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CLOV 10-K & 10-Q changes, risk factors and insider trading

Clover Health Investments, Corp. · Nasdaq · Hospital & Medical Service Plans · CIK 1801170 · All filings on SEC.gov

Everything below is quoted or computed from Clover Health Investments, Corp.'s public SEC filings. It is not a recommendation to buy or sell. Automated comparisons can contain errors; confirm with the original filing.

At a glance

4 / 0risk-factor paragraphs added / removed in latest 10-K
0new risk-factor headings
0Form 4 filings reporting open-market purchases (last 180 days)
29Form 4 filings reporting open-market sales (last 180 days)

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What changed in the latest 10-K

Comparing 10-K filed 2026-02-27 (period ending 2025-12-31) with 10-K filed 2025-03-03 (period ending 2024-12-31).

Risk Factors (10-K Item 1A)

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0removed paragraphs
45reworded paragraphs
28,982 → 29,341words in section

Largest changes (selected automatically by length and topic keywords; quoted verbatim, no commentary)

Reworded topics: investigation, litigation, breach, generative ai

Paragraph as it now reads, with added and removed wording marked:

Breaches of our security measures or those of our third-party service providers or other cyber security incidents could result in unauthorized access to our sites, networks, systems, and accounts; unauthorized access to, and misappropriation of, individuals' personal identifying information, personal health information, or other confidential or proprietary information of ourselves, our members, or other third parties; viruses, worms, spyware, or other malware being served from our platform, networks, or systems; deletion or modification of content or the display of unauthorized content on our platform; the loss of access to critical data or systems through ransomware, destructive attacks or other means; and business delays, service or system disruptions or denials of service. IfAttacks anyon information technology systems, particularly in the healthcare system, are increasing in their frequency, levels of thesepersistence, breachessophistication and intensity, they are being conducted by increasingly sophisticated and organized groups and individuals with a wide range of securitymotives shouldand occur,expertise, weand cannotthey guaranteemay remain undetected for an extended period of time. For instance, as AI technologies, including generative AI models, develop rapidly, threat actors are using these technologies to create sophisticated new attack methods that recoveryare protocolsincreasingly automated, targeted, coordinated and backup systems will be sufficientdifficult to preventdefend data loss, or the interruption, disruption, or malfunction of our operations, including with respect to telehealth services. As a result, we could incur costs relating to breach remediation, deployment of additional personnel and protection technologies, and response to governmental investigations and media inquiries and coverage; be required to engage third-party experts and consultants; and face litigation, regulatory action, and other potential liabilities. Our reputation and brand could be damaged, our business may suffer, and we could be required to expend significant capital and other resources to alleviate problems caused by such breaches. Actual or anticipated security breaches or attacks may cause us to incur increasing costs, including costs to deploy additional personnel and protection technologies, train employees, and engage third-party experts and consultants.against.
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New text topics: investigation, litigation, breach
“If any of these breaches of security should occur, we cannot guarantee that recovery protocols and backup systems will be sufficient to prevent data loss, or the interruption, disruption, or malfunction of our operations, including with respect to telehealth services. …”
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Paragraph as it now reads, with added and removed wording marked:

AlthoughWhile ourthe Company may enter into share repurchase programprograms isfrom time to time, which are intended to enhance long-term shareholder value, we cannot provide assurance that this will occur, and thisany such program may be suspended or terminated at any time.
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Our long-term success depends on maintaining and continuing to improve Clover Assistant,CA, and the expansion of CA to external partners, as such, our past results may not be indicative of future performance.
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The Star Ratings system considers various measures adopted by CMS, including, among others, quality of care, preventative services, chronic illness management and member satisfaction. Our Star Ratings may be negatively impacted if we fail to meet the quality, performance and regulatory compliance criteria established by CMS. Furthermore, the Star Ratings system is also subject to change annually by CMS, which may make it more difficult to achieve and maintain three (3.0) Stars or greater. OnIn JuneOctober 14,2025, 2024, the CompanyCMS announced that CMS had recalculated the Company's 2024 Star ratings for its PPO Medicare Advantage plans for the 2025 payment year, and had increased such plans’ rating by 0.5 Star, to a revised rating of 3.5 Stars. In the calendar year 2024, the Company was paid on the basis of 3.5 Stars for both our PPO and HMO plans. In October 2024, CMS increased the Star Rating of our PPO MA plans towould 4be 3.5 Stars for 20252026 rating year, and increased the Star Rating of our HMO MA plan would be increased to 3.54.0 Stars for 2025,2026 rating year, each of which Star Rating will affect payment year 2026,2027. Despite our operational efforts to improve our Star Ratings, there can be no assurances that we will be successful in maintaining or improving our Star Ratings in future years. For example, our higher concentration of minority members and members residing in socioeconomically disadvantaged neighborhoods generally may make it more difficult for us to achieve and maintain high Star Ratings as compared to our competitors, given the well-documented health disparities among different minority and socioeconomic groups. Also, audits of our performance for past or future periods may result in downgrades to our Star Ratings.
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“Failure to effectively manage our growth could also lead us to over-invest or under-invest in development and operations, result in weaknesses in our infrastructure, systems or controls, give rise to operational mistakes, financial losses, loss of productivity or business opportunities and result in loss of employees and reduced productivity of remaining employees. …”
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Full comparison: every changed paragraph (49)

Green = added, red = removed. Unchanged paragraphs, 7 paragraphs where only numbers/dates changed, and tables are not shown. Read the complete text in the original filing.

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Furthermore, we may not be able to sustain profitability in subsequent periods. Our cash flowflows from operations waswere negative for the years ended December 31, 2023,2025 and 2022,2023 and positive for the year ended December 31, 2024, and we may not generate positive cash flow from operations in any given period. If we are not able to maintain profitability or achieve positive cash flow, we will require additional financing, which may not be available on favorable terms, or at all, and which could be dilutive to our stockholders. See the sectionrisk factor entitled "— We may require additional capital to support business growth, and this capital might not be available on acceptable terms, or at all." If we are unable to successfully address these risks and challenges as we encounter them, our business may be harmed, which could negatively affect the value of our common stock.

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Our long-term success depends on maintaining and continuing to improve Clover Assistant,CA, and the expansion of CA to external partners, as such, our past results may not be indicative of future performance.

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Since launching Clover Assistant in 2018, we have continued to develop its features and capabilities, adapt our go-to-market strategy and adjust its integration with our MA plans and third-party systems. As a result, we may not fully understand the impact of Clover Assistant on our future business and long-term prospects. Our continued long-term success depends on maintaining and continuing to improve Clover Assistant and the margins we generate from its operations over time in the markets we currently serve or potential future markets. There can be no assurance that these effects will continue to improve or persist over time in our current markets or that we can replicate these results as we expand into new markets, and the failure to do so may have a negative effect on our business and results of operations. See the risk factor entitled "Our launch of Counterpart Assistant as a Software-as-a-Service (“SaaS”) product for external payors and providers serving the Medicare eligible population may not be successful, and, as a result, our business may be adversely affected."

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To successfully execute on our SaaS product, we must develop sales and customer service teams, invest in marketing efforts and securely maintain, expand and upgrade our technology and infrastructure prior to determining whether our expectations will reasonably reflect customer demand for our solutions. Failure by us to anticipate the market for our SaaS product and external payors and providers’ changing needs, our inability to invest sufficiently in strategic growth areas, or our inability to otherwise successfully execute this strategy, could harm our reputation, results of operations and financial performance. Additionally, our Counterpart Assistant offering could also subject us to increased risk of liability, particularly liability arising from U.S. federal and state laws and regulations governing the security, use and disclosure of protected health information, related to the provision of this SaaS product, as well as operational, technical, legal, regulatory, or other costs. See the sectionsrisk factors entitled “—"Our failure to protect our sites, networks, and systems against security breaches, or otherwise to protect our confidential or health information or the confidential or health information of our members, providers, or other third parties, could damage our reputation and brands, and substantially harm our business and results of operations”" and —"Our use and disclosure of personally identifiable information, including health information, is subject to federal and state privacy and security regulations. Our failure to comply with those regulations or to adequately secure the information we hold could result in significant liability or reputational harm and, in turn, a material adverse effect on our client base and results of operations."

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The lifetime value of our enrollments could be impacted by a variety of factors, including but not limited to cost of care reductions from our clinical programs and the length of time a member remains enrolled in our plan. Thus, our future performance is heavily dependent on our ability to utilize Clover Assistant to drive down the medical care ratios for our members. By doing so, we aim to drive per member per month ("PMPM") medical expense savings and generate more accurate risk adjustment data over time. If we fail to achieve such decreases in cost of care, our business, financial condition, and results of operations will be adversely affected. See the sectionrisk factor entitled "—If we fail to estimate, price for and manage medical expenses in an effective manner, the profitability of our business could decline, which could materially and adversely affect our results of operations, financial condition, and cash flows."

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An important part of our growth strategy is to increase adoption and use of Clover Assistant, including by providers who also use EHR systems. We have directed, and intend to continue to direct, a significant portion of our financial and operating resources toward developing Clover Assistant platform and expanding its usage. OnFor May 29, 2024, we announced thatexample, Clover Assistant wouldis be madenow available to external payors and providers serving the Medicare eligible population under the brand name Counterpart Assistant, which is housed in our subsidiary Counterpart Health. There can be no assurance that adoption of Clover Assistant will continue to grow, or that rates of use will be maintained or increase. A number of factors could potentially negatively affect provider adoption and use of Clover Assistant, including, but not limited to:

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•experiencing unfavorable shifts in perception of Clover Assistant;

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•technical or other problems impacting availability or reliability of the platform,platform and frustrating the experience of members or providers, including limited broadband access in certain rural areas;

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•the lack of brand recognition.

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CMS'CMS's risk adjustment payment system makes our revenues and profitability difficult to predict and could result in material retroactive adjustments to our results of operations.

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CMS has implemented a risk adjustment payment system for Medicare health plans to improve the accuracy of payments and establish appropriate compensation for Medicare plans that enroll and treat less healthy Medicare beneficiaries.members. CMS'CMS's risk adjustment model bases a portion of the total CMS reimbursement payments on various clinical and demographic factors, including hospital inpatient diagnoses, diagnosis data from hospital outpatient facilities and provider visits, gender, age, and Medicaid eligibility. CMS requires that all managed care companies capture, collect, and report the necessary diagnosis code information to CMS, which information is subject to review and audit for accuracy by CMS. Although we have an auditing and monitoring process in place to collect and provide accurate risk adjustment data to CMS for these purposes, that program may not be sufficient to ensure accuracy, and additional investment and testing will be required to enhance and expand it. Therefore, there is a possibility that our risk adjustment data collection efforts and data submitted to CMS might have been or will be inadequate. If the risk adjustment data incorrectly overstates the health risk of our members, we might be required to return to CMS overpayments and/or be subject to penalties or sanctions; conversely, if the data incorrectly understates the health risk of our members, we might be underpaid for the care that we must provide to our members. Either of those situations could harm our reputation and have a negative impact on our results of operations and financial condition. CMS may change the way that it measures risk or adjust risk scores, and the potential impact on any such changes on our business is difficult to predict.

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Historically, we have financed our operations and capital expenditures principally from the sale of our equity securities, MA premiums earned, and the incurrence of indebtedness. In the future, we may be required to raise additional capital through additional debt or equity financings to support our business growth, to respond to business opportunities, challenges, or unforeseen circumstances, or for other reasons. On an ongoing basis, we are evaluating sources of financing and may raise additional capital in the future. Our ability to obtain additional capital will depend on our development efforts, business plans, investor demand, operating performance, the condition of the credit markets and capital markets, and other volatility or disruptions impacting financial markets, and other factors. There can be no assurance that additional financing will be available to us on favorable terms when required, or at all. If we raise additional funds through the issuance of equity, equity-linked, or debt securities, those securities may have rights, preferences, or privileges senior to the rights of existing stockholders, and existing stockholders may experience dilution. Further, if we are unable to obtain additional capital when required or are unable to obtain additional capital on satisfactory terms, our ability to continue to support our business growth or to respond to business opportunities, challenges, or unforeseen circumstances would be adversely affected.

