |
• | Ronald Kuerbitz, Former Chief Executive Officer (until June 1, 2020) |
• | To reward our executives commensurate with their performance, experience and capabilities. |
• | To cause our executives to have equity in the Company in order to align their interests with the interests of our owners and allow our executives to share in our owners’ success. |
• | To enable us to attract and retain top executive talent. |
Pay Component | Objective of Pay Component | Key Measure | ||
Base Salary | • Provide competitive pay and reflect individual contributions | • Current compensation relative to competitive rates for similar roles • Individual performance | ||
Annual Cash Incentives | • Reward achievement of short-term business objectives and results | • Adjusted EBITDA goal • Operational goals | ||
Equity Awards | • Stock options to align executive and stockholder interests • Stock purchase opportunities to create “buy in” and immediate stock ownership • Create “ownership culture” • Provide retention incentives | • Stock price appreciation • Continuation of employment | ||
Benefits | • Health, disability and life insurance, 401(k) retirement plan and other employee benefits provide a safety net of protection in the case of illness, disability, death or retirement. | • Generally, competitive benefits relative to market |
Name and Principal Position | Fiscal Year | Salary ($) | Option Awards ($) (2) | Non-Equity Incentive Plan Compensation ($) (3) | All Other Compensation ($) (4) | Total ($) | ||||||||||||||||||
Steven J. Sell, Chief Executive Officer and President (1) | 2020 | 432,692 | 5,277,000 | 328,893 | — | 6,038,585 | ||||||||||||||||||
Theodore Halkias, Chief Financial Officer | 2020 | 400,000 | — | 284,000 | 13,000 | 697,000 | ||||||||||||||||||
Joan Danieley, Chief Administrative Officer | 2020 | 365,000 | 255,690 | 225,001 | 26,000 | 871,691 | ||||||||||||||||||
Lisa Dombro, Chief Experience & Innovation Officer | 2020 | 350,000 | 519,140 | 275,625 | 7,947 | 1,152,712 | ||||||||||||||||||
Benjamin Kornitzer, M.D., Chief Medical and Quality Officer | 2020 | 481,731 | 1,400,465 | 366,803 | 9,615 | 2,258,614 | ||||||||||||||||||
Ronald Kuerbitz, Former Chief Executive Officer | 2020 | 372,115 | 762,555 | — | 2,670,987 | 3,805,657 |
(1) | Mr. Sell commenced his employment with the Company as of June 1, 2020, and amounts reported for Mr. Sell in this table reflect that his annual base salary and non-equity incentive plan compensation were prorated for the 2020 calendar year. |
(2) | Option Awards |
(3) | Non-Equity Incentive Plan Compensationpre-established annual financial and individual performance goals. Pursuant to the terms of his separation agreement, Mr. Kuerbitz was not eligible for an annual cash incentive bonus in respect of the 2020 Fiscal Year. See “Elements of Our Executive Compensation Program— Annual Cash Incentives” above for more information. |
(4) | All Other Compensation |
Name | 401(k) Contributions | Severance Benefits | Other | |||||||||
Steven J. Sell | — | — | — | |||||||||
Theodore Halkias | 13,000 | — | — | |||||||||
Joan Danieley | 26,000 | — | — | |||||||||
Lisa Dombro | 7,947 | — | — | |||||||||
Benjamin Kornitzer, M.D. | 9,615 | — | — | |||||||||
Ronald Kuerbitz | 9,987 | 2,661,000 | — |
Grant Date | Estimated Possible Payouts Under Non-Equity Incentive PlanAwards | Estimated Possible Payouts Under Equity Incentive Plan Awards | All Other Option Awards: Number of Securities Underlying Options (#) | Exercise or Base Price of Option Awards ($) | Grant Date Fair Value of Stock and Option Awards ($) (3) | |||||||||||||||||||||||||||
Name | Threshold $ | Target $ | Maximum $ | Target (#) (2) | ||||||||||||||||||||||||||||
Steven J. Sell | — | 562,500 | 843,750 | |||||||||||||||||||||||||||||
5/22/2020 | 2,000,000 | $ | 4.49 | 5,277,000 | ||||||||||||||||||||||||||||
5/22/2020 | 2,500,000 | $ | 10.11 | — | ||||||||||||||||||||||||||||
5/22/2020 | 1,000,000 | $ | 4.49 | — | ||||||||||||||||||||||||||||
Theodore Halkias | — | 300,000 | 450,000 | |||||||||||||||||||||||||||||
Joan Danieley | — | 244,550 | 366,825 | |||||||||||||||||||||||||||||
1/31/2020 | 100,000 | $ | 4.45 | 255,690 | ||||||||||||||||||||||||||||
1/31/2020 | 100,000 | $ | 8.90 | — | ||||||||||||||||||||||||||||
Lisa Dombro | — | 262,500 | 393,750 | |||||||||||||||||||||||||||||
7/29/2020 | 200,000 | $ | 4.49 | 519,140 | ||||||||||||||||||||||||||||
Benjamin Kornitzer, M.D. | — | 375,000 | 562,500 | |||||||||||||||||||||||||||||
1/31/2020 | 550,000 | $ | 4.49 | 1,400,465 | ||||||||||||||||||||||||||||
1/31/2020 | 250,000 | $ | 8.99 | — | ||||||||||||||||||||||||||||
Ronald Kuerbitz (1) | 6/1/2020 | 5,100,000 | $ | 1.00 | 762,555 |
(1) | For Mr. Kuerbitz, the amounts reported in this column represent the incremental fair value, calculated as of the modification date in accordance with FASB ASC Topic 718, resulting from the extension and acceleration of the post-termination exercise period of Mr. Kuerbitz’s vested time-based option awards in connection with his separation as described below under the heading “—Ronald Kuerbitz Separation Agreement.” |
(2) | Amounts reported in this column represent the number of stock options that were eligible to be earned upon the achievement of certain performance conditions. In the event the applicable performance conditions are not achieved, none of these options will vest. |
(3) | Amounts reported in this column represent the aggregate grant date fair value of stock options, computed in accordance with FASB ASC Topic 718. See “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Critical Accounting Estimates—Stock-based Compensation” for a discussion of the relevant assumptions used to calculate these amounts. With respect to stock options that vest subject to a performance condition, the grant date fair value is calculated based upon the probable outcome of the performance condition being achieved, consistent with the estimate of aggregate compensation cost to be recognized over the service period determined as of the grant date, excluding the effect of estimated forfeitures. |
Name | Number of Securities Underlying Unexercised Options (#) Exercisable(1) | Number of Securities Underlying Unexercised Options (#) Unexercisable | Equity Incentive Plan Awards Number of Securities Underlying Unexercised Unearned Options (#) | Option Exercise Price ($) | Option Expiration Date | |||||||||||||||
Steven J. Sell | — | 2,000,000 | (2) | — | 4.49 | 5/22/2030 | ||||||||||||||
— | — | 2,500,000 | (6) | 10.11 | 5/22/2030 | |||||||||||||||
— | — | 1,000,000 | (7) | 4.49 | 5/22/2030 | |||||||||||||||
Theodore Halkias | 1,350,000 | 450,000 | (3) | — | 1.00 | 4/27/2027 | ||||||||||||||
— | — | 1,700,000 | (6) | 3.00 | 4/27/2027 | |||||||||||||||
Joan Danieley | 375,000 | 125,000 | (2) | — | 1.00 | 11/15/2027 | ||||||||||||||
— | — | 500,000 | (6) | 3.00 | 11/15/2027 | |||||||||||||||
25,000 | 75,000 | (4) | — | 4.45 | 01/31/2030 | |||||||||||||||
— | — | 100,000 | (6) | 8.90 | 01/31/2030 | |||||||||||||||
Lisa Dombro | 375,000 | 125,000 | (3) | — | 1.00 | 4/27/2027 | ||||||||||||||
— | — | 750,000 | (6) | 3.00 | 4/27/2027 | |||||||||||||||
125,000 | 125,000 | (5) | — | 1.00 | 1/24/2028 | |||||||||||||||
— | 200,000 | (2) | — | 4.49 | 7/29/2030 | |||||||||||||||
Benjamin Kornitzer, M.D. | — | 550,000 | (2) | — | 4.49 | 1/31/2030 | ||||||||||||||
— | — | 250,000 | (6) | 8.99 | 1/31/2030 | |||||||||||||||
Ronald Kuerbitz | 4,250,000 | — | — | 1.00 | 12/30/2026 | |||||||||||||||
850,000 | — | — | 1.00 | 4/27/2027 |
(1) | The awards in this column consist of nonqualified stock options granted under our Stock Incentive Plan that have previously vested. |
(2) | These awards consist of nonqualified stock options granted under our Stock Incentive Plan that will vest (a) for Mr. Sell, 20% on each anniversary of June 1, 2020, (b) for Ms. Danieley, in full on September 15, 2021, (c) for Ms. Dombro, 25% on each anniversary of July 29, 2020 and (d) for Dr. Kornitzer, 25% on each anniversary of January 9, 2020, in each case subject to that NEO’s continued employment through each applicable vesting date, except as described above under “Narrative Disclosure to Summary Compensation Table—Equity Compensation Plan.” |
(3) | These awards consist of nonqualified stock options granted under our Stock Incentive Plan, which vested (a) for Mr. Halkias, on May 15, 2021, and (b) for Ms. Dombro, on March 1, 2021. |
(4) | These awards consist of nonqualified stock options granted under our Stock Incentive Plan that will vest in three equal installments on each anniversary of August 14, 2019, subject to Ms. Danieley’s continued service through such date. |
(5) | These awards consist of nonqualified stock options granted under our Stock Incentive Plan, of which half vested on January 24, 2021 and the remaining half will vest on January 24, 2022, subject to Ms. Dombro’s continued service through such dates. |
(6) | These awards consist of nonqualified stock options granted under our Stock Incentive Plan, which vest (a) for Mr. Sell, 20% on each anniversary of June 1, 2020, but only if as of such date or a later date prior to the option’s termination, the Performance Condition has been achieved, and (b) for Mr. Halkias, Ms. Danieley, Ms. Dombro and Dr. Kornitzer, on the date the Performance Condition is achieved, in each case subject to that NEO’s continued employment through each applicable vesting date, except as described above under “Elements of Our Executive Compensation Program—Long-Term Equity Incentives—Stock Incentive Plan.” |
(7) | These awards consist of nonqualified stock options granted under our Stock Incentive Plan, which vested upon the completion of the IPO on April 19, 2021. |
Name | Salary ($) | Target Bonus ($) | Earned and Unpaid Bonus ($) | COBRA Benefit Payment ($) | Total ($) | |||||||||||||||
Steven J. Sell | 1,125,000 | 562,500 | 328,893 | 22,622 | 2,039,015 | |||||||||||||||
Theodore Halkias | 800,000 | 600,000 | N/A | 33,934 | 1,433,934 | |||||||||||||||
Joan Danieley | 730,000 | N/A | N/A | N/A | 730,000 | |||||||||||||||
Lisa Dombro | 700,000 | 525,000 | N/A | 33,934 | 1,258,934 | |||||||||||||||
Benjamin Kornitzer, M.D. | 1,000,000 | N/A | N/A | N/A | 1,000,000 |
• | the acquisition by any person, entity or “group” (as defined in Section 13(d) of the Exchange Act) of more than 50% of the combined voting power of the Company’s then outstanding voting securities, other than any such acquisition by the Company, any of the subsidiaries, any employee benefit plan of the Company or any of the subsidiaries, or by the CD&R Investors, or any affiliates of any of the foregoing; |