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We derive substantially all of our Total revenues from premiums earned, which is primarily driven by the number of members under our MA plans. Additionally, the number of lives under Clover management is critical to our success, and we are continually executing several growth initiatives, strategies, and operating plans designed to maintain or increase the number of Liveslives under Clover Management.management. We may not be able to successfully execute on these initiatives, strategies, and operating plansplans, and even if we are able to successfully execute on these initiatives, we may not fully realize the expected potential benefits, including achieving cost savings, better plan economics and more affordable healthcare. In addition, even if we are successful in maintaining or achieving growth, as applicable, doing so may be more costly than we anticipate, and if we are not able to manage our costs our results could be materially adversely affected. See the sectionrisk factor entitled "—If we fail to estimate, price for and manage medical expenses in an effective manner, the profitability of our business could decline, which could materially and adversely affect our results of operations, financial condition, and cash flows."

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While we intend to continue to maintain or grow our membership by increasing our share in existing service areas and entering into new service areas, weWe may not be able to successfully maintain our current growth or achieve future growth for a number of reasons. Our ability to attract and retain members may be impacted by several factors, including, without limitation:

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•general lack of shopping for plans by MA eligible beneficiariesmembers;

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•regulatory changes affecting the overall pool of MA eligible beneficiariesmembers; and

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Failure to effectively manage our growth could also lead us to over-invest or under-invest in development and operations, result in weaknesses in our infrastructure, systems or controls, give rise to operational mistakes, financial losses, loss of productivity or business opportunities and result in loss of employees and reduced productivity of remaining employees. If our management is unable to effectively manage our growth, our revenue may not increase (including sufficiently to offset our expenses) or may grow more slowly than expected, and we may be unable to implement our business strategy.

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The markets for MA plans and related products are highly competitive. We compete in certain segments within the healthcare market, including MA plans as well as other healthcare technology platforms and the FFSfee-for-service market. Competition in our market involves rapidly changing technologies, evolving regulatory requirements and industry expectations, new product offerings and constantly evolving beneficiary and provider preferences and user requirements. We currently face competition from a range of companies, including other incumbent MA providers and health insurance companies, many of whom are developing their own technology or partnering with third-party technology providers to drive improvements in care. Our competitors generally include large, national insurers, such as United Health, Aetna, Humana, Cigna, Centene, and Elevance Health that provide MA plans, as well as regional-based companies or health plans that provide MA plans, including Blue Cross Blue Shield affiliates, Alignment Health, Devoted Health, Oscar Health, hospital systems and provider-based organizations. Competition from these and other new entrants may intensify as the FFSfee-for-service market develops and business models evolve to address it. In addition, as we enter into new markets, we may compete with regional start-up companies that offer MA plans. Also, as we develop other products and enter new lines of business, and other companies do the same, we may compete with providers of healthcare technology platforms, EHR providers, telehealth providers, healthcare data analytics providers and accountable care organizations. Furthermore, accountable care organizations and practice management companies, which aggregate physician practices for administrative efficiency and marketing leverage, and other organizational structures that physicians, hospitals, and other healthcare providers choose, may change the way in which providers interact with us and may change the competitive landscape. As a result, our current and potential competitors may be able to respond more quickly and effectively than we can to new or changing opportunities, technologies, standards, or client requirements. Further, even if our product or service offerings are more effective than the product or service offerings of our competitors, current or potential provider users and members might select competitive products and services in lieu of purchasing our product or service offerings. If we are unable to continue to grow and enhance our product and service offerings to our provider users and members, develop and deliver innovative and potentially disruptive products and services to satisfy evolving market demands, or develop and recruit qualified physicians and other provider specialists, we may not remain competitive, and we risk inability to maintain or increase our lives under Clover management, lack of adoption of our products and services by members and provider users, and loss of current market share to existing competitors and disruptive new market entrants.

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Some of our competitors have greater name recognition, longer operating histories, stronger and more extensive provider networks and other partner relationships, significantly greater financial, technical, marketing, and other resources, lower labor and development costs, greater access to healthcare data and larger beneficiary bases than we do. These competitors may engage in more extensive research and development efforts, undertake more far-reaching marketing campaigns, and adopt more aggressive pricing or payment policies that could allow them to build larger beneficiary bases or provider networks than we have. Our competitors may also provide more desirable products or services or take better care of their beneficiaries.members.

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Further, the healthcare industry in the United States has experienced a substantial amount of consolidation in recent years, resulting in a decrease in the number of insurance carriers, providers, and payors. If we are unable to contract with a provider in a market that has experienced significant consolidation, we may face challenges to establishing or maintaining network adequacy and attractiveness in those markets. Additionally, new competitors may arise as consolidation may create providers that, in and of themselves, meet network adequacy requirements for a market and, as a result, start their own MA plans in that market. In addition, our current or potential competitors may be acquired by third parties with greater available resources. As a result, our competitors may be able to respond more quickly and effectively than we can to new or changing opportunities, technologies, standards, or customer requirements and may have the ability to initiate or withstand substantial price competition. Our future growth and success depend on our ability to successfully compete with other companies providing similar services and technological offerings. New competitors or alliances may emerge that have greater market share, a larger member base, a stronger and larger provider network, more widely adopted proprietary technologies, greater ability to care for their beneficiaries,members, greater marketing expertise, or greater financial resources and larger sales forces than we have, which could put us at a competitive disadvantage. Considering these factors, even if our MA plans and technology platform are more effective than those of our competitors, current or potential members may purchase competitive plans in lieu of purchasing our health plans, or providers may adopt competing technology platforms in lieu of Clover Assistant. Any such events could adversely affect our business, financial condition, and results of operations.

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Reinsurance and low-income cost subsidies represent payments from CMS in connection with the Medicare Part D program for which we assume no risk. Reinsurance subsidies represent payments for CMS' portion of claims costs that exceed the member's out-of-pocket threshold, or the catastrophic coverage level. Low-income cost subsidies represent payments from CMS for all or a portion of the deductible, the coinsurance and co-payment amounts above the out-of-pocket threshold for low-income beneficiaries.members. Monthly prospective payments from CMS for reinsurance and low-income cost subsidies are based on assumptions submitted with our annual bid. A reconciliation and settlement of CMS' prospective subsidies against actual prescription drug costs we paid is made after the end of the applicable year.

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We believe that developing widespread brand recognition and maintaining and enhancing our reputation is critical to our relationships with existing providers and members, and to our ability to attract new providers and members to our platform and offerings. The promotion of our brands, including in our relatively new brand of Counterpart Assistant, may require us to make substantial investments, and we anticipate that, as our market becomes increasingly competitive, these marketing initiatives may become increasingly difficult and expensive. Brand promotion and marketing activities may not be successful or yield increased revenue, and to the extent that these activities yield increased revenue, the increased revenues may not offset the expenses we incur, and our results of operations could be harmed. In addition, any factor that diminishes our reputation or that of our management, including failing to meet the expectations of our providers or members, could harm our reputation and brands and make it substantially more difficult for us to attract new providers or members. If we do not successfully develop widespread brand recognition and maintain and enhance our reputation, our business may not grow and we could lose our relationships with providers or members, which would harm our business, financial condition, and results of operations.

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We may experience system slowdowns and interruptions from time to time. In addition, continued growth in our beneficiarymember and provider base could place additional demands on our Clover Assistant platform and our technical operations infrastructure and could cause or exacerbate slowdowns or interrupt the availability of our platform and operations. If there is a substantial increase in the volume of usage on our platform or internal tools we use to operate our business, we will be required to further expand and upgrade our technology and infrastructure. There can be no assurance that we will be able to accurately project the rate or timing of increases, if any, in the use of our platform and internal tools or expand and upgrade our systems and infrastructure to accommodate such increases on a timely basis. In such cases, if our users are not able to access our platform or encounter slowdowns when doing so, we may lose users. In order to remain competitive, we must continue to enhance and improve the responsiveness, functionality, and features of our platform. Our disaster recovery plan may not be sufficient to address all aspects or any unanticipated consequence or incidents, and although we maintain insurance covering certain business interruptions, such coverage may not be sufficient to compensate us for the losses that could occur.

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We use machine learning and artificial intelligenceAI technologies as part of our Clover Assistant platform, and we are making investments in expanding our artificial intelligenceAI capabilities in our products, services, and tools, including ongoing deployment and improvement of existing machine learning and AI technologies, as well as developing new product features using AI technologies, including, for example, generative AI. AI technologies are complex and rapidly evolving, and we face significant competition from other companies as well as an evolving regulatory landscape under existing and proposed federal, state and international regulations. The introduction of AI technologies into new or existing products may result in new or enhanced governmental or regulatory scrutiny, litigation, confidentiality or security risks, ethical concerns, legal liability, or other complications that could adversely affect our business, reputation, or financial results.

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Our business, results of operations, and financial condition may fluctuate on a quarterly and annual basis and could fall below the expectations of investors and securities analysts due to a number of factors, somemany of which are beyond our control, resulting either in volatility or a decline in the price of the shares of our Class A common stock.

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•the incoming presidential administration, and changes in the legislative or regulatory environment, including with respect to healthcare, telehealth, privacy, or data protection, artificial intelligence,AI, or enforcement by government regulators, including fines, orders, sanctions, or consent decrees;

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Our business may be affected by conditions and trends in the financial markets and general economic and political conditions, including the newcurrent presidential administration and Congress. The global economy, including credit and financial markets, has experienced extreme volatility and disruptions, higher cost of human capital, geopolitical uncertainty and instability, including heightened rates of inflation, higherfluctuations in interest rates, changes in tax and trade policies and uncertainty about economic stability. There is also uncertainty surrounding potential changes to the healthcare regulatory environment in the United States, and it is not possible to predict how these changes may be implemented, and the ultimate effects of such changes on our business. In addition, the U.S. federal government and other governments may reduce funding for health care or other programs or make changes that adversely affect the number of persons eligible for certain programs, the services provided to enrollees in such programs and premiums we can charge. The levels of U.S. federal government spending are difficult to predict and are subject to significant risk. Considerable uncertainty exists regarding how future budget and program decisions will unfold, including the spending priorities of the newcurrent presidential administration and Congress, and what challenges budget reductions, if any, will present for our business and our industry generally. For example, on January 20, 2025, President Trump established by executive order the U.S. DOGE Service Temporary Organization ("DOGE") to reform federal government processes and reduce expenditures, and on February 5, 2025, CMS announced that it is collaborating with DOGE to determine where there may be opportunities for more effective and efficient use of resources. While DOGE was officially disbanded as a governmental organization in 2025, many of its functions and personnel were absorbed into various federal agencies, and its principles and agenda to cut waste and modernize operations may continue in other forms. Pressures on and uncertainty surrounding the U.S. federal government’s budget, and potential changes in budgetary priorities and healthcare spending levels, could adversely affect the funding for Medicare and other healthcare programs upon which our business depends. Any of these factors could have a material adverse effect on our businesses, results of operations, and cash flows. In addition, the failure of the U.S. federal government to manage its fiscal matters or to raise or further suspend the debt ceiling, and changes in the amount of federal debt, may negatively impact the economic environment, curtail spending on health and health care related matters and adversely impact our results of operations. Any such volatility or disruption, or a general sustained economic downturn or other developments, may have adverse consequences on us or on our third party relationships (including relationships with vendors and health care providers).