• | the merger, consolidation or other similar transaction involving the Company, as a result of which both ( x ) persons who were stockholders of the Company immediately prior to such merger, consolidation, or other similar transaction do not, immediately thereafter, own, directly or indirectly, more than 50% of the combined voting power entitled to vote generally in the election of directors of the merged or consolidated company, and (y ) the CD&R Investors (individually or collectively) do not, immediately thereafter, own, directly or indirectly, more than 50% of the combined voting power entitled to vote generally in the election of directors of the merged or consolidated company; |
• | within any 12-month period, the persons who were directors of the Company at the beginning of such period (the “Incumbent Directors”) shall cease to constitute at least a majority of the Board, provided that |
any director elected or nominated for election to the Board by a majority of the Incumbent Directors then still in office shall be deemed to be an Incumbent Director for purposes of this clause (iii); or |
• | the sale, transfer or other disposition of all or substantially all of the assets of the Company to one or more persons or entities that are not, immediately prior to such sale, transfer or other disposition, affiliates of the Company. |
Name | Acceleration of Options ($)(1) | |||
Steven J. Sell | 13,336,200 | |||
Theodore Halkias | 13,671,000 | |||
Joan Danieley | 4,079,245 | |||
Lisa Dombro | 7,329,080 | |||
Benjamin Kornitzer, M.D. | 2,444,970 |
(1) | Fair market value as of December 31, 2020 of $8.94 per share was determined in accordance with the terms of the Stock Incentive Plan. |
Position | Multiple | |||
Chief Executive Officer | 6x Annual Base Salary | |||
All Other Executive Officers | 2x Annual Base Salary | |||
Non-Employee Directors* | 5x Annual Board Cash Retainer |
* | Excludes CD&R affiliated directors |
Name | Fees earned or paid in cash ($) | Stock awards ($) (1) | Option awards ($) (2) | All other compensation ($) | Total ($) | |||||||||||||||
Ronald A. Williams | — | — | — | — | — | |||||||||||||||
Ravi Sachdev | — | — | — | — | — | |||||||||||||||
Richard J. Schnall | — | — | — | — | — | |||||||||||||||
Derek L. Strum | — | — | — | — | — | |||||||||||||||
Sharad Mansukani, M.D. | 215,000 | — | — | — | 215,000 | |||||||||||||||
William A. Sanger (3) | 50,000 | 50,000 | — | — | 100,000 | |||||||||||||||
Michael L. Smith | 75,000 | 50,000 | — | — | 125,000 | |||||||||||||||
J. William Wulf, M.D. | 50,000 | 50,000 | 527,700 | — | 627,700 |
(1) | The amount in this column represents the grant date fair value of restricted stock units issued to Messrs. Sanger, Smith and Wulf in the 2020 Fiscal Year, computed in accordance with FASB ASC Topic 718. The restricted stock units vest in three equal annual installments, subject to each director’s continued service as a member of our board of directors through such date. As of December 31, 2020, Messrs. Sanger, Smith and Wulf each held 36,500 outstanding restricted stock units. |
(2) | Amounts reported in this column represent the aggregate grant date fair value of stock options granted to Dr. Wulf in the 2020 Fiscal Year, computed in accordance with FASB ASC Topic 718. As of December 31, 2020, Messrs. Mansukani, Williams and Wulf held 800,000, 1,100,000 and 500,000 outstanding stock options awards, respectively. With respect to stock options that vest subject to a performance condition, the grant date fair value is calculated based upon the probable outcome of the performance condition being achieved, consistent with the estimate of aggregate compensation cost to be recognized over the service period determined as of the grant date, excluding the effect of estimated forfeitures. Assuming the applicable performance conditions are achieved, the value of the performance-based vesting option awards at the grant date would be $435,240 for Dr. Wulf. See “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Critical Accounting Estimates—Stock-based Compensation” for a discussion of the relevant assumptions used to calculate these amounts. |
(3) | Messr. Sanger retired as a director effective as of January 4, 2021. |
• | the selling stockholders and each person known to own beneficially more than five percent of our common stock; |
• | each of our directors; |
• | each of our named executive officers; and |
• | all of our current executive officers and directors as a group. |
Shares Beneficially Owned Before the Offering and After the Offering Assuming the Underwriters’ Option Is Not Exercised (1) | Shares Beneficially Owned After the Offering Assuming the Underwriters’ Option Is Exercised in Full | |||||||||||||||||||||||
Name and Address of Beneficial Owner | Number of Shares Owned | Percent of Class Before the Offering (%) | Percent of Class After the Offering (%) | Shares Being Offered by Selling Stockholder | Number of Shares Owned | Percent of Class After the Offering (%) | ||||||||||||||||||
5% Stockholders | ||||||||||||||||||||||||
CD&R Vector Holdings, L.P. (2) (3) | 224,718,177 | 57.5 | % | % | % | |||||||||||||||||||
Morgan Stanley Investor (4) | 26,444,000 | 8.1 | % | % | 26,444,000 | % | ||||||||||||||||||
Capital World Investor (5) | 21,946,500 | 5.6 | % | % | 21,946,500 | % | ||||||||||||||||||
Directors and Named Executive Officers | ||||||||||||||||||||||||
Ron Williams | 3,394,900 | * | * | 3,394,900 | * | |||||||||||||||||||
Michelle A. Gourdine, M.D. | — | * | * | — | * | |||||||||||||||||||
Sharad Mansukani, M.D. | 1,872,400 | * | * | * | ||||||||||||||||||||
Clay Richards | — | * | * | — | * | |||||||||||||||||||
Michael Smith (6) | 270,800 | * | * | 270,800 | * | |||||||||||||||||||
William Wulf, M.D. (7) | 171,350 | * | * | 171,350 | * | |||||||||||||||||||
Karen McLoughlin | — | * | * | — | * | |||||||||||||||||||
Ravi Sachdev | — | * | * | — | * | |||||||||||||||||||
Richard J. Schnall | — | * | * | — | * | |||||||||||||||||||
Derek L. Strum | — | * | * | — | * | |||||||||||||||||||
Steven J. Sell (8) | 1,400,000 | * | * | 1,400,000 | * | |||||||||||||||||||
Lisa Dombro | 687,500 | * | * | 687,500 | * | |||||||||||||||||||
Benjamin Kornitzer, M.D. | 137,500 | * | * | 137,500 | * | |||||||||||||||||||
All current directors and executive officers as a group (19 persons) (9) | 12,559,450 | 3.2 | % | % | 12,559,450 | % |
Shares Beneficially Owned Before the Offering and After the Offering Assuming the Underwriters’ Option Is Not Exercised (1) | Shares Beneficially Owned After the Offering Assuming the Underwriters’ Option Is Exercised in Full | |||||||||||||||||||||||
Name and Address of Beneficial Owner | Number of Shares Owned | Percent of Class Before the Offering (%) | Percent of Class After the Offering (%) | Shares Being Offered by Selling Stockholder | Number of Shares Owned | Percent of Class After the Offering (%) | ||||||||||||||||||
Ronald Kuerbitz (10) | 5,100,000 | 1.3 | % | 13 | % | — | | 5,100,000 | | 1.3 | % |
* | Less than one percent. |
(1) | The selling stockholders have granted the underwriters an option to purchase up to an additional shares. |
(2) | CD&R Investment Associates IX, Ltd. (“CD&R Holdings GP”), as the general partner of the CD&R Investor, may be deemed to beneficially own the shares of common stock in which the CD&R Investor has beneficial ownership. CD&R Holdings GP expressly disclaims beneficial ownership of the shares of common stock in which the CD&R Investor has beneficial ownership. Investment and voting decisions with respect to the shares of common stock held by the CD&R Investor are made by an investment committee of limited partners of CD&R Associates IX, L.P., currently consisting of more than ten individuals, each of whom is also an investment professional of CD&R (the “Investment Committee”). All members of the Investment Committee disclaim beneficial ownership of the shares shown as beneficially owned by the CD&R Investor. CD&R Holdings GP is managed by a two-person board of directors. Donald J. Gogel and Nathan K. Sleeper, as the directors of CD&R Holdings GP, may be deemed to share beneficial ownership of the shares of common stock directly held by the CD&R Investor. Such persons expressly disclaim such beneficial ownership. The principal office of the CD&R Investor is c/o Clayton, Dubilier & Rice, LLC, 375 Park Avenue, New York, New York, 10152. |
(3) | Certain CD&R investment professionals may make a contribution of shares to one or more charities prior to this offering. In that event, a recipient charity, if it chooses to participate in this offering, will be the selling stockholder with respect to the donated shares. |
(4) | Includes 26,444,000 shares owned by Morgan Stanley Investment Management Inc. on behalf of certain funds and accounts (such entities collectively, the “Morgan Stanley Investor”). The mailing address for each of the foregoing entities is c/o Morgan Stanley Investment Management Inc., 522 Fifth Avenue, New York, New York 10036. The amounts in the table above do not take into account the shares of our common stock, if any, that Counterpoint Global (Morgan Stanley Investment Management) may purchase in this offering as a cornerstone investor. |
(5) | Includes 8,832,200 shares owned by The New Economy Fund and 13,114,300 shares owned by SMALLCAP World Fund, Inc. (such entities together, the “Capital World Investor”). The mailing address of each of the foregoing entities is c/o Capital Research and Management Company, 333 South Hope Street, 55th Floor, Los Angeles, CA 90071. The amounts in the table above do not take into account the shares of our common stock, if any, that Capital World Investors may purchase in this offering as a cornerstone investor. |
(6) | Includes 120,800 shares of our common stock subject to outstanding vested RSUs. |
(7) | Includes 85,200 shares of our common stock subject to outstanding vested RSUs. |
(8) | Excludes 556,200 shares held by the Sell Family Trust and the Sell Children’s Trust, each an irrevocable trust of which Mr. Sell is neither the trustee nor a beneficiary. |
(9) | Includes an aggregate amount of 8,040,000 shares which the current executive officers and directors have the right to acquire prior to September 24, 2021 through the exercise of stock options and 206,000 shares of our common stock subject to outstanding vested RSUs granted to directors. |
(10) | Includes 5,100,000 shares which Mr. Kuerbitz has the right to acquire through the exercise of stock options. |
• | at least a majority of the total number of directors comprising our board of directors at such time as long as the CD&R Investor beneficially owns at least 50% of the outstanding shares of our common stock; |