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We and our affiliated professional entities may be subject to professional liability claims and, if these claims are successful, substantial damage awards. With respect to Clover HomeCare Care,Services (Clover's in-home care offering), the direct provision of healthcare services by certain of our subsidiaries involves risks arising from medical malpractice claims relating to the delivery of healthcare and related services. Although we maintain insurance covering medical malpractice claims in amounts that we believe are appropriate in light of the risks attendant to our business, we cannot predict the outcomes of medical malpractice cases, or the effect that any claims of this nature, regardless of their ultimate outcome, could have on our business or reputation or on our ability to attract and retain members.

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We have direct operations in Hong Kong and Canada, as well as contracted operations in various other countries. We may in the future expand our operations to other countries. SubstantiallyA allsignificant portion of our software research and development is performed internationally, by internal resources and a variety of offshore vendors in locations such as Hong Kong and elsewhere. While these arrangements may lower operating costs, they also subject us to the uncertain political climates, including political unrest and uncertainty in Hong Kong, such as Hong Kong national security law and other developments, and potential disruptions in international trade, including export control laws (such as deemed export restrictions applicable to software) and any amendments to those laws, as well as potentially increased data security and privacy risks and local economic and labor conditions.

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Breaches of our security measures or those of our third-party service providers or other cyber security incidents could result in unauthorized access to our sites, networks, systems, and accounts; unauthorized access to, and misappropriation of, individuals' personal identifying information, personal health information, or other confidential or proprietary information of ourselves, our members, or other third parties; viruses, worms, spyware, or other malware being served from our platform, networks, or systems; deletion or modification of content or the display of unauthorized content on our platform; the loss of access to critical data or systems through ransomware, destructive attacks or other means; and business delays, service or system disruptions or denials of service. IfAttacks anyon information technology systems, particularly in the healthcare system, are increasing in their frequency, levels of thesepersistence, breachessophistication and intensity, they are being conducted by increasingly sophisticated and organized groups and individuals with a wide range of securitymotives shouldand occur,expertise, weand cannotthey guaranteemay remain undetected for an extended period of time. For instance, as AI technologies, including generative AI models, develop rapidly, threat actors are using these technologies to create sophisticated new attack methods that recoveryare protocolsincreasingly automated, targeted, coordinated and backup systems will be sufficientdifficult to preventdefend data loss, or the interruption, disruption, or malfunction of our operations, including with respect to telehealth services. As a result, we could incur costs relating to breach remediation, deployment of additional personnel and protection technologies, and response to governmental investigations and media inquiries and coverage; be required to engage third-party experts and consultants; and face litigation, regulatory action, and other potential liabilities. Our reputation and brand could be damaged, our business may suffer, and we could be required to expend significant capital and other resources to alleviate problems caused by such breaches. Actual or anticipated security breaches or attacks may cause us to incur increasing costs, including costs to deploy additional personnel and protection technologies, train employees, and engage third-party experts and consultants.against.

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If any of these breaches of security should occur, we cannot guarantee that recovery protocols and backup systems will be sufficient to prevent data loss, or the interruption, disruption, or malfunction of our operations, including with respect to telehealth services. As a result, we could incur costs relating to breach remediation, deployment of additional personnel and protection technologies, and response to governmental investigations and media inquiries and coverage; be required to engage third-party experts and consultants; and face litigation, regulatory action, and other potential liabilities. Our reputation and brand could be damaged, our business may suffer, and we could be required to expend significant capital and other resources to alleviate problems caused by such breaches. Actual or anticipated security breaches or attacks may cause us to incur increasing costs, including costs to deploy additional personnel and protection technologies, train employees, and engage third-party experts and consultants.

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For example, in 2024, one of our vendors, UnitedHealth Group’s Change Healthcare, experienced a securityransomware breach,attack, which compromised certain of our members’ personal information (including protected health information). Although the Change Healthcare incident did not have a material impact on our business, financial condition or results of operation, there can be no assurance that a future compromise or breach of our security measures, or those of our third-party service providers will not have a material impact on us. Any such compromise could violate applicable privacy, data protection, data security, network and information systems security, and other laws, and cause significant legal and financial exposure, adverse publicity, and a loss of confidence in our security measures. These factors could have a material adverse effect on our business, results of operations, and financial condition. We devote significant resources to protect against security breaches, and we may need to devote significantly more resources in the future to address problems caused by breaches, including notifying affected subscribers and responding to any resulting litigation. Any such use of resources would divert resources from the growth and expansion of our business.

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Identifying partners, and negotiating and documenting relationships with them, requires significant time and resources. In addition, acquisitions of our partners by our competitors could result in a decrease in the number of our members and provider users, as our partners may no longer facilitate the enrollment of Medicare-eligible beneficiariesmembers into, or the effective and efficient operations of, our business or the adoption of Clover Assistant by providers. If we are unsuccessful in establishing or maintaining our relationships with third parties, our ability to compete in the marketplace or to grow our revenues could be impaired and our results of operations may suffer. Even if we are successful, there can be no assurance that these relationships will result in increased revenues or an increase in the number of beneficiariesmembers or provider users of Clover Assistant.

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There has been increased government scrutiny and litigation involving MA plans under the FCA related to diagnosis coding and risk adjustment practices. In some proceedings involving MA plans, there have been allegations that certain financial arrangements with providers violate other laws governing fraud and abuse, such as the Anti-Kickback Statute. We perform ongoing monitoring of our business practices to help ensure compliance with CMS risk adjustment requirements and applicable laws, which includes review of Clover Assistant features that may be relevant to patient risk assessments and the submission of risk adjustment data to CMS. We also monitor our physician payment practices to help ensure compliance with applicable laws, such as the Anti-Kickback Statute. While we believe that our risk adjustment data collection efforts and relationships with providers, including those related to Clover Assistant, comply with applicable laws, we and our Counterpart Health customers are and may be subject to audits, reviews and investigation of our practices and arrangements, and the federal government might conclude that they violate the FCA, the Anti-Kickback Statute and/or other federal and state laws governing fraud and abuse. See the sectionrisk factor entitled "—Our business activities are highly regulated, and new and proposed government regulation or legislative reforms could increase our cost of doing business and reduce our number of members, profitability, and liquidity."

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The Star Ratings system considers various measures adopted by CMS, including, among others, quality of care, preventative services, chronic illness management and member satisfaction. Our Star Ratings may be negatively impacted if we fail to meet the quality, performance and regulatory compliance criteria established by CMS. Furthermore, the Star Ratings system is also subject to change annually by CMS, which may make it more difficult to achieve and maintain three (3.0) Stars or greater. OnIn JuneOctober 14,2025, 2024, the CompanyCMS announced that CMS had recalculated the Company's 2024 Star ratings for its PPO Medicare Advantage plans for the 2025 payment year, and had increased such plans’ rating by 0.5 Star, to a revised rating of 3.5 Stars. In the calendar year 2024, the Company was paid on the basis of 3.5 Stars for both our PPO and HMO plans. In October 2024, CMS increased the Star Rating of our PPO MA plans towould 4be 3.5 Stars for 20252026 rating year, and increased the Star Rating of our HMO MA plan would be increased to 3.54.0 Stars for 2025,2026 rating year, each of which Star Rating will affect payment year 2026,2027. Despite our operational efforts to improve our Star Ratings, there can be no assurances that we will be successful in maintaining or improving our Star Ratings in future years. For example, our higher concentration of minority members and members residing in socioeconomically disadvantaged neighborhoods generally may make it more difficult for us to achieve and maintain high Star Ratings as compared to our competitors, given the well-documented health disparities among different minority and socioeconomic groups. Also, audits of our performance for past or future periods may result in downgrades to our Star Ratings.

Reworded

The healthcare industry is heavily regulated and closely scrutinized by federal, state and local governments. Comprehensive statutes and regulations govern the manner in which we are compensated for providing coverage for our members, our contractual relationships with our providers, vendors and beneficiaries,members, our marketing activities and other aspects of our operations. The new presidential administration and Congress has proposed and may propose changes to statutes that could significantly impact the healthcare industry, which in turn could harm our business, operating results and financial condition.

Added

•the “One Big Beautiful Bill Act,” which impacts funding and eligibility to federal healthcare programs, particularly Medicaid;

Reworded

Numerous U.S. federal and state laws and regulations govern the collection, dissemination, use, privacy, confidentiality, security, availability and integrity of personally identifiable information ("PII"), including protected health information ("PHI"). These federal and state laws and regulations include, but are not limited to HIPAA, as amended by HITECH, which we refer to collectively as HIPAA, and the California Consumer Privacy Act of 2018, as amended by the California Privacy Rights Act (the "CPRA"),Act, which took effect on January 1, 2023 (the “CCPA”). HIPAA establishes a set of basic national privacy and security standards for the protection of PHI by health plans, healthcare clearinghouses and certain healthcare providers, referred to as covered entities, which includes us, and the business associates with whom such covered entities contract for services, which also includes us.

Reworded

HIPAA requires healthcare payers and providers—and we are both—to develop and maintain policies and procedures with respect to PHI that is used or disclosed, including the adoption of administrative, physical and technical safeguards to protect such information. HIPAA also implemented the use of standard transaction code sets and standard identifiers that covered entities must use when submitting or receiving certain electronic healthcare transactions, including activities associated with the billing and collection of healthcare claims.

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Penalties for failure to comply with a requirement of HIPAA may vary significantly depending on the nature of violation and could include civil monetary or criminal penalties. HIPAA also authorizes state attorneys general to file suit on behalf of their residents. Courts are able to award damages, costs and attorneys' fees related to violations of HIPAA in such cases. While HIPAA does not create a private right of action allowing individuals to sue us in civil court for violations of HIPAA, its standards have been used as the basis for duty of care in state civil suits such as those for negligence or recklessness in the misuse or breach of PHI.

Reworded

Numerous other U.S. federal and state laws, such as the CCPA, protect the confidentiality, privacy, availability, integrity, and security of PII, including PHI. These laws in many cases are more restrictive than, and may not be preempted by, the HIPAA rules and may be subject to varying interpretations by courts and government agencies, creating complex compliance issues for us and our providers and business associates and potentially exposing us to additional expense, adverse publicity and liability. Among other things, the CCPA gives California residents expanded data privacy rights, allowing consumers to opt out of certain data sharing with third parties, provides a private cause of action for data breaches, imposes additional obligations such as data minimization and storage limitations; on covered businesses; and forms a dedicated privacy regulator in California, the California Privacy Protection Agency, to implement and enforce the law. The CCPA marked the beginning of a trend toward more stringent state data privacy legislation in the United States, which may result in significant costs to our business, damage our reputation, and require us to amend our business practices, and could adversely affect our business, especially to the extent the specific requirements vary from those and other existing laws. Similar laws are now in effect in more than tenfifteen other states and have been adopted or proposed in additional states and at the federal level. If passed, such laws may have potentially conflicting requirements that would make compliance challenging. In addition, in response to such laws, we may need to update and/or change our data collection practices, which may be costly, time-consuming, and present potential liability while we adapt to comply with such legislation.

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New health information standards, whether implemented pursuant to HIPAA, state or federal legislative action or otherwise, including state and federal AI laws, could have a significant effect on the manner in which we must handle healthcare related data, and the cost of complying with those standards could be significant. If we do not comply with existing or new laws and regulations related to PHI, we could be subject to criminal or civil sanctions.

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Because of the extreme sensitivity of personal information, including PHI, that we store and transmit, the security features of our technology platform are very important. We also contract with third parties for important aspects of the storage and transmission of member information, and thus rely on those third parties to manage functions that have material cyber-security risks. We attempt to address these risks by requiring such vendors and subcontractors who handle member information to sign business associate agreements which contractually require those vendors subcontractors to adequately safeguard personal health data to the same extent that applies to us and in some cases by requiring such subcontractors to undergo third-party security examinations. However, we cannot ensure that these contractual measures and other safeguards will adequately protect us from the risks associated with the storage and transmission of such information by our subcontractors on our behalf.

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If our security measures, some of which are managed by third parties, or those of the third parties with whom we contract, are breached or fail, unauthorized persons may be able to obtain access to sensitive provider and member data, including HIPAA-regulated PHI. As a result, our reputation could be severely damaged, adversely affecting the confidence of members, PCPs, and Counterpart Assistant customers. Members may curtail their use of or stop using our services, including the use of telehealth, our number of members could decrease, and Counterpart Assistant customers may terminate their relationship with us, which would cause our business to suffer. In addition, we could face litigation, damages for contract breach, penalties and regulatory actions for violation of HIPAA and other applicable laws or regulations and significant costs for remediation, notification to individuals and for measures to prevent future occurrences. Any potential security breach could also result in increased costs associated with liability for stolen assets or information, repairing system damage that may have been caused by such breaches, incentives offered to business partners in an effort to maintain our business relationships after a breach and implementing measures to prevent future occurrences, including organizational changes, deploying additional personnel and protection technologies, training employees and engaging third-party experts and consultants. While we maintain insurance covering certain security and privacy damages and claim expenses, we may not carry insurance or maintain coverage sufficient to compensate for all cyber-related liability. In any event, insurance coverage would not address the reputational damage that could result from a security incident.

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Our Class A common stock is listed on the Nasdaq Global Select Market, which imposes continued listing requirements with respect to listed securities, including a minimum bid price requirement. DuringIn fiscalthe year 2024,past, we have received written notice from the Nasdaq Stock Market LLC ("NASDAQ") notifying us that, for 30 consecutive business days, the bid price for our Class A common stock had closed below the $1.00 per share minimum bid price requirement for continued inclusion on the Nasdaq Global Select Market pursuant to Nasdaq Listing Rule 5450(a)(1) (the “Minimum Bid Price Requirement”). While we have subsequently regained compliance with such standards, there can be no assurance that we will be able to maintain compliance with the NASDAQ listing requirements, including the Minimum Bid Price Requirement in the future. If we fail to maintain compliance with the Minimum Bid Price Requirement or to meet the other applicable continued listing requirements in the future and NASDAQ determines to delist our Class A common stock, this would, among other things, substantially impair our ability to raise additional funds and could result in a loss of institutional investor interest and fewer development opportunities for us. Furthermore, a delisting would likely have a negative effect on the price of our Class A common stock and would impair the ability of stockholders to sell or purchase our Class A common stock when they wish to do so. In the event of a delisting, we would expect to take actions to restore our compliance with NASDAQ’s listing requirements, but we can provide no assurance that any such action taken by us would allow our Class A common stock to become listed again, lead to stability in the market price of our Class A common stock, improve the liquidity of our Class A common stock, prevent our Class A common stock from dropping below the NASDAQ minimum bid price requirement, or prevent future non-compliance with NASDAQ’s listing requirements. As a result of these factors, a delisting of our Class A common stock from NASDAQ would have an adverse impact on the trading, liquidity, and market price of our Class A common stock.

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As a public company, we are subject to the reporting requirements of the Securities Exchange Act of 1934, as amended (the "Exchange Act"),Act, the Sarbanes-Oxley Act and the rules and regulations of NASDAQ. The Sarbanes-Oxley Act requires, among other things, that we maintain effective disclosure controls and procedures and internal control over financial reporting.

Reworded

AlthoughWhile ourthe Company may enter into share repurchase programprograms isfrom time to time, which are intended to enhance long-term shareholder value, we cannot provide assurance that this will occur, and thisany such program may be suspended or terminated at any time.

Reworded

On May 6, 2024, the Board of Directors of the Company authorized the repurchase of up to $20.0 million in shares of the Company’s outstanding Class A common stock over a two-year period. Our share repurchase program may be modified, suspended or discontinued at any time without prior notice. In the first quarter of 2025, the Company exhausted its all availability under such repurchase program, and the Company may in the future enter into a new repurchase program. The specific timing and amount of any share repurchases under a share repurchase program will depend on prevailing share prices, general economic and market conditions, Company performance and other considerations. Although theany share repurchase program is intended to enhance long-term shareholder value, we cannot provide assurance that this will occur. A share repurchase program does not obligate the Company to acquire any particular amount of common stock and any such repurchase program may be suspended or discontinued at any time at the Company’s discretion.

Reworded

As a public company, we are subject to the reporting requirements of the Securities Exchange Act of 1934, or the Exchange Act, the listing standards of NASDAQ and other applicable securities rules and regulations. The requirements of these rules and regulations have increased, and will continue to increase our legal, accounting, and financial compliance costs, made some activities more difficult, time-consuming, and costly, and placed significant strain on our personnel, systems, and resources. For example, the Exchange Act requires, among other things, that we file annual, quarterly, and current reports with respect to our business and results of operations. Changing laws, regulations, and standards relating to corporate governance and public disclosure are creating uncertainty for public companies, increasing legal and financial compliance costs, and making some activities more time-consuming. These laws, regulations, and standards are subject to varying interpretations, in many cases due to their lack of specificity, and, as a result, their application in practice may evolve over time as new guidance is provided by regulatory and governing bodies. This could result in continuing uncertainty regarding compliance matters and higher costs necessitated by ongoing revisions to disclosure and governance practices. We intend to invest substantial resources to comply with evolving laws, regulations and standards, and this investment may result in increased general and administrative expenses and a diversion of management's time and attention from business operations to compliance activities. If our efforts to comply with new laws, regulations, and standards differ from what is intended by regulatory or governing bodies due to ambiguities related to their application and practice, regulatory authorities may initiate legal proceedings against us and our business may be harmed.

Management's Discussion & Analysis (MD&A) (10-K Item 7)

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23reworded paragraphs
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New heading “Consolidated Gross profit”

New heading “Insurance Benefits expense ratio & Normalized Insurance Benefits expense ratio”

Removed heading “Counterpart Health”

Removed heading “Premiums earned, gross.”

Removed heading “Insurance gross medical claims incurred.”

Removed heading “Medical care ratio, gross and net.”

Removed heading “Benefits expense ratio, gross and net.”

Removed heading “General and administrative expenses”

Removed heading “Restructuring costs”

Removed heading “Loss on investment”

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New text topics: impairment, restructuring, goodwill
“Consolidated Gross profit represents net loss from continuing operations before salaries and benefits, general and administrative expenses, depreciation and amortization, premium deficiency reserve expense, restructuring costs, impairment of goodwill and other intangible assets, interest expense, change in fair value of warrants, and loss on investment. We believe that Consolidated Gross profit provides management, investors, and others a useful view of consolidated business performance and is much more informative of operational results. …”
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“Restructuring costs”
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Reworded topics: impairment, goodwill

Paragraph as it now reads, with added and removed wording marked:

For the year ended December 31, 2023,2024, Net cash usedprovided inby operating activities was $35.1$82.5 million, which reflects a Net loss from continuing operations of $210.1$46.3 million. Non-cash activities primarily included a $140.9$114.3 million charge to Stock-based compensation expense, $15.9 million Goodwill and intangible asset impairment, $7.2 million amortization of the 2022 Premium deficiency reserve, and a $4.7$0.5 million Loss on investment.
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“Insurance Benefits expense ratio & Normalized Insurance Benefits expense ratio”
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“Insurance Benefits expense ratio ("BER") and Normalized Insurance Benefits expense ratio are non-GAAP financial measures. We calculate our BER by taking the total of Insurance net medical expenses incurred and quality improvements, and dividing that total by premiums earned on a net basis, in a given period. Quality improvements include expenses associated with activities that improve health outcomes, as defined by the U.S. …”
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“Benefits expense ratio ("Insurance BER") is a non-GAAP financial measure. We calculate our Insurance BER by taking the total of Insurance net medical expenses incurred and quality improvements, and dividing that total by premiums earned on a net basis, in a given period. Quality improvements include expenses associated with activities that improve health outcomes, as defined by the U.S. …”
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Green = added, red = removed. Unchanged paragraphs, 14 paragraphs where only numbers/dates changed, and tables are not shown. Read the complete text in the original filing.

Reworded

On January 13,14, 2025,2026, the Company announced a 27%53% year-over-year growth of its MA membership during the most recent Annual Election Period ("AEP").Period. The Company entered 20252026 with over 100,000153,000 members, approximatelyover 95%97% of whom are enrolled in Clover’sthe Company's flagship PPO plans.

Reworded

Beginning in 2025,2026, our MA plans will be available in a total of 200203 counties and 5five states.

Removed

In October 2023, CMS initially released the Company’s 2024 Star ratings, which related to the 2022 measurement year and would have impacted the 2025 payment year. For both of the Company's plans (PPO and HMO), CMS had awarded a rating of 3.0 Stars for the measurement year 2022, which represented a 0.5 Star rating decrease for both plans from the 2021 measurement year. Subsequently, on June 14, 2024, the Company announced that CMS had recalculated the Company's 2024 Star ratings for its PPO Medicare Advantage plans for the 2025 payment year, and had increased such plans’ rating by 0.5 Star, to a revised rating of 3.5 Stars. Pursuant to CMS’s Medicare Advantage Star ratings system, CMS annually awards between 1.0 and 5.0 Stars to Medicare Advantage plans based on performance in several categories. In the calendar year 2024, the Company was paid on the basis of 3.5 Stars for both our PPO and HMO plans.

Reworded

On October 10,9, 2024,2025, the Company announced that CMS hadhas increaseddecreased the Star rating of its PPO Medicare Advantage plans to 4.03.5 Stars for 2025,Star rating year 2026, which will affect payment year 2026. In payment year 2026, the Company expects to experience a general 5% quality bonus increase in benchmark rates as a result of its PPO contract being rated 4.0 Stars, in accordance with CMS regulations. Increased quality bonus payments enable the Company to further reinvest in more competitive benefits, which the Company believes will deliver greater value to its members while fueling continued membership growth.2027. Additionally, CMS increased the rating of Clover’s HMO MA plan to 3.54.0 Stars. AsCurrently discussedover earlier, as97% of December 31, 2024, over 95% of the Company'sour insurance members are members of our PPO Medicare Advantage Plans.

Removed

Counterpart Health

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During the second quarter of 2024, the Company launched Counterpart Health, Inc., or ("Counterpart Health"), a subsidiary of the Company which houses a new software-as-a-service and tech enabled services solution to bring the power of Counterpart Assistant technology to external payors and providers serving the Medicare eligible population. This external offering aims to equip clinician users with our already built, clinician-centric, and AI-powered care management platform. Strategically, Counterpart Health aims to extend the benefits of data-driven proven technology and personalized care to a wider audience, enabling enhanced patient outcomes and reduced healthcare costs across the nation. Counterpart Health is complementary to Clover Health, and enables the Company to deploy and expand the reach of its existing technology asset for new potential growth and high margin business opportunities, with low startup costs. Revenue from our Counterpart Health SaaS and tech enabled services is included within Other income on our consolidated statements of operations and comprehensive loss.

Removed

ACO REACH

Removed

We previously participated as a Direct Contracting Entity ("DCE") in the Centers for Medicare and Medicaid Services ("CMS") Accountable Care Organization Realizing Equity, Access, and Community Health Model ("ACO REACH Model" or "ACO REACH"). On December 1, 2023, the Company notified CMS that it will no longer participate as a REACH ACO in connection with the 2024 performance year. The remaining activity recognized during 2024 directly relates to prior performance years with CMS. As of January 1, 2024, this line of business met the definition of discontinued operations, and prior period amounts have been updated to conform to the current period presentation. At December 31, 2024, the Company did not anticipate any further material activity related to its discontinued operations. Refer to Note 22 "Discontinued Operations" in the accompanying notes to the consolidated financial statements included in this Form 10-K for additional information.

Reworded

Starting in the first quarter of 2024, weWe manage our operations based on one reportable segment: Insurance. Through our Insurance segment, we provide PPO and HMO plans to Medicare Advantage members in several states. All other clinical services and all corporate overhead not included in the reportable segments are included in Corporate/Other.