• | at least 40% of the total number of directors comprising our board of directors at such time as long as the CD&R Investor beneficially owns at least 40% but less than 50% of the outstanding shares of our common stock; |
• | at least 30% of the total number of directors comprising our board of directors at such time as long as the CD&R Investor beneficially owns at least 30% but less than 40% of the outstanding shares of our common stock; |
• | at least 20% of the total number of directors comprising our board of directors at such time as long as the CD&R Investor beneficially owns at least 20% but less than 30% of the outstanding shares of our common stock; and |
• | at least 5% of the total number of directors comprising our board of directors at such time as long as the CD&R Investor beneficially owns at least 5% but less than 20% of the outstanding shares of our common stock. |
• | to cast one vote for each share held of record on all matters submitted to a vote of the stockholders; |
• | to receive, on a pro rata basis, dividends and distributions, if any, that our board of directors may declare out of legally available funds, subject to preferences that may be applicable to preferred stock, if any, then outstanding; and |
• | upon our liquidation, dissolution or winding-up, to share equally and ratably in any assets remaining after the payment of all debt and other liabilities, subject to the prior rights, if any, of holders of any outstanding shares of preferred stock. |
• | liability and indemnification of directors; |
• | corporate opportunities; |
• | elimination of stockholder action by written consent if the CD&R Investor ceases to beneficially own at least 40% of the outstanding shares of our common stock; |
• | prohibition on the rights of stockholders to call a special meeting if the CD&R Investor ceases to beneficially own at least 40% of the outstanding shares of our common stock; |
• | removal of directors for cause if the CD&R Investor ceases to own at least 40% of our outstanding common stock; |
• | classified board of directors; and |
• | required approval of the holders of at least 66 2/3% of the outstanding shares of our common stock to amend our By-laws and certain provisions of our Certificate of Incorporation if the CD&R Investor ceases to beneficially own at least 40% of the outstanding shares of our common stock. |
• | any breach of the director’s duty of loyalty; |
• | acts or omissions not in good faith or which involve intentional misconduct or a knowing violation of the law; |
• | unlawful payments of dividends or unlawful stock repurchases, redemptions or other distributions; or |
• | any transaction from which the director derives an improper personal benefit. |
• | 1% of the number of shares of our common stock then outstanding, which will equal approximately 3,908,825 shares immediately after this offering; and |
• | the average reported weekly trading volume of our common stock on the NYSE during the four calendar weeks preceding the date of filing a Notice of Proposed Sale of Securities Pursuant to Rule 144 with respect to the sale. |
• | an individual who is neither a citizen nor a resident of the United States; |
• | a corporation that is not created or organized in or under the laws of the United States, any state thereof or the District of Columbia; |
• | an estate that is not subject to U.S. federal income tax on income from non-U.S. sources that is not effectively connected with the conduct of a trade or business in the United States; or |
• | a trust unless (i) a court within the United States is able to exercise primary supervision over its administration and one or more U.S. persons have the authority to control all of its substantial decisions or (ii) it has in effect a valid election under applicable U.S. Treasury regulations to be treated as a U.S. person. |
Underwriter | Number of Shares | |||
J.P. Morgan Securities LLC | ||||
Goldman Sachs & Co. LLC | ||||
Total | ||||
Per Share | Total | |||||||||||||||
No Exercise | Full Exercise | No Exercise | Full Exercise | |||||||||||||
Public offering price | $ | $ | $ | $ | ||||||||||||
Underwriting discounts and commissions borne by the selling stockholders | $ | $ | $ | $ |
• | does not constitute a disclosure document or a prospectus under Chapter 6D.2 of the Corporations Act 2001 (Cth) (the “Corporations Act”); |
• | has not been, and will not be, lodged with the Australian Securities and Investments Commission (“ASIC”), as a disclosure document for the purposes of the Corporations Act and does not purport to include the information required of a disclosure document for the purposes of the Corporations Act; and |
• | may only be provided in Australia to select investors who are able to demonstrate that they fall within one or more of the categories of investors, available under section 708 of the Corporations Act (“Exempt Investors”). |
Section 96 (1) (a) | the offer, transfer, sale, renunciation or delivery is to: (i) persons whose ordinary business, or part of whose ordinary business, is to deal in securities, as principal or agent; (ii) the South African Public Investment Corporation; (iii) persons or entities regulated by the Reserve Bank of South Africa; (iv) authorised financial service providers under South African law; (v) financial institutions recognised as such under South African law; |
(vi) a wholly-owned subsidiary of any person or entity contemplated in (c), (d) or (e), acting as agent in the capacity of an authorised portfolio manager for a pension fund, or as manager for a collective investment scheme (in each case duly registered as such under South African law); or (vii) any combination of the person in (i) to (vi); or | ||
Section 96 (1) (b) | the total contemplated acquisition cost of the securities, for any single addressee acting as principal is equal to or greater than ZAR1,000,000 or such higher amount as may be promulgated by notice in the Government Gazette of South Africa pursuant to section 96(2)(a) of the South African Companies Act. |
F-2 | ||||
F-3 | ||||
F-4 | ||||
F-6 | ||||
F-7 | ||||
F-22 |
F-25 | ||||
F-27 | ||||
F-28 | ||||
F-29 | ||||
F-30 | ||||
F-31 | ||||
F-63 |
June 30, 2021 | December 31, 2020 | |||||||
(unaudited) | ||||||||
ASSETS | ||||||||
Current assets: | ||||||||
Cash and cash equivalents | $ | 1,109,372 | $ | 106,795 | ||||
Restricted cash and equivalents | 16,343 | 28,383 | ||||||
Receivables, net | 338,359 | 144,555 | ||||||
Prepaid expenses and other current assets, net | 15,740 | 9,639 | ||||||
Current assets held for sale and discontinued operations, net | — | 4,825 | ||||||
Total current assets | 1,479,814 | 294,197 | ||||||
Property and equipment, net | 4,589 | 6,456 | ||||||
Intangible assets, net | 58,663 | 60,468 | ||||||
Goodwill | 41,540 | 41,540 | ||||||
Other assets, net | 117,128 | 43,700 | ||||||
Total assets | $ | 1,701,734 | $ | 446,361 | ||||
LIABILITIES, CONTINGENTLY REDEEMABLE COMMON STOCK AND STOCKHOLDERS’ EQUITY (DEFICIT) | ||||||||
Current liabilities: | ||||||||
Medical claims and related payables | $ | 300,981 | $ | 162,868 | ||||
Accounts payable and accrued expenses | 107,599 | 97,244 | ||||||
Current portion of long-term debt | 3,750 | 3,041 | ||||||
Current liabilities held for sale and discontinued operations | — | 3,682 | ||||||
Total current liabilities | 412,330 | 266,835 | ||||||
Long-term debt, net of current portion | 45,862 | 64,665 | ||||||
Other liabilities | 93,264 | 90,091 | ||||||
Total liabilities | 551,456 | 421,591 | ||||||
Commitments and contingencies | 0 | 0 | ||||||
Contingently redeemable common stock, $00.01 par value: 0076,201 shares issued and outstanding at December 31, 2020 | — | 309,500 | ||||||
Stockholders’ equity (deficit): | ||||||||
Common stock, $0.01 par value: 2,000,000 shares authorized; 390,883 and 249,374 shares issued and outstanding, respectively | 3,909 | 2,494 | ||||||
Additional paid-in capital | 2,011,651 | 263,966 | ||||||
Accumulated deficit | (865,113 | ) | (551,190 | ) | ||||
Total agilon health, inc. stockholders’ equity (deficit) | 1,150,447 | (284,730 | ) | |||||
Noncontrolling interests | (169 | ) | — | |||||
Total stockholders’ equity (deficit) | 1,150,278 | (284,730 | ) | |||||
Total liabilities, contingently redeemable common stock and stockholders’ equity (deficit) | $ | 1,701,734 | $ | 446,361 | ||||
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||
Revenues: | ||||||||||||||||
Medical services revenue | $ | 497,678 | $ | 292,495 | $ | 910,090 | $ | 582,309 | ||||||||
Other operating revenue | 1,278 | 1,099 | 1,970 | 2,333 | ||||||||||||
Total revenues | 498,956 | 293,594 | 912,060 | 584,642 | ||||||||||||
Expenses: | ||||||||||||||||
Medical services expense | 442,483 | 220,363 | 802,837 | 468,016 | ||||||||||||
Other medical expenses | 33,694 | 34,761 | 57,355 | 53,187 | ||||||||||||
General and administrative | 43,013 | 34,248 | 79,318 | 60,832 | ||||||||||||
Stock-based compensation expense | 274,548 | 2,155 | 276,020 | 3,176 | ||||||||||||
Depreciation and amortization | 3,581 | 3,319 | 7,008 | 6,517 | ||||||||||||
Total expenses | 797,319 | 294,846 | 1,222,538 | 591,728 | ||||||||||||
Income (loss) from operations | (298,363 | ) | (1,252 | ) | (310,478 | ) | (7,086 | ) | ||||||||
Other income (expense): | ||||||||||||||||
Other income (expense), net | 2,967 | (74 | ) | 4,303 | 48 | |||||||||||
Interest expense | (1,498 | ) | (2,080 | ) | (4,439 | ) | (4,229 | ) | ||||||||
Income (loss) before income taxes | (296,894 | ) | (3,406 | ) | (310,614 | ) | (11,267 | ) | ||||||||
Income tax benefit (expense) | (435 | ) | (39 | ) | (451 | ) | (39 | ) | ||||||||
Income (loss) from continuing operations | (297,329 | ) | (3,445 | ) | (311,065 | ) | (11,306 | ) | ||||||||
Discontinued operations: | ||||||||||||||||
Income (loss) before income taxes | (1,547 | ) | (4,340 | ) | (2,898 | ) | (12,429 | ) | ||||||||
Income tax benefit (expense) | (65 | ) | (126 | ) | (129 | ) | (275 | ) | ||||||||
Total discontinued operations | (1,612 | ) | (4,466 | ) | (3,027 | ) | (12,704 | ) | ||||||||
Net income (loss) | (298,941 | ) | (7,911 | ) | (314,092 | ) | (24,010 | ) | ||||||||
Noncontrolling interests’ share in (earnings) loss | 96 | — | 169 | — | ||||||||||||
Net income (loss) attributable to common shares | $ | (298,845 | ) | $ | (7,911 | ) | $ | (313,923 | ) | $ | (24,010 | ) | ||||
Net income (loss) per common share, basic and diluted | ||||||||||||||||
Continuing operations | $ | (0.79 | ) | $ | (0.01 | ) | $ | (0.88 | ) | $ | (0.03 | ) | ||||
Discontinued operations | $ | — | $ | (0.01 | ) | $ | (0.01 | ) | $ | (0.04 | ) | |||||
Weighted average shares outstanding, basic and diluted | 377,445 | 323,702 | 351,695 | 321,827 |