Reworded

The segment grouping is consistent with the information used by our Chief Executive Officer (identified as our chief operating decision maker) ("CODM")) to assess performance and allocate the Company's resources.

Added

Total revenues

Added

Total revenues represents the sum of Premiums earned, net and Other income for a given period. Premiums earned, net reflects the earned portion of premiums under our Medicare Advantage contracts with CMS, net of premiums ceded to reinsurers and inclusive of risk adjustment revenue. Other income primarily consists of investment income and other ancillary revenues. We believe Total revenues is a useful measure of the overall scale and growth of our business, as it captures the aggregate economic inflows generated from our Insurance operations and related activities. Management uses Total revenues to evaluate period-over-period growth, assess the impact of membership levels and risk adjustment performance, analyze revenue trends relative to medical cost and operating expense trends, and support strategic planning and capital allocation decisions.

Removed

(1) Calculated per member per month ("PMPM") figures are based on the applicable amount divided by member months in the given period. Member months represents the number of months members are enrolled in a Clover Health plan in the period.

Reworded

Membership and associated premiums earned and medical claim expenses.expenses

Removed

Premiums earned, gross.

Removed

Premiums earned, gross is the amount received, or to be received, for insurance policies written by us during a specific period of time without reduction for premiums ceded to reinsurance. We believe premiums earned, gross provides useful insight into the gross economic benefit generated by our business operations and allows us to evaluate our underwriting performance without regard to changes in our underlying reinsurance structure. Premiums earned, gross excludes the effects of premiums ceded to reinsurers, and therefore should not be used as a substitute for Premiums earned, net, Total revenues, or any other measure presented in accordance with GAAP.

Reworded

Premiums earned, net.net

Removed

Insurance gross medical claims incurred.

Removed

Insurance gross medical claims incurred reflects claims incurred, excluding amounts ceded to reinsurers, and the costs associated with processing those claims. We believe gross medical claims incurred provides useful insight into the gross medical expense incurred by members and allows us to evaluate our underwriting performance without regard to changes in our underlying reinsurance structure.

Removed

Insurance gross medical claims incurred excludes the effects of medical claims and associated costs ceded to reinsurers, and therefore should not be used as a substitute for Net claims incurred, Total operating expenses, or any other measure presented in accordance with GAAP.

Reworded

Insurance net medical claims incurred.incurred

Removed

Medical care ratio, gross and net.

Removed

We calculate our medical care ratio ("MCR") by dividing total Insurance medical claim expenses incurred by premiums earned, in each case on a gross or net basis, as the case may be, in a given period. We believe our MCR is an indicator of our gross margin for our Insurance plans and the ability of our Clover Assistant platform to capture and analyze data over time to generate actionable insights for returning members to improve care and reduce medical expenses.

Reworded

We use non-GAAP measures in this Form 10-K, including InsuranceConsolidated BER,Gross profit, Adjusted SG&AA, Adjusted EBITDA, and Adjusted EBITDA.Net income from continuing operations, and Insurance Benefits expense ratio ("BER") and Normalized Insurance BER. These non-GAAP financial measures are provided to enhance the reader's understanding of Clover Health's past financial performance and our prospects for the future. Clover Health's management team uses these non-GAAP financial measures in assessing Clover Health's performance, as well as in planning and forecasting future periods. These non-GAAP financial measures are not computed according to generally accepted accounting principles in the United States ("GAAP"),GAAP, and the methods we use to compute them may differ from the methods used by other companies. Non-GAAP financial measures are supplemental to and should not be considered a substitute for financial information presented in accordance with GAAP and should be read only in conjunction with our consolidated financial statements prepared in accordance with GAAP.

Reworded

For a description of these non-GAAP financial measures, including the reasons management uses such measures, and the reconciliations of these non-GAAP financial measures to the comparable GAAP measures, please see "BenefitsConsolidated expenseGross ratio, gross and netprofit", "Adjusted SG&A" and, "Adjusted EBITDA", Adjusted Net income from continuing operations, and "Benefits expense ratio & Normalized benefits expense ratio" below.

Added

Consolidated Gross profit

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Consolidated Gross profit represents net loss from continuing operations before salaries and benefits, general and administrative expenses, depreciation and amortization, premium deficiency reserve expense, restructuring costs, impairment of goodwill and other intangible assets, interest expense, change in fair value of warrants, and loss on investment. We believe that Consolidated Gross profit provides management, investors, and others a useful view of consolidated business performance and is much more informative of operational results. Accordingly, we believe that Consolidated Gross profit provides investors and others useful information to understand and evaluate our operating results in the same manner as our management and our board of directors.

Removed

Benefits expense ratio, gross and net.

Removed

Benefits expense ratio ("Insurance BER") is a non-GAAP financial measure. We calculate our Insurance BER by taking the total of Insurance net medical expenses incurred and quality improvements, and dividing that total by premiums earned on a net basis, in a given period. Quality improvements include expenses associated with activities that improve health outcomes, as defined by the U.S. Department of Health and Human Services ("HHS"), as well as those directly tied to enhancing healthcare quality, such as the Company's spend on health information technology, wellness and prevention programs, initiatives to reduce hospital readmissions, and our clinically focused Member Rewards program. We believe our Insurance BER is useful to management, investors, and others because it offers a clearer and more accurate representation of our investment in healthcare quality and member engagement, and gives a comprehensive view of costs related to maintaining and improving the quality of care of our members, which is crucial for sustaining member satisfaction and adherence to treatment regimens.

Removed

The table below provides a reconciliation of Net medical claims incurred and Premiums earned, net, both of which are GAAP measures, to Insurance BER, a non-GAAP measure.

Reworded

Adjusted EBITDA is a non-GAAP financial measure defined by us as net loss from continuing operations before depreciation and amortization, loss on investment, interest expense, change in fair value of warrants, stock-based compensation, premium deficiency reserve benefit,expense, restructuring (recoveries) costs, impairment of goodwill and other intangible assets, and non-recurring legal expenses and settlements. Adjusted EBITDA is a key measure used by our management team and the board of directors to understand and evaluate our operating performance and trends, to prepare and approve our annual budget and to develop short and long-term operating plans. In particular, we believe that the exclusion of the amounts eliminated in calculating Adjusted EBITDA provide useful measures for period-to-period comparisons of our business. Accordingly, we believe that Adjusted EBITDA provides investors and others useful information to understand and evaluate our operating results in the same manner as our management and our board of directors.

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Adjusted Net income (loss) from continuing operations

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Adjusted Net income (loss) from continuing operations is a non-GAAP financial measure defined by us as net loss from continuing operations before stock-based compensation, premium deficiency reserve benefit, restructuring costs, non-recurring legal expenses and settlement, and impairment of goodwill and other intangible assets. Adjusted Net income (loss) from continuing operations is a key measure used by our management team and the board of directors to understand and evaluate our operating performance and trends. We believe that Adjusted Net income (loss) from continuing operations is helpful to investors in assessing the Company’s financial performance in the same manner as our management and our board of directors.

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Insurance Benefits expense ratio & Normalized Insurance Benefits expense ratio

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Insurance Benefits expense ratio ("BER") and Normalized Insurance Benefits expense ratio are non-GAAP financial measures. We calculate our BER by taking the total of Insurance net medical expenses incurred and quality improvements, and dividing that total by premiums earned on a net basis, in a given period. Quality improvements include expenses associated with activities that improve health outcomes, as defined by the U.S. Department of Health and Human Services ("HHS"), as well as those directly tied to enhancing healthcare quality, such as the Company's spend on health information technology, wellness and prevention programs, initiatives to reduce hospital readmissions, and our clinically focused Member Rewards program for the current year. We believe our BER is useful to management, investors, and others because it offers a clearer and more accurate representation of our investment in healthcare quality and member engagement, and gives a comprehensive view of costs related to maintaining and improving the quality of care of our members, which is crucial for sustaining member satisfaction and adherence to treatment regimens. Furthermore, Normalized Insurance BER adjusts out activity related to prior period development. Prior period development refers to changes in the Company’s Insurance Revenue and Insurance Medical claims levels from previous periods. Management believes that Normalized Insurance BER presents a clearer representation of performance during the current period being presented.

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The tables below provide reconciliations of Insurance Net medical claims incurred, net and Premiums earned, net which are GAAP measures, to Insurance BER and Normalized Insurance BER, which represent non-GAAP measures.

Reworded

Premiums earned, net increased $109.1$546.9 million, or 9%,41%, to $1,344.9$1,891.7 million for the year ended December 31, 2024,2025, compared to the year ended December 31, 2023.2024. The increase was primarily due to an increase in our average members over the period, which increased approximately 33%. The remaining increase was due to an increase in our risk adjustment revenue driving favorability as a result of the CompanyCompany's focusing onhigh member retention.retention rate.

Reworded

Other income increased $1.5$6.3 million, or 6%,24%, to $26.3$32.6 million for the year ended December 31, 2024,2025, compared to the year ended December 31, 2023.2024. The increase was primarily attributable to an increase in netfair investmentvalue incomeof dueour toequity a higher interest rate environment as compared to the prior period.investments.

Added

Net medical claims incurred increased $562.1 million, or 56%, to $1,568.4 million for the year ended December 31, 2025, compared to the year ended December 31, 2024. The increase was primarily driven by growth in our average members during the period, which increased approximately 33% and an increase in our Part D cost sharing due to changes arising from the Inflation Reduction Act. Additionally, prior year amounts were impacted by more favorable prior period developments as compared to the current year.

Removed

Net medical claims incurred remained materially consistent for the year ended December 31, 2024 as compared to the year ended December 31, 2023.

Reworded

Salaries and benefits decreased $24.7$7.0 million, or 10%,3%, to $232.5$225.5 million for the year ended December 31, 2024,2025, compared to the year ended December 31, 2023.2024. This decrease was primarily attributable to lower variable incentive compensation and stock-based compensation, partially offset by higher base salaries driven by aheadcount decrease in share-based compensation related costs.growth.

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General and administrative expenses

Reworded

General and administrative expenses decreasedincreased $6.6$37.8 million, or 4%,21%, to $176.5$214.3 million for the year ended December 31, 2024,2025, compared to the year ended December 31, 2023.2024. The decreaseincrease was primarily driven by ahigher decreaseprofessional in legal, consultingfees and contractorhigher relatedbroker costs.fees, both being driven by membership growth during the most recent annual enrollment period.

Removed

Restructuring costs

Removed

On April 17, 2023, the Company announced it would implement certain business transformation initiatives, including an agreement to move its core plan operations to UST HealthProof’s integrated technology platform and additional corporate restructuring actions. The agreement with UST HealthProof includes the transition of certain of the Company’s plan operation functions in support of its Medicare Advantage members pursuant to a master services agreement. In addition to the arrangement with UST HealthProof, the Company conducted a reduction in force to better align its Selling, General, and Administrative cost structure with its revenue base. For the year ended December 31, 2024 the Company recorded $0.3 million of restructuring charges related to these business transformation initiatives, which consisted of employee termination benefits, vendor related costs, and other costs. Refer to Note 15 "Restructuring Costs" of the notes to the consolidated financial statements included in Part II, Item 8 of this Form 10-K.

Removed

Loss on investment

Removed

In February 2022, Character Biosciences completed a private capital transaction. After the Company evaluated its ownership interest in Character Biosciences, it began applying the equity method of accounting. From this point forward, the Company recognizes its proportionate share of the gain/loss on equity of that entity during the period. For the year ended December 31, 2024, the Company recognized $0.5 million in shared losses. Refer to Note 12 "Variable Interest Entity and Equity Method of Accounting" of the notes to the consolidated financial statements included in Part II, Item 8 of this Form 10-K.