Contingently Redeemable Common Stock | Total Stockholders’ Equity | |||||||||||||||||||||||||||||||||||
Common Stock | Additional Paid-In Capital | Accumulated Deficit | Noncontrolling Interest | Total Stockholders’ Equity (Deficit) | ||||||||||||||||||||||||||||||||
Shares | Amount | Shares | Amount | |||||||||||||||||||||||||||||||||
April 1, 2021 | 76,201 | $ | 309,500 | 249,474 | $ | 2,494 | $ | 265,603 | $ | (566,268 | ) | $ | (73 | ) | $ | (298,244 | ) | |||||||||||||||||||
Net income (loss) | — | — | — | — | — | (298,845 | ) | (96 | ) | (298,941 | ) | |||||||||||||||||||||||||
Reclassification of contingently redeemable common stock in connection with initial public offering (“IPO”) | (76,201 | ) | (309,500 | ) | 76,201 | 762 | 308,738 | — | — | 309,500 | ||||||||||||||||||||||||||
Issuance of common stock in connection with IPO, net of offering costs | — | — | 53,590 | 536 | 1,162,493 | — | — | 1,163,029 | ||||||||||||||||||||||||||||
Issuance of common stock under partner physician group equity agreements upon IPO | — | — | 11,672 | 117 | 268,350 | �� | — | — | 268,467 | |||||||||||||||||||||||||||
Exercise of stock options and other, net | — | — | (54 | ) | — | 386 | — | — | 386 | |||||||||||||||||||||||||||
Stock-based compensation expense | — | — | — | — | 6,081 | — | — | 6,081 | ||||||||||||||||||||||||||||
June 30, 2021 | — | $ | — | 390,883 | $ | 3,909 | $ | 2,011,651 | $ | (865,113 | ) | $ | (169 | ) | $ | 1,150,278 | ||||||||||||||||||||
Contingently Redeemable Common Stock | Total Stockholders’ Equity | |||||||||||||||||||||||||||||||||||
Common Stock | Additional Paid-In Capital | Accumulated Deficit | Noncontrolling Interest | Total Stockholders’ Equity (Deficit) | ||||||||||||||||||||||||||||||||
Shares | Amount | Shares | Amount | |||||||||||||||||||||||||||||||||
January 1, 2021 | 76,201 | $ | 309,500 | 249,374 | $ | 2,494 | $ | 263,966 | $ | (551,190 | ) | $ | — | $ | (284,730 | ) | ||||||||||||||||||||
Net income (loss) | — | — | — | — | — | (313,923 | ) | (169 | ) | (314,092 | ) | |||||||||||||||||||||||||
Reclassification of contingently redeemable common stock in connection with IPO | (76,201 | ) | (309,500 | ) | 76,201 | 762 | 308,738 | — | — | 309,500 | ||||||||||||||||||||||||||
Issuance of common stock in connection with IPO, net of offering costs | — | — | 53,590 | 536 | 1,162,493 | — | — | 1,163,029 | ||||||||||||||||||||||||||||
Issuance of common stock under partner physician group equity agreements upon IPO | — | — | 11,672 | 117 | 268,350 | — | — | 268,467 | ||||||||||||||||||||||||||||
Exercise of stock options and other, net | — | — | 46 | — | 551 | — | — | 551 | ||||||||||||||||||||||||||||
Stock-based compensation expense | — | — | �� | — | — | 7,553 | — | — | 7,553 | |||||||||||||||||||||||||||
June 30, 2021 | — | $ | — | 390,883 | $ | 3,909 | $ | 2,011,651 | $ | (865,113 | ) | $ | (169 | ) | $ | 1,150,278 | ||||||||||||||||||||
Contingently Redeemable Common Stock | Total Stockholders’ Equity | |||||||||||||||||||||||||||||||
Common Stock | Additional Paid-In Capital | Accumulated Deficit | Total Stockholders’ Equity (Deficit) | |||||||||||||||||||||||||||||
Shares | Amount | Shares | Amount | |||||||||||||||||||||||||||||
April 1, 2020 | 76,201 | $ | 309,500 | 246,924 | $ | 2,469 | $ | 257,254 | $ | (507,237 | ) | $ | (247,514 | ) | ||||||||||||||||||
Net income (loss) | — | — | — | — | — | (7,911 | ) | (7,911 | ) | |||||||||||||||||||||||
Issuance of common stock, net | — | — | 1,023 | 10 | 4,591 | — | 4,601 | |||||||||||||||||||||||||
Exercise of stock options and other, net | — | — | 335 | 3 | 310 | — | 313 | |||||||||||||||||||||||||
Stock-based compensation expense | — | — | — | — | 2,231 | — | 2,231 | |||||||||||||||||||||||||
June 30, 2020 | 76,201 | $ | 309,500 | 248,282 | $ | 2,482 | $ | 264,386 | $ | (515,148 | ) | $ | (248,280 | ) | ||||||||||||||||||
Contingently Redeemable Common Stock | Total Stockholders’ Equity | |||||||||||||||||||||||||||||||
Common Stock | Additional Paid-In Capital | Accumulated Deficit | Total Stockholders’ Equity (Deficit) | |||||||||||||||||||||||||||||
Shares | Amount | Shares | Amount | |||||||||||||||||||||||||||||
January 1, 2020 | 69,860 | $ | 281,000 | 246,743 | $ | 2,467 | $ | 256,643 | $ | (491,138 | ) | $ | (232,028 | ) | ||||||||||||||||||
Net income (loss) | — | — | — | — | — | (24,010 | ) | (24,010 | ) | |||||||||||||||||||||||
Issuance of contingently redeemable common stock | 6,341 | 28,500 | — | — | (460 | ) | — | (460 | ) | |||||||||||||||||||||||
Issuance of common stock, net | — | — | 1,023 | 10 | 4,591 | — | 4,601 | |||||||||||||||||||||||||
Exercise of stock options and other, net | — | — | 516 | 5 | 310 | — | 315 | |||||||||||||||||||||||||
Stock-based compensation expense | — | — | — | — | 3,302 | — | 3,302 | |||||||||||||||||||||||||
June 30, 2020 | 76,201 | $ | 309,500 | 248,282 | $ | 2,482 | $ | 264,386 | $ | (515,148 | ) | $ | (248,280 | ) | ||||||||||||||||||
Six Months Ended June 30, | ||||||||
2021 | 2020 | |||||||
Cash flows from operating activities: | ||||||||
Net income (loss) | $ | (314,092 | ) | $ | (24,010 | ) | ||
Adjustments to reconcile net loss to net cash used in operating activities: | ||||||||
Depreciation and amortization | 7,095 | 6,845 | ||||||
Stock-based compensation expense | 276,020 | 3,302 | ||||||
Loss on debt extinguishment | 1,590 | — | ||||||
Loss (income) from equity method investments | (2,532 | ) | (380 | ) | ||||
Other noncash items | 2,011 | 520 | ||||||
Changes in operating assets and liabilities | (50,211 | ) | (21,775 | ) | ||||
Net cash provided by (used in) operating activities | (80,119 | ) | (35,498 | ) | ||||
Cash flows from investing activities: | ||||||||
Purchase of property and equipment, net | (646 | ) | (941 | ) | ||||
Purchase of intangible assets | (4,018 | ) | (306 | ) | ||||
Investment in loans receivable and other | (70,307 | ) | (2,166 | ) | ||||
Proceeds from repayment of loans receivable | 1,277 | 1,062 | ||||||
Proceeds from sale of business and property, net of cash divested | (2,644 | ) | — | |||||
Net cash provided by (used in) investing activities | (76,338 | ) | (2,351 | ) | ||||
Cash flows from financing activities: | ||||||||
Proceeds from initial public offering | 1,170,942 | — | ||||||
Proceeds from other equity issuances, net | — | 32,727 | ||||||
Proceeds from exercise of stock options | 551 | 315 | ||||||
Proceeds from the issuance of long-term debt | 100,000 | — | ||||||
Equity and debt issuance costs and other | (9,768 | ) | — | |||||
Repayments of long-term borrowings and other | (118,648 | ) | (1,520 | ) | ||||
Net cash provided by (used in) financing activities | 1,143,077 | 31,522 | ||||||
Net increase (decrease) in cash, cash equivalents and restricted cash and equivalents | 986,620 | (6,327 | ) | |||||
Cash, cash equivalents and restricted cash and equivalents from continuing operations, beginning of period | 135,178 | 139,152 | ||||||
Cash, cash equivalents and restricted cash and equivalents from discontinued operations, beginning of period | 3,917 | 6,460 | ||||||
Cash, cash equivalents and restricted cash and equivalents, beginning of period | 139,095 | 145,612 | ||||||
Cash, cash equivalents and restricted cash and equivalents from continuing operations, end of period | 1,125,715 | 134,552 | ||||||
Cash, cash equivalents and restricted cash and equivalents from discontinued operations, end of period | — | 4,733 | ||||||
Cash, cash equivalents and restricted cash and equivalents, end of period | $ | 1,125,715 | $ | 139,285 | ||||
• | During 2020, the Company entered into strategic partnerships to further expand its operations beginning January 1, 2021 into: (i) Buffalo, New York; (ii) Toledo, Ohio; and (iii) Hartford, Connecticut. In December 2020, the Company entered into a strategic partnership to further expand its operations beginning January 1, 2022 into Syracuse, New York. |
• | During 2021, the Company entered into strategic partnerships to further expand its operations beginning January 1, 2022 into: (i) Grand Rapids and Traverse City, Michigan; (ii) Pinehurst, North Carolina; and (iii) Longview and Texarkana, Texas, along with additional partnerships in the Company’s existing Ohio and Texas markets. |
• | On April 1, 2021, the Company launched 5 Direct Contracting Entities (“DCE”) that, in collaboration with 7 of its physician group partners, are participating in the Center for Medicare & Medicaid Innovation’s Direct Contracting Model. |
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||
Payor A | 24 | % | 38 | % | 26 | % | 38 | % | ||||||||
Payor B | 19 | % | 20 | % | 20 | % | 20 | % | ||||||||
Payor C | 20 | % | 12 | % | 17 | % | 12 | % | ||||||||
Payor D | 11 | % | * | 10 | % | * |
* | Less than 10% of total revenues. |
June 30, 2021 | December 31, 2020 | |||||||
Payor A | 18 | % | 38 | % | ||||
Payor B | 24 | % | 27 | % | ||||
Payor C | 13 | % | * | |||||
Payor D | 14 | % | * |
* | Less than 10% of total receivables. |
June 30, 2021 | December 31, 2020 | |||||||
Loans to physician partners | $ | 67,828 | $ | 0 | ||||
Indemnification assets | 10,137 | 10,009 | ||||||
Health plan deposits | 11,523 | 11,523 | ||||||
Equity method investments | 11,997 | 8,502 | ||||||
Right-of-use | 9,208 | 9,585 | ||||||
Other | 6,435 | 4,081 | ||||||
$ | 117,128 | $ | 43,700 | |||||
June 30, 2021 | December 31, 2020 | |||||||
Direct contracting entities | $ | 2,603 | $ | 0 | ||||
Other | 9,394 | 8,502 | ||||||
$ | 11,997 | $ | 8,502 | |||||
Total | ||||
Medical services revenue | $ | 163,984 | ||
Medical services expens e | (152,154 | ) | ||
Other medical expenses (1) | (7,156 | ) | ||
Net income | 1,840 | |||
(1) | Includes physician incentive expenses of $3.6 million. |
June 30, 2021 | December 31, 2020 | |||||||
Medical claims and related payables, beginning of the year | $ | 164,161 | $ | 121,779 | ||||
Components of incurred costs related to: | ||||||||
Current year | 803,711 | 1,026,940 | ||||||
Prior years | (874 | ) | (5,063 | ) | ||||
Discontinued operations—current year | 1,234 | 85,732 | ||||||
Discontinued operations—prior year s | (1,862 | ) | (1,543 | ) | ||||
802,209 | 1,106,066 | |||||||
Claims paid related to: | ||||||||
Current year | (517,368 | ) | (870,979 | ) | ||||
Prior years | (144,260 | ) | (94,868 | ) | ||||
Discontinued operations—current year | (298 | ) | (80,754 | ) | ||||
Discontinued operations—prior year (1) | (3,463 | ) | (17,083 | ) | ||||
(665,389 | ) | (1,063,684 | ) | |||||
Medical claims and related payables, end of the period | $ | 300,981 | $ | 164,161 | ||||
(1) | Includes $1.5 million that was disposed in February 2021. |
June 30, 2021 | December 31, 2020 | |||||||
Other long-term contingencies | $ | 74,808 | $ | 71,693 | ||||