Reworded

For the year ended December 31, 2024,2025, Net cash providedused byin operating activities was $82.5$66.9 million, which reflects a Net loss from continuing operations of $46.3$85.5 million. Non-cash activities primarily included a $114.3$103.7 million charge to Stock-based compensation expense.

Reworded

For the year ended December 31, 2023,2024, Net cash usedprovided inby operating activities was $35.1$82.5 million, which reflects a Net loss from continuing operations of $210.1$46.3 million. Non-cash activities primarily included a $140.9$114.3 million charge to Stock-based compensation expense, $15.9 million Goodwill and intangible asset impairment, $7.2 million amortization of the 2022 Premium deficiency reserve, and a $4.7$0.5 million Loss on investment.

Removed

Net cash used in financing activities for the year ended December 31, 2024 of $17.4 million was primarily the result of the acquisition of $16.5 million in Treasury stock and repurchases of $1.8 million of Class A Common stock.

Reworded

Net cash used in financing activities for the year ended December 31, 20232025 of $5.1$53.4 million was primarily the result of thecash acquisitionpaid offor $6.2shares withheld related to stock-based compensation totaling $36.9 million inand Treasuryclass stock.A common share repurchases totaling $18.3 million.

Added

Net cash used in financing activities for the year ended December 31, 2024 of $17.4 million was primarily the result of was primarily the result of cash paid for shares withheld related to stock-based compensation totaling $16.5 million and class A common share repurchases totaling $1.8 million.

Reworded

Material cash requirements from known contractual obligations and commitments at December 31, 20242025 include operating lease obligations of $2.3$2.7 million. These commitments are associated with contracts that were enforceable and legally binding at December 31, 2024,2025, and that specified all significant terms, including fixed or minimum serves to be used, fixed, minimum, or variable price provisions, and the approximate timing of the actions under the contracts. There were no other material cash requirements from known contractual obligations and commitments at December 31, 2024.2025. For additional information regarding our remaining estimated contractual obligations and commitments, see Note 13 "Commitments and Contingencies" and Note 22 "Discontinued Operations" in the accompanying notes to the consolidated financial statements included in this Form 10-K.

Reworded

The completion factors are the most significant factor impacting the IBNR estimate. We continually adjust our completion factor with our knowledge of recent events that may impact current completion factors when establishing our reserves. Because our reserving practice is to consistently recognize the actuarial best estimate using an assumption of moderately adverse conditions as required by actuarial standards, there is a reasonable possibility that there could be variances between actual completion factors and those assumed in our December 31, 20242025 and 20232024 unpaid claim estimates.estimates, which may impact results of operations in the period such differences are recognized.

Reworded

Actuarial standards require the use of assumptions based on moderately adverse experience, and as such, a provision for adverse deviation ("PAD") is recognized on current reserves and released on prior reserves. For further discussion of our reserving methodology, including our use of completion factors to estimate IBNR, refer to Note 2 "Summary of Significant Accounting Policies" in the consolidated financial statements included in this Form 10-K.

What changed in the latest 10-Q

Comparing 10-Q filed 2026-08-07 (period ending 2026-06-30) with 10-Q filed 2026-05-08 (period ending 2026-03-31).

Risk Factors (10-Q Part II, Item 1A)

6new paragraphs
0removed paragraphs
1reworded paragraphs
202 → 1,189words in section

New heading “Our failure to protect our sites, networks, and systems against security breaches, or otherwise to protect our confidential or health information or the confidential or health information of our members, providers, or other third parties, could damage our reputation and brands, and substantially harm our business and results of operations.”

Largest changes (selected automatically by length and topic keywords; quoted verbatim, no commentary)

New text topics: cyberattack, cybersecurity incident, breach, ransomware
“Breaches of our security measures or those of our third-party service providers or other cybersecurity incidents could result in unauthorized access to our sites, networks, systems and accounts; unauthorized access to, and misappropriation of, individuals' personally identifiable information (“PII”), protected health information (“PHI”) or other confidential or proprietary information of ourselves, our members or other third parties; viruses, worms, spyware or other malware being served from our platform, networks or systems; …”
see in full comparison
New text topics: investigation, litigation, cybersecurity incident, breach
“If any of these breaches of security should occur, whether involving our systems or those of our vendors, business partners or other third parties, we cannot guarantee that recovery protocols and backup systems will be sufficient to prevent data loss or the interruption, disruption or malfunction of our operations, including with respect to telehealth services. As a result, we could face regulatory investigations or enforcement actions, litigation, indemnification obligations, contractual disputes, and other liabilities. …”
see in full comparison
New text topics: litigation, cybersecurity incident, breach
“While we maintain administrative, technical and physical safeguards designed to protect our systems and information, including employee training, incident response procedures and other security controls, these measures may not be effective in preventing or detecting all cybersecurity incidents or mitigating all related risks. Any compromise could violate applicable privacy, data protection, data security, network and information systems security and other laws, and cause significant legal and financial exposure, adverse publicity and a loss of confidence in our security measures. …”
see in full comparison
New text topics: breach
“Our failure to protect our sites, networks, and systems against security breaches, or otherwise to protect our confidential or health information or the confidential or health information of our members, providers, or other third parties, could damage our reputation and brands, and substantially harm our business and results of operations.”
see in full comparison
New text topics: investigation, litigation
“For example, as previously disclosed, on July 4, 2026, we identified unauthorized access to certain of our information systems resulting from a social engineering attack involving three non-managerial employee accounts. Based on our investigation to date, the affected accounts were associated with member visit-scheduling and broker-facing sales functions and had access to certain PII and PHI, but did not have access to our corporate financial or claims systems. …”
see in full comparison
New text topics: cyberattack, ransomware
“Moreover, certain of our third-party service providers provide technology-related services and/or store or have access to our data and may not have effective controls, processes or practices to protect our information from loss, unauthorized disclosure, unauthorized use or misappropriation, cyberattacks or other data security incidents. A vulnerability in such service providers’ software or systems, a failure in their safeguards, policies or procedures, or a cyberattack or other data security incident affecting any of these third parties could result in harm to our business. …”
see in full comparison
Full comparison: every changed paragraph (7)

Green = added, red = removed. Unchanged paragraphs and tables are not shown. Read the complete text in the original filing.

Reworded

Except as set forth below or as subsequently disclosed in our periodic reports, there have been no material changes in our risk factors from those disclosed in Part I, Item 1A of the 2025 Form 10-K. In the course of conducting our business operations, we are exposed to a variety of recurring and new risks, any of which have affected or could materially adversely affect our business, financial condition, and results of operations. The market price of our Class A common stock could decline, possibly significantly or permanently, if one or more of these risks and uncertainties occurs. Any factor described in this report or in any of our other SEC filings could by itself, or together with other factors, adversely affect our financial results and condition. For a discussion of risk factors that could adversely affect our financial results and condition, and the value of, and return on, an investment in the Company, please see the "Item 1A. Risk Factors" section included in the 2025 Form 10-K, as updated by the risk factor set forth below, as well as the factors identified under "Cautionary Note Regarding Forward-Looking Statements" at the beginning of Part I, Item 1 of this Form 10-Q and as may be updated in subsequent filings with the SEC.

Added

Our failure to protect our sites, networks, and systems against security breaches, or otherwise to protect our confidential or health information or the confidential or health information of our members, providers, or other third parties, could damage our reputation and brands, and substantially harm our business and results of operations.

Added

Breaches of our security measures or those of our third-party service providers or other cybersecurity incidents could result in unauthorized access to our sites, networks, systems and accounts; unauthorized access to, and misappropriation of, individuals' personally identifiable information (“PII”), protected health information (“PHI”) or other confidential or proprietary information of ourselves, our members or other third parties; viruses, worms, spyware or other malware being served from our platform, networks or systems; deletion or modification of content or the display of unauthorized content on our platform; the loss of access to critical data or systems through ransomware, destructive attacks or other means; and business delays, service or system disruptions or denials of service. Healthcare organizations are frequent targets of increasingly sophisticated cyberattacks, including phishing, social engineering, ransomware, credential compromise and other attempts to gain unauthorized access to systems and sensitive information. Such attacks are increasing in their frequency, levels of persistence, sophistication and intensity, and they are being conducted by increasingly sophisticated and organized groups and individuals with a wide range of motives and expertise, including through the use of artificial intelligence and other technologies (including generative AI models). Threat actors are using these technologies to create sophisticated new attack methods that are increasingly automated, targeted, coordinated and difficult to defend against. This may increase the effectiveness of social engineering and other attacks and make detection more difficult. Such attacks may remain undetected for an extended period of time.

Added

If any of these breaches of security should occur, whether involving our systems or those of our vendors, business partners or other third parties, we cannot guarantee that recovery protocols and backup systems will be sufficient to prevent data loss or the interruption, disruption or malfunction of our operations, including with respect to telehealth services. As a result, we could face regulatory investigations or enforcement actions, litigation, indemnification obligations, contractual disputes, and other liabilities. We could also incur costs relating to breach remediation, deployment of additional personnel and protection technologies, and response to governmental investigations and media inquiries and coverage; be required to engage third-party experts and consultants; and face litigation, regulatory action, notification obligations, operational disruptions, and other potential liabilities. Our reputation and brand could be damaged, and our business may suffer. We could face loss of business, reputational harm, reduced member, provider or broker confidence and be required to expend significant capital and other resources to alleviate problems caused by such breaches. Actual or anticipated security breaches or attacks may cause us to incur increasing costs, including costs to respond to and remediate cybersecurity incidents, deploy additional personnel and protection technologies, train employees, engage third-party experts and consultants, enhance our security measures and comply with applicable legal and regulatory requirements.

Added

For example, as previously disclosed, on July 4, 2026, we identified unauthorized access to certain of our information systems resulting from a social engineering attack involving three non-managerial employee accounts. Based on our investigation to date, the affected accounts were associated with member visit-scheduling and broker-facing sales functions and had access to certain PII and PHI, but did not have access to our corporate financial or claims systems. Although we believe our prompt response successfully contained and terminated this unauthorized access and, based on information currently available, we do not believe this incident has had, or is reasonably likely to have, a material impact on our business, financial condition or results of operations, our investigation remains ongoing and the ultimate scope, nature and extent of any unauthorized access to or acquisition of data has not been fully determined. For a discussion of litigation arising from this incident, see Note 12 “Commitments and Contingencies – Legal Actions” in the accompanying notes to the condensed consolidated financial statements included in this Form 10-Q.

Added

Moreover, certain of our third-party service providers provide technology-related services and/or store or have access to our data and may not have effective controls, processes or practices to protect our information from loss, unauthorized disclosure, unauthorized use or misappropriation, cyberattacks or other data security incidents. A vulnerability in such service providers’ software or systems, a failure in their safeguards, policies or procedures, or a cyberattack or other data security incident affecting any of these third parties could result in harm to our business. For example, in 2024, one of our vendors, UnitedHealth Group’s Change Healthcare, experienced a ransomware attack that compromised certain of our members’ personal information (including PHI). Although the Change Healthcare incident did not have a material impact on our business, financial condition or results of operations, it illustrates the ongoing and evolving nature of cybersecurity threats facing the Company and its service providers.

Added

While we maintain administrative, technical and physical safeguards designed to protect our systems and information, including employee training, incident response procedures and other security controls, these measures may not be effective in preventing or detecting all cybersecurity incidents or mitigating all related risks. Any compromise could violate applicable privacy, data protection, data security, network and information systems security and other laws, and cause significant legal and financial exposure, adverse publicity and a loss of confidence in our security measures. We devote significant resources to protect against security breaches, and we may need to devote significantly more resources in the future to address problems caused by breaches, including notifying affected subscribers and responding to any resulting litigation, which would divert resources from the growth and expansion of our business. Any future cybersecurity incident could have a material effect on our business, financial condition or results of operations.

Management's Discussion & Analysis (MD&A) (10-Q Part I, Item 2)

24new paragraphs
2removed paragraphs
22reworded paragraphs
4,143 → 5,319words in section

New heading “Executive Summary”

New heading “Recent Developments”

New heading “CMS Star Ratings”

New heading “Comparison of the Six Months Ended June 30, 2026 and 2025”

New heading “Premiums earned, net”

New heading “Net medical claims incurred”

New heading “General and administrative expenses”

Removed heading “Salaries and benefits”

Largest changes (selected automatically by length and topic keywords; quoted verbatim, no commentary)

New text
“Comparison of the Six Months Ended June 30, 2026 and 2025”
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New text
“General and administrative expenses”
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New text topics: liquidity
“Our results reflect continued membership growth alongside disciplined management of administrative spend. Adjusted SG&A as a percentage of total revenues improved to 16% for the six months ended June 30, 2026, from 18% in the prior-year period, as revenue growth outpaced growth in our administrative cost base. Adjusted EBITDA increased to $81.2 million for the six months ended June 30, 2026, from $42.9 million in the prior-year period. We continued to maintain a strong liquidity position, with cash, cash equivalents, and investments of $443.0 million at June 30, 2026.”
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New text
“Net medical claims incurred”
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Removed text
“Salaries and benefits”
see in full comparison
New text
“Premiums earned, net”
see in full comparison
Full comparison: every changed paragraph (48)

Green = added, red = removed. Unchanged paragraphs and tables are not shown. Read the complete text in the original filing.

Reworded

The following discussion and analysis provides information that management believes is relevant to an assessment and understanding of our condensed consolidated results of operations and financial condition. The discussion should be read in conjunction with the unaudited condensed consolidated financial statements and notes thereto for the three and six months ended MarchJune 31,30, 2026, contained in this Quarterly Report on Form 10-Q (the "Form 10-Q") and the audited consolidated financial statements and notes thereto for the year ended December 31, 2025, contained in the Company's Annual Report on Form 10-K for the year ended December 31, 2025, filed with the Securities and Exchange Commission (the "SEC") on February 27, 2026 (the "2025 Form 10-K"). This discussion contains forward-looking statements and involves numerous risks and uncertainties, including, but not limited to, those described in the "Risk Factors" section of the 2025 Form 10-K. Actual results may differ materially from those contained in any forward-looking statements. See "Cautionary Note Regarding Forward-Looking Statements" for additional information. Unless the context otherwise requires, references in this "Management's Discussion and Analysis of Financial Condition and Results of Operations" to "we," "us," "our," "Clover," "Clover Health," and the "Company" mean the business and operations of Clover Health Investments, Corp. and its consolidated subsidiaries.

Reworded

We operate Preferred Provider Organization ("PPO") and Health Maintenance Organization ("HMO") Medicare Advantage ("MA") plans for Medicare-eligible individuals. We aim to provide high-quality, affordable healthcare for all Medicare beneficiaries. Among plans with similar major characteristics, we offer most members in our MA plans (the "members") among the lowest average out-of-pocket costs for primary care provider and specialist co-pays in their markets. We strongly believe in providing our members provider choice, and we consider our PPO plans to be our flagship insurance product. An important feature of our MA product is wide network access. We believe the use of Clover Assistant and related data insights allows us to improve clinical decision-making through a highly scalable platform. At MarchJune 31,30, 2026, we operated our MA plans in five states and 203 counties, with 155,773157,309 members.

Added

Executive Summary

Added

The following summary highlights matters that management considers most significant to an understanding of our results for the three and six months ended June 30, 2026. It is not a complete description of, and should be read together with, the more detailed discussion that follows and our condensed consolidated financial statements.

Added

Total revenues increased 56% to $743.2 million for the three months ended June 30, 2026, and 59% to $1,492.4 million for the six months ended June 30, 2026, compared to the respective prior-year periods, driven primarily by growth in our Medicare Advantage membership and higher per-member premium. We reported income from operations of $28.0 million and $55.3 million for the three and six month periods, respectively, compared to losses in the prior-year periods.

Added

Our results reflect continued membership growth alongside disciplined management of administrative spend. Adjusted SG&A as a percentage of total revenues improved to 16% for the six months ended June 30, 2026, from 18% in the prior-year period, as revenue growth outpaced growth in our administrative cost base. Adjusted EBITDA increased to $81.2 million for the six months ended June 30, 2026, from $42.9 million in the prior-year period. We continued to maintain a strong liquidity position, with cash, cash equivalents, and investments of $443.0 million at June 30, 2026.

Added

Consolidated gross profit increased approximately 50% to $312.5 million for the six months ended June 30, 2026, broadly in line with our membership growth.

Added

As described under "Recent Developments" below, developments during the quarter relating to our 2026 Star Ratings are expected to affect payment year 2027 rather than our current period results.

Added

Recent Developments

Added

CMS Star Ratings

Added

Pursuant to CMS’s MA Star Ratings system, CMS annually awards between 1.0 and 5.0 Stars to MA plans based on performance in several categories. CMS released the Company’s 2026 Star Ratings on October 9, 2025 and had awarded the Company's PPO (contract H5141) and HMO plans (contract H8010) with 3.5 Stars and 4.0 Stars, respectively.

Added

As previously disclosed, on June 9, 2026, CMS informed the Company that, consistent with a court judgment in Clover Insurance Co. V. HHS, Civ. A. No. 25-142 (S.D. Ga) (the "Stars Litigation"), CMS had recalculated the 2026 Star Rating for the Company's PPO MA contract, H5141, from 3.5 Stars to 4.5 Stars for payment year 2027.

Added

On June 17, 2026, CMS issued updated guidance informing all MA Organizations that it was voluntarily recalculating the 2027 Quality Bonus Payment ratings for certain MA contracts as a result of the decision in the Stars Litigation.

Added

CMS’s guidance stated that MA organizations can view their recalculated 2027 QBP ratings in the Health Plan Management System ("HPMS"). HPMS displays the Company's PPO MA contract, H5141, rated at 4.5 Stars for payment year 2027, and also displays that the 2026 Star Rating for the Company's HMO MA contract, H8010, increased from 4.0 Stars to 4.5 Stars, which also impacts payment year 2027.

Added

On July 21, 2026, CMS filed its Notice of Appeal of the district court's decision in the Stars Litigation with the United States Court of Appeals for the Eleventh Circuit.

Reworded

Comparison of the Three Months Ended MarchJune 31,30, 2026 and 2025

Reworded

The following table summarizes our condensed consolidated results of operations for the three months ended MarchJune 31,30, 2026 and 2025. The period-to-period comparison of results is not necessarily indicative of results for future periods.

Reworded

Premiums earned, net increased $287.3$267.9 million, or 63%,57%, to $744.2$737.8 million for the three months ended MarchJune 31,30, 2026, compared to the three months ended MarchJune 31,30, 2025. The increase was primarily driven by growth in our average membersmembership over the period, which increased approximately 51%.49%, Intogether addition,with wean areapproximately currently6% increase in per-member premium. The higher per-member premium reflected higher CMS premium rates, including the effect of being paid on 4.0 starsStars in the current payment year as compared to 3.5 starsStars in the prior period for our PPO plansplans, which comprisescover the large majority of our members.

Removed

Other income

Reworded

Other income decreased by $0.4$2.4 million, or 8%,31%, to $5.0$5.4 million for the three months ended MarchJune 31,30, 2026, compared to the three months ended MarchJune 31,30, 2025. The decrease was primarily driven by the absence in 2026 of a non-recurring gain recognized in the prior-year period from the fair value remeasurement of an equity investment in a privately held company, and by lower investment income resulting from a lower interest rate environmentenvironment, duringto which our returns are closely correlated given the period,short-duration whichnature resultedof in lowerour investment income.portfolio.

Reworded

Net medical claims incurred increased $236.2$212.2 million, or 67%,56%, to $589.6$590.2 million for the three months ended MarchJune 31,30, 2026, compared to the three months ended MarchJune 31,30, 2025. The increase was primarily driven by growth in our average membersmembership during the period, which increased approximately 51%.49%, together with higher per-member medical costs. On a per-member basis, net medical claims incurred increased approximately 5% to $1,254 from $1,194, driven by the current-year benefit design and general medical cost trends.

Removed

Salaries and benefits

Reworded

Salaries and benefits decreased by $2.0$7.2 million, or 3%,12%, to $57.1$54.1 million for the three months ended MarchJune 31,30, 2026, compared to the three months ended MarchJune 31,30, 2025. ThisThe decrease was driven primarily driven by a decrease in ourlower stock-based compensation expenseexpense, reflecting the completion in January 2026 of the requisite service period for certain founder equity awards granted in 2021, partially offset by anhigher increasecash incompensation, including base salaries asassociated awith result of an increase inincreased headcount to support our membership growth.

Reworded

General and administrative expenses increased $24.0$21.8 million, or 47%,45%, to $74.6$70.3 million for the three months ended MarchJune 31,30, 2026, compared to the three months ended MarchJune 31,30, 2025. The increase was primarily driven by higher administrative costs to support the growth in our membership, including higher professional feesfees, broker commissions, and brokerother feesoperating driven by membership growth during the most recent annual enrollment period.expenses.

Added

Comparison of the Six Months Ended June 30, 2026 and 2025

Added

The following table summarizes our condensed consolidated results of operations for the six months ended June 30, 2026 and 2025. The period-to-period comparison of results is not necessarily indicative of results for future periods.

Added

* Not presented because the current or prior period amount is zero or the amount for the line item changed from a gain to a loss (or vice versa) and thus yields a result that is not meaningful.

Added

Premiums earned, net

Added

Premiums earned, net increased $555.2 million, or 60%, to $1,482.0 million for the six months ended June 30, 2026, compared to the six months ended June 30, 2025. The increase was primarily driven by growth in our average membership over the period, which increased approximately 50%, together with an approximately 7% increase in per-member premium. The higher per-member premium reflected higher CMS premium rates, including the effect of being paid on 4.0 Stars in the current payment year compared to 3.5 Stars in the prior period for our PPO plans, which cover the large majority of our members.

Added

Other income decreased by $2.8 million, or 21%, to $10.4 million for the six months ended June 30, 2026, compared to the six months ended June 30, 2025. The decrease was primarily driven by the absence in 2026 of a non-recurring gain recognized in the prior-year period from the fair value remeasurement of an equity investment in a privately held company, and by lower investment income resulting from a lower interest rate environment, to which our returns are closely correlated given the short-duration nature of our investment portfolio.

Added

Net medical claims incurred

Added

Net medical claims incurred increased $448.4 million, or 61%, to $1,179.8 million for the six months ended June 30, 2026, compared to the six months ended June 30, 2025. The increase was primarily driven by growth in our average members during the period, which increased approximately 50%, together with higher per-member medical costs. On a per-member basis, net medical claims incurred increased approximately 7% to $1,263 from $1,175, driven by the current-year benefit design and general medical cost trends.

Added

Salaries and benefits decreased by $9.1 million, or 8%, to $111.2 million for the six months ended June 30, 2026, compared to the six months ended June 30, 2025. This decrease was primarily driven by lower stock-based compensation expense, reflecting the completion in January 2026 of the requisite service period for certain founder equity awards granted in 2021, partially offset by higher cash compensation, including base salaries associated with increased headcount to support our membership growth.

Added

General and administrative expenses

Added

General and administrative expenses increased $45.8 million, or 46%, to $144.9 million for the six months ended June 30, 2026, compared to the six months ended June 30, 2025. The increase was primarily driven by higher administrative costs to support the growth in our membership, including higher professional fees, broker commissions, and other operating expenses.

Reworded

Our cash equivalents and investment securities consist primarily of money market funds, U.S. government debt securities, and corporate debt securities. At MarchJune 31,30, 2026 and December 31, 2025, total cash, cash equivalents, and investments were $418.2$443.0 million and $319.9 million, respectively. These totals consist of $240.7$241.7 million and $224.6 million at MarchJune 31,30, 2026 and December 31, 2025, respectively, that specifically relate to available-for-sale and held-to-maturity investment securities.