Reserve for uncertain tax positions | 10,137 | 10,009 | ||||||
Lease liabilities, long-term | 5,345 | 5,508 | ||||||
Other | 2,974 | 2,881 | ||||||
$ | 93,264 | $ | 90,091 | |||||
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||
Numerator | ||||||||||||||||
Income (loss) from continuing operations | $ | (297,329 | ) | $ | (3,445 | ) | $ | (311,065 | ) | $ | (11,306 | ) | ||||
Income (loss) from discontinued operations | (1,612 | ) | (4,466 | ) | (3,027 | ) | (12,704 | ) | ||||||||
Noncontrolling interests’ share in (earnings) loss | 96 | 0 | 169 | 0 | ||||||||||||
Net income (loss) attributable to common stockholders | $ | (298,845 | ) | $ | (7,911 | ) | $ | (313,923 | ) | $ | (24,010 | ) | ||||
Denominator | ||||||||||||||||
Weighted average shares outstanding, basic and diluted | 377,445 | 323,702 | 351,695 | 321,827 | ||||||||||||
Net income (loss) per share attributable to common stockholders | ||||||||||||||||
Net income (loss) per common share from continuing operations, basic and diluted | $ | (0.79 | ) | $ | (0.01 | ) | $ | (0.88 | ) | $ | (0.03 | ) | ||||
Net income (loss) per common share from discontinued operations, basic and diluted | $ | 0 | $ | (0.01 | ) | $ | (0.01 | ) | $ | (0.04 | ) |
Six Months Ended June 30, | ||||||||
2021 | 2020 | |||||||
Stock options—service only condition | 24,542 | 26,620 | ||||||
Stock options—market and/or performance condition | 16,655 | 18,315 | ||||||
Restricted stock units | 881 | 138 |
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||
Revenues: | ||||||||||||||||
Medical services revenu e | $ | (534 | ) | $ | 51,757 | $ | 3,313 | $ | 101,941 | |||||||
Other operating revenue | 0 | 56 | 23 | 111 | ||||||||||||
Total revenues | (534 | ) | 51,813 | 3,336 | 102,052 | |||||||||||
Expenses: | ||||||||||||||||
Medical services expense | (1,266 | ) | 28,981 | (628 | ) | 57,421 | ||||||||||
Other medical expenses | 11 | 18,741 | 2,491 | 37,863 | ||||||||||||
General and administrative | 2,154 | 8,351 | 4,742 | 19,030 | ||||||||||||
Depreciation and amortization | 33 | 163 | 87 | 328 | ||||||||||||
Income (loss) from operations | (1,466 | ) | (4,423 | ) | (3,356 | ) | (12,590 | ) | ||||||||
Other income (expense), net | (81 | ) | 154 | (33 | ) | 336 | ||||||||||
Gain (loss) on sale of assets | 0 | 0 | 491 | 0 | ||||||||||||
Interest expense | 0 | (71 | ) | 0 | (175 | ) | ||||||||||
Income (loss) before income taxes | (1,547 | ) | (4,340 | ) | (2,898 | ) | (12,429 | ) | ||||||||
Income tax benefit (expense) | (65 | ) | (126 | ) | (129 | ) | (275 | ) | ||||||||
Net income (loss) from discontinued operations | $ | (1,612 | ) | $ | (4,466 | ) | $ | (3,027 | ) | $ | (12,704 | ) | ||||
Six Months Ended June 30, | ||||||||
2021 | 2020 | |||||||
Non-cash operating activities from discontinued operations: | ||||||||
Depreciation and amortization | $ | 87 | $ | 328 | ||||
Stock-based compensation expense | 0 | 127 |
Six Months Ended June 30, | ||||||||
2021 | 2020 | |||||||
Supplemental cash flow information: | ||||||||
Interest paid | $ | 2,907 | $ | 4,055 | ||||
Income taxes paid | 1,653 | — | ||||||
Supplemental disclosure of non-cash investing and financing activities | ||||||||
Right-of-use | 861 | — | ||||||
Reclassification of contingently redeemable common stock in connection with IPO | 309,500 | — | ||||||
Issuance of common stock under partner physician group equity agreements upon IPO | 268,467 | — | ||||||
Deferred offering costs accrued at end of period | 558 | — �� | ||||||
Non-cash investment in unconsolidated subsidiaries | 763 | — |
June 30, 2021 | December 31, 2020 | |||||||
Cash and cash equivalents | $ | 1,109,372 | $ | 106,795 | ||||
Restricted cash and equivalents (1) | 16,343 | 28,383 | ||||||
Cash, cash equivalents and restricted cash equivalents | $ | 1,125,715 | $ | 135,178 | ||||
(1) | Restricted cash and equivalents primarily consist of amounts used as collateral to secure letters of credit that the Company is required to maintain pursuant to contracts with payors. |
June 30, 2021 | December 31, 2020 | |||||||
Assets (1) | ||||||||
Cash and cash equivalents | $ | 93,835 | $ | 93,053 | ||||
Restricted cash equivalents | 14,202 | 25,032 | ||||||
Receivables, net | 319,178 | 136,636 | ||||||
Prepaid expenses and other current assets, net | 2,106 | 5,986 | ||||||
Property and equipment, net | 735 | 797 | ||||||
Intangible assets, net | 8,469 | 8,208 | ||||||
Other assets, net | 17,382 | 13,343 | ||||||
Assets held for sale and discontinued operations, net | — | 4,825 | ||||||
Liabilities (1) | ||||||||
Medical claims and related payables | 244,014 | 97,146 | ||||||
Accounts payable and accrued expenses | 74,941 | 62,294 | ||||||
Other liabilities | 11,635 | 10,926 | ||||||
Liabilities held for sale and discontinued operations | — | 3,682 |
(1) | Assets and liabilities of VIEs presented above include the assets and liabilities of the Company’s Independent Practice Associations in California, which are consolidated VIEs and whose operations are reflected in the condensed consolidated financial statements as discontinued operations. |
June 30, 2021 | December 31, 2020 | |||||||
(unaudited) | ||||||||
ASSETS | ||||||||
Prepaid expenses and other current assets, net | $ | 110 | $ | — | ||||
Total current assets | 110 | — | ||||||
Investment in wholly owned subsidiary | 1,083,272 | 24,770 | ||||||
Loans receivable | 67,828 | — | ||||||
Total assets | $ | 1,151,210 | $ | 24,770 | ||||
LIABILITIES, CONTINGENTLY REDEEMABLE COMMON STOCK AND STOCKHOLDERS’ EQUITY (DEFICIT) | ||||||||
Other liabilities | $ | 763 | $ | — | ||||
Contingently redeemable common stock, $0.01 par value: 76,201 shares issued and outstanding at December 31, 2020 | — | 309,500 | ||||||
Stockholders’ equity (deficit): | ||||||||
Common stock, $0.01 par value: 2,000,000 shares authorized; 390,883 and 249,374 shares issued and outstanding, respectively | 3,909 | 2,494 | ||||||
Additional paid-in capital | 2,011,651 | 263,966 | ||||||
Accumulated deficit | (865,113 | ) | (551,190 | ) | ||||
Total stockholders’ equity (deficit) | 1,150,447 | (284,730 | ) | |||||
Total liabilities, contingently redeemable common stock and stockholders’ equity (deficit) | $ | 1,151,210 | $ | 24,770 | ||||
Three Months Ended June 30, | Six Months Ended June 30, | |||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||
Equity in net income (loss) of subsidiary | $ | (298,955 | ) | $ | (7,911 | ) | $ | (314,033 | ) | $ | (24,010 | ) | ||||
Interest income | 110 | 0 | 110 | 0 | ||||||||||||
Net income (loss) attributable to common shares | $ | (298,845 | ) | $ | (7,911 | ) | $ | (313,923 | ) | $ | (24,010 | ) | ||||
Valuation of incurred but not reported claims | ||
Description of the Matter | As of December 31, 2020, the Company’s medical claims and related payables totaled $164.2 million, substantially all of which related to the Company’s estimate for claims that have been incurred but have either not yet been received, processed, or paid and as such, not reported (“IBNR”). As discussed in Note 2 of the consolidated financial statements, management develops its IBNR liability estimate using actuarial methods commonly used by health insurance actuaries that include a number of factors and assumptions, including medical service utilization trends, historical claims payment patterns, changes in membership, observed medical cost trends and other factors. Auditing management’s estimate of the IBNR liability was complex and required the involvement of actuarial specialists due to the highly judgmental nature of the factors and assumptions used in the measurement process. These assumptions have a significant effect on the valuation of the IBNR liability. | |
How We Addressed the Matter in Our Audit | To test the IBNR liability, our audit procedures included, among others, testing the completeness and accuracy of data used in the Company’s models by testing reconciliations of underlying claims and membership data recorded in source systems to the actuarial reserve models, and comparing claims to source documentation. With the assistance of our actuarial specialists, we compared methods and assumptions used by management with historical experience, consistency with generally accepted actuarial methodologies used within the industry, and observable healthcare trend levels within the industry the Company operates. With the assistance of our actuarial specialists, we used the Company’s underlying claims and membership data to develop an independent range of IBNR estimates and compared management’s recorded IBNR liability to our range. Additionally, we performed a review of prior period estimates using subsequent claims development, and we evaluated management’s IBNR disclosures. |
December 31, | ||||||||
2020 | 2019 | |||||||
ASSETS | ||||||||
Current assets: | ||||||||
Cash and cash equivalents | $ | 106,795 | $ | 123,633 | ||||
Restricted cash and equivalents | 28,383 | 15,519 | ||||||
Receivables, net | 144,555 | 93,254 | ||||||
Prepaid expenses and other current assets, net | 9,639 | 4,312 | ||||||
Current assets held for sale and discontinued operations, net | 4,825 | 8,810 | ||||||
Total current assets | 294,197 | 245,528 | ||||||
Property and equipment, net | 6,456 | 7,152 | ||||||
Intangible assets, net | 60,468 | 71,146 | ||||||
Goodwill | 41,540 | 41,540 | ||||||
Other assets, net | 43,700 | 33,284 | ||||||
Non-current assets held for sale and discontinued operations, net | — | 4,144 | ||||||
Total assets | $ | 446,361 | $ | 402,794 | ||||
LIABILITIES, CONTINGENTLY REDEEMABLE COMMON STOCK AND STOCKHOLDERS’ EQUITY (DEFICIT) | ||||||||
Current liabilities: | ||||||||
Medical claims and related payables | $ | 162,868 | $ | 120,705 | ||||
Accounts payable and accrued expenses | 97,244 | 67,555 | ||||||
Current portion of long-term debt | 3,041 | 3,041 | ||||||
Current liabilities held for sale and discontinued operations | 3,682 | 8,309 | ||||||
Total current liabilities | 266,835 | 199,610 | ||||||
Long-term debt, net of current portion | 64,665 | 67,143 | ||||||
Other liabilities | 90,091 | 86,949 | ||||||
Non-current liabilities held for sale and discontinued operations | — | 120 | ||||||
Total liabilities | 421,591 | 353,822 | ||||||
Commitments and contingencies | 0 | 0 | ||||||
Contingently redeemable common stock, 76,201 and 69,860 shares issued and outstanding, respectively | 309,500 | 281,000 | ||||||
Stockholders’ equity (deficit): | ||||||||
Common stock, $0.01 par value: 500,000 shares authorized; 249,374 and 246,743 shares issued and outstanding, respectively | 2,494 | 2,467 | ||||||
Additional paid-in capital | 263,966 | 256,643 | ||||||
Accumulated deficit | (551,190 | ) | (491,138 | ) | ||||