Reworded

At MarchJune 31,30, 2026 and December 31, 2025, total cash, cash equivalents, and investments for the parent company, Clover Health Investments, Corp., and unregulated subsidiaries were $105.5$128.5 million and $122.0 million, respectively. We operate as a holding company in a highly regulated industry. As such, we may receive dividends and administrative expense reimbursements from our subsidiaries, two of which are subject to regulatory restrictions. We continue to maintain significant levels of aggregate excess statutory capital and surplus in our state-regulated insurance subsidiaries.

Reworded

At MarchJune 31,30, 2026 and December 31, 2025, total cash, cash equivalents, and investments for our regulated subsidiaries were $312.7$314.5 million and $197.9 million, respectively. Additionally, our regulated insurance subsidiaries held $178.5$177.4 million and $178.1 million of available-for-sale and held-to-maturity investment securities at MarchJune 31,30, 2026 and December 31, 2025, respectively. Our use of operating cash derived from our unregulated subsidiaries is generally not restricted by departments of insurance (or comparable state regulatory agencies). Our regulated insurance subsidiaries are subject to regulations and standards in their respective jurisdictions on their ability to declare and pay dividends to the parent. As of MarchJune 31,30, 2026, there have been no dividends paid to the parent. Insurance regulators have broad powers to prevent reduction of statutory surplus to inadequate levels, and there is no assurance that dividends of the maximum amounts calculated under any applicable formula would be permitted. State insurance regulatory authorities that have jurisdiction over the payment of dividends by our regulated insurance subsidiary may in the future adopt statutory provisions more restrictive than those currently in effect.

Reworded

The following table summarizes our condensed consolidated cash flows for the threesix months ended MarchJune 31,30, 2026 and 2025.

Reworded

For the threesix months ended MarchJune 31,30, 2026, Net cash provided by operating activities was $107.9$133.1 million, which reflects Net income of $27.3$55.3 million. The changes in operating assets and liabilities were largely attributable to a $107.2$97.6 million increase in Unpaid claims. Non-cash activities primarily included a $12.3$21.4 million charge to Stock-based compensation.

Reworded

For the threesix months ended MarchJune 31,30, 2025, Net cash used in operating activities was $16.3$10.9 million, which reflects a Net loss of $1.3$11.9 million. Non-cash activities primarily included a $26.4$52.6 million charge to Stock-based compensation expense.

Reworded

Net cash used in investing activities for the threesix months ended MarchJune 31,30, 2026 of $5.1 million was primarily due to $40.9$68.1 million used to purchase investments. This was partiallylargely offsetattributable byto $36.7$64.5 million provided from the sales and maturities of investment securities.

Reworded

Net cash provided by investing activities for the threesix months ended MarchJune 31,30, 2025 of $8.9$44.5 million was primarily due to $42.3$105.1 million provided from the sales and maturities of investment securities. This was partially offset by $33.2$59.9 million used to purchase investments.

Reworded

Net cash used in financing activities for the threesix months ended MarchJune 31,30, 2026 of $7.9$7.4 million was primarily the result of cash paid for shares withheld related to stock-based compensation totaling $7.9$9.7 million.

Reworded

Net cash used in financing activities for the threesix months ended MarchJune 31,30, 2025 of $31.7$39.5 million was primarily the result of cash paid for repurchases our Class A common stock totaling $18.3 million in addition to cash paid for shares withheld related to stock-based compensation totaling $13.7$22.1 million in addition to repurchases of our Class A common stock totaling $18.3 million.

Reworded

There have been no material changes to our financing arrangements at MarchJune 31,30, 2026.

Reworded

Material cash requirements from known contractual obligations and commitments at MarchJune 31,30, 2026 include operating lease obligations of $3.8$3.6 million. These commitments are associated with contracts that were enforceable and legally binding at MarchJune 31,30, 2026, and that specified all significant terms, including fixed or minimum servesservices to be used, fixed, minimum, or variable price provisions, and the approximate timing of the actions under the contracts. There were no other material cash requirements from known contractual obligations and commitments at MarchJune 31,30, 2026. For additional information regarding our remaining estimated contractual obligations and commitments, see Note 12 "Commitments and Contingencies" in the accompanying notes to the condensed consolidated financial statements included in this Form 10-Q.

Reworded

We believe that the accounting policies and estimates involve a significant degree of judgment and complexity. There have been no significant changes in our critical accounting policies and estimates during the three months ended MarchJune 31,30, 2026, as compared to the critical accounting policies and estimates disclosed in the section titled "Management's Discussion and Analysis of Financial Condition and Results of Operations" included in the 2025 Form 10-K.

CLOV insider buying and selling (Form 4)

Since 2026-04-11, insiders reported open-market purchases in 0 Form 4 filings and open-market sales in 29 filings (8 insiders, 22 trade dates, 1,688,574 shares, about $7.6M; 26 of these filings say the sales were made under a Rule 10b5-1 trading plan). Net open-market shares: -1,688,574 (purchases minus sales); net value about -$7.6M.Totals add up every open-market (code P and S) line in those filings, using the prices reported in the filings. Awards, option exercises, tax withholding and gifts are listed below but not counted.

Trade dateInsiderTransactionSharesPriceValueOwned afterFiling
2026-10-07Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
2,006$4.63 $9.3K2,792,690 SEC
2026-10-05Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
8,750$4.42 $38.7K2,794,696 SEC
2026-10-01Toy Andrew
Director, Chief Executive Officer
Open-market sale
10b5-1 plan
318,806$4.19 $1.3M9,140,510 SEC
2026-09-30Miller Brian James
Director
Grant/award 12,481— —12,481 SEC
2026-09-30Torricelli Robert G
Director
Grant/award 12,481— —186,897 SEC
2026-09-17Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
1,921$4.56 $8.8K2,803,446 SEC
2026-09-16Oldakowski Joseph Frank
VP OF FINANCE AND CONTROLLER
Open-market sale
10b5-1 plan
3,170$4.64 $14.7K275,897 SEC
2026-09-15Wai Conrad
CEO, Counterpart Health
Open-market sale
10b5-1 plan
300,000$4.72 $1.4M1,170,056 SEC
2026-09-15Soares Karen
Chief Legal Officer
Open-market sale
10b5-1 plan
6,846$4.78 $32.7K1,607,371 SEC
2026-09-15Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
9,273$4.78 $44.3K2,805,367 SEC
2026-09-14Oldakowski Joseph Frank
VP OF FINANCE AND CONTROLLER
Open-market sale 20,000$5.16 $103.2K279,067 SEC
2026-08-17Thornton Joseph Clay
Interim CFO
Open-market sale
10b5-1 plan
17,775$4.39 $78.0K1,249,526 SEC
2026-08-12Soares Karen
Chief Legal Officer
Grant/award 108,695— —1,614,217 SEC
2026-08-12Thornton Joseph Clay
Interim CFO
Grant/award 54,347— —1,267,301 SEC
2026-08-10Toy Andrew
Director, Chief Executive Officer
Open-market sale
10b5-1 plan
87,798$4.65 $408.3K9,459,316 SEC
2026-07-20Soares Karen
Chief Legal Officer
Open-market sale
10b5-1 plan
51,700$4.51 $233.2K1,505,522 SEC
2026-07-17Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
4,839$4.53 $21.9K2,814,640 SEC
2026-07-15Toy Andrew
Director, Chief Executive Officer
Open-market sale
10b5-1 plan
62,711$4.67 $292.9K9,547,114 SEC
2026-07-15Wai Conrad
CEO, Counterpart Health
Open-market sale
10b5-1 plan
24,215$4.67 $113.1K1,145,699 SEC
2026-07-15Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
13,119$4.67 $61.3K2,819,479 SEC
2026-07-15Soares Karen
Chief Legal Officer
Open-market sale
10b5-1 plan
10,519$4.67 $49.1K1,557,222 SEC
2026-07-15Thornton Joseph Clay
Interim CFO
Open-market sale
10b5-1 plan
4,630$4.67 $21.6K1,212,954 SEC
2026-07-08Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
2,384$4.68 $11.2K2,832,598 SEC
2026-07-06Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
6,229$5.26 $32.8K2,834,982 SEC
2026-07-01Toy Andrew
Director, Chief Executive Officer
Open-market sale
10b5-1 plan
313,476$5.32 $1.7M9,609,825 SEC
2026-06-17Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
2,360$4.78 $11.3K2,841,211 SEC
2026-06-16Oldakowski Joseph Frank
VP OF FINANCE AND CONTROLLER
Open-market sale
10b5-1 plan
12,102$4.86 $58.8K299,067 SEC
2026-06-15Soares Karen
Chief Legal Officer
Open-market sale
10b5-1 plan
4,681$4.61 $21.6K1,567,741 SEC
2026-06-15Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
6,350$4.61 $29.3K2,843,571 SEC
2026-06-11Reynoso Jamie L.
CEO, Medicare Advantage
Open-market sale
10b5-1 plan
7,289$4.91 $35.8K2,849,921 SEC
2026-05-28Wai Conrad
CEO, Counterpart Health
Open-market sale
10b5-1 plan
220,426$3.99 $879.5K1,390,056 SEC
2026-05-18Edwards Carladenise Armbrister
Director
Open-market sale 67,160$3.42 $229.7K285,432 SEC
2026-05-16Thornton Joseph Clay
Interim CFO
Shares withheld for tax 16,942$3.47 $58.8K1,217,584 SEC
2026-05-13Priest Brady Patrick
CEO of Clover Care Services
Open-market sale 98,039$3.52 $345.1K2,040,222 SEC
2026-05-08Toy Andrew
Director, Chief Executive Officer
Shares withheld for tax 85,704$2.82 $241.7K9,923,301 SEC
2026-04-18Priest Brady Patrick
CEO of Clover Care Services
Shares withheld for tax 36,113$2.19 $79.1K2,138,261 SEC
2026-04-15Priest Brady Patrick
CEO of Clover Care Services
Shares withheld for tax 15,471$2.04 $31.6K2,174,374 SEC
2026-04-15Soares Karen
Chief Legal Officer
Shares withheld for tax 10,161$2.04 $20.7K1,572,422 SEC
2026-04-15Toy Andrew
Director, Chief Executive Officer
Shares withheld for tax 60,765$2.04 $124.0K10,009,005 SEC
2026-04-15Thornton Joseph Clay
Interim CFO
Shares withheld for tax 4,158$2.04 $8.5K1,234,526 SEC
2026-04-15Reynoso Jamie L.
CEO, Medicare Advantage
Shares withheld for tax 12,712$2.04 $25.9K2,857,210 SEC
2026-04-15Wai Conrad
CEO, Counterpart Health
Shares withheld for tax 23,463$2.04 $47.9K1,169,914 SEC

Well-known investors holding CLOV (13F)

InvestorQuarterSharesReported value% of their 13FChange vs prior quarter
Renaissance Technologies COM CL A2026-06-302,807,441$14.7M0.02%Reduced 17%
Citadel Advisors (Ken Griffin) COM CL A2026-06-302,163,205$11.3M0.01%Added 15%
D. E. Shaw & Co. COM CL A2026-06-301,965,493$10.3M0.01%Added 2060%
Millennium Management (Israel Englander) COM CL A2026-06-301,108,721$5.8M0.0%Reduced 5%
Point72 Asset Management (Steve Cohen) COM CL A2026-06-301,069,645$5.6M0.01%Added 113%
AQR Capital Management (Cliff Asness) COM CL A2026-06-30488,182$2.6M0.0%Added 364%

13F reports are filed up to 45 days after quarter end and show long U.S. equity positions only; options positions are omitted here.

Coming soon: email alerts when CLOV files, watchlists and downloadable comparisons.