Total stockholders’ equity (deficit) | (284,730 | ) | (232,028 | ) | ||||
Total liabilities, contingently redeemable common stock and stockholders’ equity (deficit) | $ | 446,361 | $ | 402,794 | ||||
Year Ended December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Revenues: | ||||||||||||
Medical services revenue | $ | 1,214,270 | $ | 788,566 | $ | |||||||
Other operating revenue | 4,063 | 5,845 | 8,215 | |||||||||
Total revenues | 1,218,333 | 794,411 | 474,827 | |||||||||
Expenses: | ||||||||||||
Medical services expense | 1,021,877 | 725,374 | 412,669 | |||||||||
Other medical expenses | 102,306 | 40,526 | 34,092 | |||||||||
General and administrative | 137,292 | 122,832 | 88,745 | |||||||||
Depreciation and amortization | 13,531 | 12,253 | 11,385 | |||||||||
Total expenses | 1,275,006 | 900,985 | 546,891 | |||||||||
Income (loss) from operations | (56,673 | ) | (106,574 | ) | (72,064 | ) | ||||||
Other income (expense): | ||||||||||||
Other income (expense), net | 2,465 | 955 | 611 | |||||||||
Interest expense | (8,135 | ) | (9,068 | ) | (9,839 | ) | ||||||
Income (loss) before income taxes | (62,343 | ) | (114,687 | ) | (81,292 | ) | ||||||
Income tax benefit (expense) | (865 | ) | 232 | 113 | ||||||||
Income (loss) from continuing operations | (63,208 | ) | (114,455 | ) | (81,179 | ) | ||||||
Discontinued operations: | ||||||||||||
Income (loss) before impairments, gain (loss) on sales and income taxes | (20,049 | ) | (86,108 | ) | (32,132 | ) | ||||||
Impairments | — | (98,343 | ) | (40,794 | ) | |||||||
Gain (loss) on sales of assets, net | 20,401 | — | 0 | |||||||||
Income tax benefit (expense) | 2,804 | 16,166 | 7,588 | |||||||||
Total discontinued operations | 3,156 | (168,285 | ) | (65,338 | ) | |||||||
Net income (loss) | (60,052 | ) | (282,740 | ) | (146,517 | ) | ||||||
Noncontrolling interests’ share in discontinued operations | — | 152 | (409 | ) | ||||||||
Net income (loss) attributable to common shares | $ | (60,052 | ) | $ | (282,588 | ) | $ | (146,926 | ) | |||
Net income (loss) per common share, basic and diluted | ||||||||||||
Continuing operations | $ | (0.20 | ) | $ | (0.39 | ) | $ | (0.33 | ) | |||
Discontinued operations | $ | 0.01 | $ | (0.57 | ) | $ | (0.26 | ) | ||||
Weighted average shares outstanding, basic and diluted | 323,462 | 294,738 | 250,783 |
Contingently Redeemable Common Stock | Total Stockholders’ Equity (Deficit) | |||||||||||||||||||||||||||||||||||
Common Stock | Additional Paid-In Capital | Accumulated Deficit | Noncontrolling Interests | Total Stockholders’ Equity (Deficit) | ||||||||||||||||||||||||||||||||
Shares | Amount | Shares | Amount | |||||||||||||||||||||||||||||||||
January 1, 2018 | 0 | $ | 0 | 247,246 | $ | 2,472 | $ | 245,392 | $ | (61,624 | ) | $ | 46 | $ | 186,286 | |||||||||||||||||||||
Net income (loss) | — | — | — | — | — | (146,926 | ) | 409 | (146,517 | ) | ||||||||||||||||||||||||||
Issuance of contingently redeemable common stock | 26,444 | 100,000 | — | — | — | — | — | — | ||||||||||||||||||||||||||||
Repurchase of common stock, net | — | — | (1,825 | ) | (18 | ) | (1,806 | ) | — | — | (1,824 | ) | ||||||||||||||||||||||||
Stock-based compensation expense | — | — | — | — | 3,651 | — | — | 3,651 | ||||||||||||||||||||||||||||
January 1, 2019 | 26,444 | $ | 100,000 | 245,421 | $ | 2,454 | $ | 247,237 | $ | (208,550 | ) | $ | 455 | $ | 41,596 | |||||||||||||||||||||
Net income (loss) | — | — | — | — | — | (282,588 | ) | (152 | ) | (282,740 | ) | |||||||||||||||||||||||||
Issuance of contingently redeemable common stock | 43,416 | 181,000 | — | — | (806 | ) | — | — | (806 | ) | ||||||||||||||||||||||||||
Settlement of stock-based liabilities | — | — | 1,322 | 13 | 4,987 | — | — | 5,000 | ||||||||||||||||||||||||||||
Stock-based compensation expense | — | — | — | — | 5,225 | — | — | 5,225 | ||||||||||||||||||||||||||||
Distribution to noncontrolling interests | — | — | — | — | — | — | (303 | ) | (303 | ) | ||||||||||||||||||||||||||
January 1, 2020 | 69,860 | $ | 281,000 | 246,743 | $ | 2,467 | $ | 256,643 | $ | (491,138 | ) | $ | — | $ | (232,028 | ) | ||||||||||||||||||||
Net income (loss) | — | — | — | — | — | (60,052 | ) | — | (60,052 | ) | ||||||||||||||||||||||||||
Issuance of contingently redeemable common stock | 6,341 | 28,500 | — | — | (460 | ) | — | — | (460 | ) | ||||||||||||||||||||||||||
Issuance of common stock | — | — | 1,235 | 13 | 5,537 | — | — | 5,550 | ||||||||||||||||||||||||||||
Repurchase of common stock | — | — | (1,500 | ) | (15 | ) | (6,727 | ) | — | — | (6,742 | ) | ||||||||||||||||||||||||
Exercises and vesting of stock-based awards | — | — | 2,562 | 26 | 788 | — | — | 814 | ||||||||||||||||||||||||||||
Settlement of stock-based liabilities | — | — | 334 | 3 | 1,497 | — | — | 1,500 | ||||||||||||||||||||||||||||
Stock-based compensation expense | — | — | — | — | 6,688 | — | — | 6,688 | ||||||||||||||||||||||||||||
December 31, 2020 | 76,201 | $ | 309,500 | 249,374 | $ | 2,494 | $ | 263,966 | $ | (551,190 | ) | $ | — | $ | (284,730 | ) | ||||||||||||||||||||
Year Ended December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Cash flows from operating activities: | ||||||||||||
Net income (loss) | $ | (60,052 | ) | $ | (282,740 | ) | $ | (146,517 | ) | |||
Adjustments to reconcile net loss to net cash used in operating activities: | ||||||||||||
Depreciation and amortization | 14,099 | 41,413 | 21,179 | |||||||||
Stock-based compensation expense | 6,688 | 5,225 | 3,651 | |||||||||
Deferred income taxes and uncertain tax positions | (2,809 | ) | (16,177 | ) | (8,012 | ) | ||||||
Release of indemnification assets | 3,475 | 19,219 | 7,330 | |||||||||
Impairments | — | 98,343 | 40,794 | |||||||||
(Gain) loss on sale of assets, net | (20,401 | ) | — | — | ||||||||
Other non-cash items | (676 | ) | (2,321 | ) | 6,448 | |||||||
Changes in operating assets and liabilities: | ||||||||||||
Receivables, net | (59,381 | ) | (23,280 | ) | (40,628 | ) | ||||||
Prepaid expense and other current assets | (5,085 | ) | (565 | ) | 142 | |||||||
Other assets | (1,977 | ) | 2,425 | (17 | ) | |||||||
Medical claims and related payables | 42,383 | 19,810 | 12,169 | |||||||||
Accounts payable and accrued expenses | 24,922 | 18,451 | 20,332 | |||||||||
Other liabilities | 5,610 | 16,336 | 15,598 | |||||||||
Net cash provided by (used in) operating activities | (53,204 | ) | (103,861 | ) | (67,531 | ) | ||||||
Cash flows from investing activities: | ||||||||||||
Purchase of property and equipment, net | (1,775 | ) | (2,892 | ) | (2,101 | ) | ||||||
Purchase of intangible assets, net | (575 | ) | (1,014 | ) | (3,000 | ) | ||||||
Investments in loans receivable and other | (3,847 | ) | (1,154 | ) | (2,869 | ) | ||||||
Proceeds from repayment of loans receivable | 2,058 | — | — | |||||||||
Proceeds from sale of business | 26,205 | — | — | |||||||||
Net cash provided by (used in) investing activities | 22,066 | (5,060 | ) | (7,970 | ) | |||||||
Cash flows from financing activities: | ||||||||||||
Proceeds from equity issuances, net | 33,590 | 180,193 | 100,000 | |||||||||
Proceeds from exercise of stock options | 814 | — | — | |||||||||
Repurchase of shares, net | (6,742 | ) | — | (1,824 | ) | |||||||
Proceeds from the issuance of long-term debt | — | — | 35,000 | |||||||||
Repayments of long-term borrowings | (3,041 | ) | (3,592 | ) | (47,792 | ) | ||||||
Debt issuance costs | — | — | (641 | ) | ||||||||
Distribution to noncontrolling interests | — | (303 | ) | — | ||||||||
Net cash provided by (used in) financing activities | 24,621 | 176,298 | 84,743 | |||||||||
Net increase (decrease) in cash, cash equivalents and restricted cash and equivalents | (6,517 | ) | 67,377 | 9,242 | ||||||||
Cash, cash equivalents and restricted cash and equivalents from continuing operations, beginning of year | 139,152 | 76,414 | 66,567 | |||||||||
Cash, cash equivalents and restricted cash and equivalents from discontinued operations, beginning of year | 6,460 | 1,821 | 2,426 | |||||||||
Cash, cash equivalents and restricted cash and equivalents, beginning of year | 145,612 | 78,235 | 68,993 | |||||||||
Cash, cash equivalents and restricted cash and equivalents from continuing operations, end of year | 135,178 | 139,152 | 76,414 | |||||||||
Cash, cash equivalents and restricted cash and equivalents from discontinued operations, end of year | 3,917 | 6,460 | 1,821 | |||||||||
Cash, cash equivalents and restricted cash and equivalents, end of year | $ | 139,095 | $ | 145,612 | $ | 78,235 | ||||||
• | The Company operates an independent practice association (“IPA”) in Hawaii. |
• | During 2017, the Company entered into a strategic partnership to expand its operations beginning January 1, 2018 into Columbus, Ohio. |
• | During 2018, the Company entered into strategic partnerships to further expand its operations beginning January 1, 2019 into the Greater Akron/Canton area of Ohio and Austin, Texas. |
• | During 2019, the Company entered into strategic partnerships to expand its operations beginning January 1, 2020 into: (i) Dayton, Ohio; (ii) Southeast Ohio; and (iii) Pittsburgh, Pennsylvania. |
• | During 2020, the Company entered into a strategic partnership to further expand its operations beginning April 1, 2020 into Wilmington, North Carolina. Additionally, during 2020, the Company entered into strategic partnerships to further expand its operations beginning January 1, 2021 into: (i) Buffalo, New York; (ii) Toledo, Ohio; and (iii) Hartford, Connecticut. In December 2020, the Company entered into a strategic partnership to further expand its operations beginning January 1, 2022 into Syracuse, New York. |
• | During 2021, the Company entered into strategic partnerships to further expand its operations beginning January 1, 2022 into: (i) Grand Rapids, Michigan; (ii) Pinehurst, North Carolina; and (iii) Longview, Texas, along with additional partnerships in the Company’s existing Ohio and Texas markets. |
• | On April 1, 2021, the Company launched five Direct Contracting Entities that, in collaboration with seven of its physician group partners, are participating in the Center for Medicare & Medicaid Innovation’s Direct Contracting Model. |
i. | the equity investment at risk is insufficient to finance the entity’s activities without additional subordinated financial support; |
ii. | substantially all of the entity’s activities either involve or are conducted on behalf of an investor that has disproportionately few voting rights; or |
iii. | the equity investors as a group lack any of the following: |
• | the power through voting or similar rights to direct the activities of the entity that most significantly impact the entity’s economic performance; |
• | the obligation to absorb the expected losses of the entity; or |
• | the right to receive the expected residual returns of the entity. |
i. | a change to the terms or in the ability of a party to exercise its kick-out rights; |
ii. | a change in the capital structure of the entity; or |
iii. | acquisitions or sales of interests that constitute a change in control. |
Years | ||
Computer equipment and software | 3 – 5 | |
Furniture and fixtures | 5 – 7 | |
Building | 39 |
• | Level 1—quoted prices for identical instruments in active markets; |
• | Level 2—quoted prices for similar instruments in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations in which significant inputs and significant value drivers are observable in active markets; and |
• | Level 3—fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable. |
Year Ended December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Payor A | 38 | % | 44 | % | 35 | % | ||||||
Payor B | 20 | % | 19 | % | 17 | % | ||||||
Payor C | 11 | % | 14 | % | 23 | % | ||||||
Payor D | * | 11 | % | 17 | % |
* | Less than 10% of total revenue. |
December 31, | ||||||||
2020 | 2019 | |||||||
Payor A | 38 | % | 31 | % | ||||
Payor B | 27 | % | 20 | % | ||||
Payor C | * | 11 | % | |||||
Payor D | * | 19 | % |
* | Less than 10% of total receivables. |
December 31, | ||||||||
2020 | 2019 | |||||||
Computer equipment and software | $ | 8,135 | $ | 6,553 | ||||
Furniture and fixtures | 2,856 | 2,745 | ||||||
Building and leasehold improvements | 2,740 | 2,704 | ||||||
13,731 | 12,002 | |||||||
Less: accumulated depreciation | (7,275 | ) | (4,850 | ) | ||||
Property and equipment, net | $ | 6,456 | $ | 7,152 | ||||
December 31, | ||||||||
2020 | 2019 | |||||||
ROU asset: | ||||||||
Other assets, net | $ | 9,585 | $ | 11,684 | ||||
Lease liabilities: | ||||||||
Accounts payable and accrued expenses | $ | 3,377 | $ | 3,366 | ||||
Other liabilities | 5,508 | 7,737 | ||||||
Total operating lease liabilities | $ | 8,885 | $ | 11,103 | ||||
Year Ended December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Operating lease costs | $ | 4,152 | $ | 3,349 | $ | 3,198 | ||||||
Short-term lease costs | 29 | 8 | 14 | |||||||||
Variable lease costs | 949 | 436 | 661 | |||||||||
Total lease costs | $ | 5,130 | $ | 3,793 | $ | 3,873 | ||||||
Year Ended December 31, | ||||||||||||
Supplemental Cash Flow Information | 2020 | 2019 | 2018 | |||||||||
Cash paid for amounts included in the measurement of lease liability: | ||||||||||||
Operating cash flows from operating leases | $ | 4,495 | $ | 4,434 | $ | 3,131 | ||||||
ROU asset obtained in exchange for new lease liability: | ||||||||||||
Operating leases | $ | 363 | $ | 1,111 | $ | — |
December 31, | ||||||||
Weighted Average Lease Term and Discount Rate | 2020 | 2019 | ||||||
Weighted average remaining lease term (years): | ||||||||
Operating leases | 5 | 6 | ||||||
Weighted average discount rate: | ||||||||
Operating leases | 9.78 | % | 9.79 | % |
Year | Amount | |||
2021 | $ | 3,554 | ||
2022 | 2,515 | |||
2023 | 2,044 | |||
2024 | 665 | |||
2025 | 536 | |||
Thereafter | 1,954 | |||
Undiscounted minimum lease payments payable | 11,268 | |||
Less: imputed interest | (2,383 | ) | ||
Present value of lease liability | $ | 8,885 | ||
Useful Life (Years) | Gross Carrying Amount | Accumulated Amortization | Net Carrying Value | |||||||||||||
Health plan contracts | 15 | $ | 39,700 | $ | (11,689 | ) | $ | 28,011 | ||||||||
Trade names | 15-30 | 20,300 | (2,989 | ) | 17,311 | |||||||||||
Provider networks | 10-15 | 8,400 | (2,473 | ) | 5,927 | |||||||||||
Noncompete enforcement agreements | 4-5 | 30,787 | (22,705 | ) | 8,082 | |||||||||||
Other | 4-15 | 2,700 | (1,563 | ) | 1,137 | |||||||||||
$ | 101,887 | $ | (41,419 | ) | $ | 60,468 | ||||||||||
Useful Life (Years) | Gross Carrying Amount | Accumulated Amortization | Net Carrying Value | |||||||||||||
Health plan contracts | 15 | $ | 39,700 | $ | (9,043 | ) | $ | 30,657 | ||||||||
Trade names | 15-30 | 45,200 | (27,212 | ) | 17,988 | |||||||||||
Provider networks | 10-15 | 8,400 | (1,913 | ) | 6,487 | |||||||||||
Noncompete enforcement agreements | 4-5 | 30,377 | (15,944 | ) | 14,433 | |||||||||||
Other | 4-15 | 2,700 | (1,119 | ) | 1,581 | |||||||||||
$ | 126,377 | $ | (55,231 | ) | $ | 71,146 | ||||||||||
Year | Amount | |||
2021 | $ | 10,332 | ||
2022 | 5,970 | |||
2023 | 4,012 | |||
2024 | 3,957 | |||
2025 | 3,957 | |||
Thereafter | 32,240 | |||
$ | 60,468 | |||
December 31, | ||||||||
2020 | 2019 | |||||||
Indemnification assets | $ | 10,009 | $ | 13,484 | ||||
Health plan deposits | 11,523 | — | ||||||
Right of use asset | 9,585 | 11,684 | ||||||
Other | 12,583 | 8,116 | ||||||
$ | 43,700 | $ | 33,284 | |||||
December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Medical claims and related payables, beginning of the year | $ | 121,779 | $ | 101,967 | $ | 89,799 | ||||||
Components of incurred costs related to: | ||||||||||||
Current yea r | 1,026,940 | 728,610 | 415,074 | |||||||||
Prior years | (5,063 | ) | (3,236 | ) | (2,405 | ) | ||||||
Discontinued operations—current year | 85,732 | 125,795 | 165,358 | |||||||||
Discontinued operations—prior years | (1,543 | ) | (1,945 | ) | 3,196 | |||||||
1,106,066 | 849,224 | 581,223 | ||||||||||
December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Claims paid related to: | ||||||||||||
Current year | (870,979 | ) | (627,422 | ) | (335,795 | ) | ||||||
Prior year s | (94,868 | ) | (76,049 | ) | (55,001 | ) | ||||||
Discontinued operations—current year | (80,754 | ) | (108,531 | ) | (142,242 | ) | ||||||
Discontinued operations—prior years | (17,083 | ) | (17,410 | ) | (36,017 | ) | ||||||
(1,063,684 | ) | (829,412 | ) | (569,055 | ) | |||||||
Medical claims and related payables, end of the year | $ | 164,161 | $ | 121,779 | $ | 101,967 |
December 31, | ||||||||
2020 | 2019 | |||||||
Other long-term contingencies | $ | 71,693 | $ | 64,489 | ||||
Reserve for uncertain tax positions | 10,009 | 12,818 | ||||||
Lease liabilities, long-term | 5,508 | 7,737 | ||||||
Other | 2,881 | 1,905 | ||||||
$ | 90,091 | $ | 86,949 | |||||
Year | Term Loan | Unsecured Debt | Total | |||||||||
2021 | $ | 3,041 | $ | — | $ | 3,041 | ||||||
2022 | 45,608 | — | 45,608 | |||||||||
2023 | 0 | 20,000 | 20,000 | |||||||||
48,649 | 20,000 | 68,649 | ||||||||||
(Discounts), premiums and (debt costs), net | (745 | ) | (198 | ) | (943 | ) | ||||||
$ | 47,904 | $ | 19,802 | $ | 67,706 | |||||||
Total | 2021 | 2022-2023 | 2023-2025 | More than Five Years | ||||||||||||||||
Capital commitments (1) | $ | 18,662 | $ | 16,412 | $ | 2,250 | $ | — | $ | — |
(1) | Represents capital commitments to physician partners to support physician partner expansion and related purposes. |
December 31, | ||||||||||
2020 | 2019 | 2018 | ||||||||
Risk-free interest rate | 0.43% - 1.68% | 2.39% - 2.53% | 2.57% - 2.97% | |||||||
Expected dividends | $0 | $0 | $ 0 | |||||||
Expected volatility | 59.39% - 63.47% | 55.38% - 55.47% | 55.83% - 58.34% | |||||||
Expected term (in years) | 6.25 | 6.25 | 6.25 |
Shares | Weighted- Average Exercise Price | Weighted- Average Remaining Contractual Term (in years) | Aggregate Intrinsic Value (in thousands) | |||||||||||||
Stock options outstanding as of January 1, 2020 | 23,080 | $ | 1.41 | 7.5 | ||||||||||||
Granted | 6,430 | 4.65 | 9.4 | |||||||||||||
Exercised | (2,783 | ) | 1.00 | 5.7 | ||||||||||||
Expired or forfeited | (2,081 | ) | 2.54 | 7.5 | ||||||||||||
Stock options outstanding as of December 31, 2020 | 24,646 | $ | 2.21 | 7.2 | $ | 165,866 | ||||||||||
Expected to vest as of December 31, 2020 | 9,663 | $ | 3.74 | 8.5 | $ | 50,245 | ||||||||||
Exercisable as of December 31, 2020 | 14,983 | $ | 1.22 | 6.3 | $ | 115,671 | ||||||||||
Shares | Weighted- Average Exercise Price | Weighted- Average Remaining Contractual Term (in years) | ||||||||||
Stock options outstanding as of January 1, 2020 | 15,090 | $ | 3.52 | 7.5 | ||||||||
Granted | 6,175 | 9.89 | 9.4 | |||||||||
Exercised | 0 | 0 | — | |||||||||
Expired or forfeited | (4,590 | ) | 3.77 | 6.5 | ||||||||
Stock options outstanding as of December 31, 2020 | 16,675 | $ | 5.81 | 7.6 | ||||||||
Expected to vest as of December 31, 2020 | 0 | $ | 0 | — | ||||||||
Exercisable as of December 31, 2020 | 0 | $ | 0 | — | ||||||||
Year Ended December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Current: | ||||||||||||
Federal | $ | 0— | $ | 0— | $ | 0 | ||||||
State | 856 | 1 | 41 | |||||||||
856 | 1 | 41 | ||||||||||
Deferred: | ||||||||||||
Federal | 38 | (179 | ) | (9 | ) | |||||||
Stat e | (29 | ) | (54 | ) | (145 | ) | ||||||
9 | (233 | ) | (154 | ) | ||||||||
Income tax expense (benefit) | $ | 865 | $ | (232 | ) | $ | (113 | ) | ||||
Year Ended December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Computed tax at US federal statutory rate of 21% | $ | (13,129 | ) | $ | (24,052 | ) | $ | (17,071 | ) | |||
Increase (decrease) in taxes resulting from: | ||||||||||||
State taxes, net of federal impact | 840 | (47 | ) | 628 | ||||||||
Unrecognized tax benefit | (71 | ) | 224 | (35 | ) | |||||||
Permanent differences | 850 | 1,287 | 1,538 | |||||||||
Valuation allowance | 12,443 | 22,530 | 15,386 | |||||||||
Other, net | (68 | ) | (174 | ) | (559 | ) | ||||||
Income tax expense (benefit) | $ | 865 | $ | (232 | ) | $ | (113 | ) | ||||
December 31, | ||||||||
2020 | 2019 | |||||||
Deferred income tax assets: | ||||||||
Net operating losses | $ | 80,316 | $ | 66,644 | ||||
State taxes | 56 | 60 | ||||||
Contingent consideration | 776 | 857 | ||||||
Accrued expenses | 20,708 | 17,441 | ||||||
Transaction costs | 1,006 | 1,097 | ||||||
Stock-based compensation | 3,530 | 2,332 | ||||||
Lease liabilities | 2,237 | 2,850 | ||||||
Interest limitation | 5,635 | 3,870 | ||||||
Goodwill | 2,480 | 1,051 | ||||||
Intangible assets | 23,166 | 7,870 | ||||||
Partnership outside basis | 0 | 128 | ||||||
Other, net | 333 | 287 | ||||||
Total deferred income tax assets | $ | 140,243 | $ | 104,487 | ||||
Deferred income tax liabilities: | ||||||||
Property and equipment | $ | (411 | ) | $ | (483 | ) | ||
ROU assets | (2,412 | ) | (2,998 | ) | ||||
Intangible assets | (9,191 | ) | (14,398 | ) | ||||
Partnership outside basis | (1,465 | ) | (1,562 | ) | ||||
Investment | (411 | ) | (423 | ) | ||||
Total deferred income tax liabilities | $ | (13,890 | ) | $ | (19,864 | ) | ||
Valuation allowance | (126,927 | ) | (85,186 | ) | ||||
Net deferred income tax liabilities | $ | (574 | ) | $ | (563 | ) | ||
December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Balance at beginning of the year | $ | 10,839 | $ | 23,219 | $ | 29,509 | ||||||
Additions related to current year | 384 | 242 | 145 | |||||||||
Additions related to prior years | 565 | — | — | |||||||||
Reductions related to the lapse of applicable statute of limitation s | (2,874 | ) | (12,622 | ) | (6,435 | ) | ||||||
Balance at end of the year | $ | 8,914 | $ | 10,839 | $ | 23,219 | ||||||
Year Ended December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Numerator | ||||||||||||
Income (loss) from continuing operations | $ | (63,208 | ) | $ | (114,455 | ) | $ | (81,179 | ) | |||
Income (loss) from discontinued operations | 3,156 | (168,285 | ) | (65,338 | ) | |||||||
Noncontrolling interests’ share in discontinued operations | 0 | 152 | (409 | ) | ||||||||
Net income (loss) attributable to common stockholder s | $ | (60,052 | ) | $ | (282,588 | ) | $ | (146,926 | ) | |||
Denominator | ||||||||||||
Weighted average shares outstanding, basic and diluted | 323,462 | 294,738 | 250,783 | |||||||||
Net income (loss) per share attributable to common stockholders | ||||||||||||
Net income (loss) per common share from continuing operations, basic and diluted | $ | (0.20 | ) | $ | (0.39 | ) | $ | (0.33 | ) | |||
Net income (loss) per common share from discontinued operations, basic and diluted | $ | 0.01 | $ | (0.57 | ) | $ | (0.26 | ) | ||||
December 31, | ||||||||||
2020 | 2019 | 2018 | ||||||||
Stock options—service only condition | 23,646 | 23,080 | 20,005 | |||||||
Stock options—market and performance condition | 17,675 | 15,090 | 16,470 | |||||||
Restricted stock units | 110 | 185 | 254 |
Year Ended December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Supplemental cash flow information: | ||||||||||||
Interest paid | $ | 7,086 | $ | 8,038 | $ | 8,894 | ||||||
Income taxes paid (refunded), net | 2 | 26 | 17 | |||||||||
Supplemental disclosure of non-cash financing activities: | ||||||||||||
Settlement of stock-based liabilities | 1,500 | 5,000 | — | |||||||||
Settlement of loans receivable with services provided | 2,047 | 0— | — |
December 31, | ||||||||
2020 | 2019 | |||||||
Cash and cash equivalents | $ | 106,795 | $ | 123,633 | ||||
Restricted cash and equivalents | 28,383 | 15,519 | ||||||
Cash, cash equivalents and restricted cash equivalents | $ | 135,178 | $ | 139,152 | ||||
December 31, | ||||||||
2020 | 2019 | |||||||
Assets (1) | ||||||||
Cash and cash equivalents | $ | 93,053 | $ | 23,441 | ||||
Restricted cash equivalents | 25,032 | 15,519 | ||||||
Receivables, net | 136,636 | 76,442 | ||||||
Prepaid expenses and other current assets, net | 5,986 | 1,708 | ||||||
Property and equipment, net | 797 | 687 | ||||||
Intangible assets, net | 8,208 | 18,388 | ||||||
Other assets, net | 13,343 | 15,188 | ||||||
Assets held for sale and discontinued operations, net | 4,825 | 8,672 | ||||||
Liabilities (1) | ||||||||
Medical claims and related payables | 97,146 | 58,221 | ||||||
Accounts payable and accrued expenses | 62,294 | 36,362 | ||||||
Other liabilities | 10,926 | 13,813 | ||||||
Liabilities held for sale and discontinued operations | 3,682 | 8,219 |
(1) | Assets and liabilities of VIEs presented above include the assets and liabilities of the Company’s independent practice associations in California, which are consolidated VIEs and whose operations are reflected in the consolidated financial statements as discontinued operations. |
December 31, | ||||||||
2020 | 2019 | |||||||
ASSETS | ||||||||
Current assets: | ||||||||
Cash and cash equivalents | $ | 3,917 | $ | 6,460 | ||||
Receivables | 908 | 2,350 | ||||||
Total current assets | 4,825 | 8,810 | ||||||
Intangible assets, net | — | 3,930 | ||||||
Other assets, net | — | 214 | ||||||
Total assets | $ | 4,825 | $ | 12,954 | ||||
LIABILITIES | ||||||||
Current liabilities: | ||||||||
Medical claims and related payables | $ | 1,293 | $ | 1,073 | ||||
Accounts payable and accrued expenses | 2,389 | 7,236 | ||||||
Total current liabilities | 3,682 | 8,309 | ||||||
Noncurrent liabilities | — | 120 | ||||||
Total liabilities | 3,682 | 8,429 | ||||||
Net assets | $ | 1,143 | $ | 4,525 | ||||
Year Ended | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Revenues: | ||||||||||||
Medical services revenue | $ | 155,108 | $ | 209,799 | $ 311,744 | |||||||
Other operating revenue | 188 | 127 | 63 | |||||||||
Total revenues | 155,296 | 209,926 | 311,807 | |||||||||
Expenses: | ||||||||||||
Medical services expense | 84,189 | 123,850 | 168,554 | |||||||||
Other medical expenses | 57,546 | 79,423 | 108,358 | |||||||||
General and administrative | 30,341 | 47,413 | 49,874 | |||||||||
Depreciation and amortization | 568 | 29,160 | 9,794 | |||||||||
Impairments (recoveries) | — | 98,343 | 40,794 | |||||||||
Income (loss) from operations | (17,348 | ) | (168,263 | ) | (65,567 ) | |||||||
Other income (expense), ne t | (2,351 | ) | (15,177 | ) | (7,330 ) | |||||||
Gain (loss) on sales of assets, net | 20,401 | — | — | |||||||||
Interest expense | (350 | ) | (1,011 | ) | (29 ) | |||||||
Income (loss) before income taxes and noncontrolling interests | 352 | (184,451 | ) | (72,926 ) | ||||||||
Income tax benefit (expense) | 2,804 | 16,166 | 7,588 | |||||||||
Net income (loss) from discontinued operations | 3,156 | (168,285 | ) | (65,338 ) | ||||||||
Noncontrolling interests’ share of earnings | — | 152 | (409 ) | |||||||||
Net income (loss) from discontinued operations attributable to common shares | $ | 3,156 | $ | (168,133 | ) | $ (65,747 ) | ||||||
Year Ended | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Non-cash operating activities from discontinued operations: | ||||||||||||
Depreciation and amortization | $ | 568 | $ | 29,160 | $ | 9,794 | ||||||
Stock-based compensation expense | 217 | 829 | 701 | |||||||||
Deferred income taxes and uncertain tax positions | (2,809 | ) | (16,177 | ) | (8,012 | ) | ||||||
Release of indemnification asset s | 3,475 | 19,219 | 7,330 | |||||||||
Impairments | — | 98,343 | 40,794 | |||||||||
Other non-cash items | (1,212 | ) | (4,042 | ) | — |
December 31, | ||||||||
2020 | 2019 | |||||||
ASSETS | ||||||||
Investment in wholly owned subsidiary | $ | 24,770 | $ | 50,472 | ||||
Total assets | $ | 24,770 | $ | 50,472 | ||||
LIABILITIES, CONTINGENTLY REDEEMABLE COMMON STOCK AND STOCKHOLDERS’ EQUITY (DEFICIT) | ||||||||
Accounts payable and accrued expenses | $ | — | $ | 1,500 | ||||
Total liabilities | — | 1,500 | ||||||
Contingently redeemable common stock, 76,201 and 69,860 shares issued and outstanding, respectively | 309,500 | 281,000 | ||||||
Stockholders’ equity (deficit): | ||||||||
Common stock, $0.01 par value: 500,000 shares authorized; 249,374 and 246,743 shares issued and outstanding, respectively | 2,494 | 2,467 | ||||||
Additional paid-in capital | 263,966 | 256,643 | ||||||
Accumulated defici t | (551,190 | ) | (491,138 | ) | ||||
Total stockholders’ equity (deficit) | (284,730 | ) | (232,028 | ) | ||||
Total liabilities, contingently redeemable common stock and stockholders’ equity (deficit) | $ | 24,770 | $ | 50,472 | ||||
Year Ended December 31, | ||||||||||||
2020 | 2019 | 2018 | ||||||||||
Equity in net income (loss) of subsidiary | $ | (60,052 | ) | $ | (282,588 | ) | $ | (146,926 | ) | |||
Net income (loss) attributable to common shares | $ | (60,052 | ) | $ | (282,588 | ) | $ | (146,926 | ) | |||
Item 13. | Other Expenses of Issuance and Distribution. |
SEC Registration Fee | $ | |||
FINRA Filing Fee | ||||
Printing Fees and Expenses | ||||
Accounting Fees and Expenses | ||||
Legal Fees and Expenses | ||||
Transfer Agent Fees and Expenses | ||||
Total | $ | |||
Item 14. | Indemnification of Directors and Officers. |
Item 15. | Recent Sales of Unregistered Securities. |
Item 16. | Exhibits and Financial Statement Schedules. |
* | Filed herewith. |
** | To be filed by amendment. |
† | Identifies each management contract or compensatory plan or arrangement. |
+ | Certain portions of this exhibit have been redacted pursuant to Item 601(b)(10)(iv) of Regulation S-K. |
Item 17. | Undertakings. |
(a) | Insofar as indemnification for liabilities arising under the Securities Act of 1933 may be permitted to directors, officers and controlling persons of the registrant pursuant to the foregoing provisions, or otherwise, the registrant has been advised that in the opinion of the Securities and Exchange Commission such indemnification is against public policy as expressed in the Act and is, therefore, unenforceable. In the event that a claim for indemnification against such liabilities (other than the payment by the registrant of expenses incurred or paid by a director, officer or controlling person of the registrant in the successful defense of any action, suit or proceeding) is asserted by such director, officer or controlling person in connection with the securities being registered, the registrant will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in the Act and will be governed by the final adjudication of such issue. |
(b) | The undersigned registrant hereby undertakes that: |
(1) | For purposes of determining any liability under the Securities Act of 1933, the information omitted from the form of prospectus filed as part of this registration statement in reliance upon Rule 430A and contained in a form of prospectus filed by the registrant pursuant to Rule 424(b) (1) or (4) or 497(h) under the Securities Act shall be deemed to be part of this registration statement as of the time it was declared effective. |
(2) | For the purpose of determining any liability under the Securities Act of 1933, each post-effective amendment that contains a form of prospectus shall be deemed to be a new registration statement relating to the securities offered therein, and the offering of such securities at that time shall be deemed to be the initial bona fide offering thereof. |
agilon health, inc. | ||
By: | /s/ Steven J. Sell | |
Name: | Steven J. Sell | |
Title: | Chief Executive Officer and President |
Signature | Title | |
/s/ Steven J. Sell | Chief Executive Officer, President, Director | |
Steven J. Sell | (Principal Executive Officer) | |
/s/ Timothy S. Bensley | Chief Financial Officer | |
Timothy S. Bensley | (Principal Financial Officer) | |
/s/ Glenn Sobotka | Chief Accounting Officer | |
Glenn Sobotka | (Principal Accounting Officer) | |
/s/ Michelle A. Gourdine | Director | |
Michelle A. Gourdine, M.D. | ||
/s/ Sharad Mansukani | Director | |
Sharad Mansukani, M.D. | ||
/s/ Clay Richards | Director | |
Clay Richards | ||
/s/ Ravi Sachdev | Director | |
Ravi Sachdev | ||
/s/ Richard J. Schnall | Director | |
Richard J. Schnall | ||
/s/ Michael Smith | Director | |
Michael Smith |
Signature | Title | |
/s/ Derek L. Strum | Director | |
Derek L. Strum | ||
/s/ Ron Williams | Director | |
Ron Williams | ||
/s/ William Wulf | Director | |
William Wulf, M.D. | ||
/s/ Karen McLoughlin | Director | |
Karen McLoughlin |