0001628280-24-019994 | 10-Q | XBRL Viewer

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Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Allowance for credit losses	$ 0	$ 0
Preferred stock par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	100,000,000	100,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	1,000,000,000	1,000,000,000
Common stock, shares issued (in shares)	191,156,569	188,951,643
Common stock, shares outstanding (in shares)	191,156,569	188,951,643

Long-Term Debt

3 Months Ended

Mar. 31, 2024

Debt Disclosure [Abstract]

Long-Term Debt

Long-term debt is recorded at carrying value in the condensed consolidated balance sheets. The carrying value of long-term debt outstanding, net of unamortized debt issuance costs, consisted of the following as of March 31, 2024 and December 31, 2023:


	March 31, 2024		December 31, 2023
Long-term debt	$	165,000	$	165,000
Less unamortized debt issuance costs	(2,970)		(3,187)
Long-term debt-net of amortization	162,030		161,813
Less current portion of long-term debt	—		—
Long-term debt - net of current portion	$	162,030	$	161,813

Oxford Term Loan

On September 2, 2022 (the "Effective Date"), Alignment Healthcare USA, LLC entered into a senior secured term loan agreement (the “Oxford Loan Agreement”) with Oxford Finance LLC (“Oxford”), as administrative agent, collateral agent and a lender, and the other lenders from time to time party thereto (collectively, the “Lenders”), pursuant to which the Lenders have agreed to lend an aggregate principal amount of up to $250,000 in a series of term loans (the “Term Loans”). Pursuant to the Oxford Loan Agreement, we received an initial Term Loan of $165,000 on the Effective Date and may borrow up to an additional $85,000 of Term Loans at our option (such additional Term Loans, the “Delayed Draw Term Loans”). Interest on the Term Loans is a variable rate equal to (i) the secured overnight financing rate ("SOFR") administered by the Federal Reserve Bank of New York for a one-month tenor, subject to a floor of 1.00%, plus (ii) an applicable margin of 6.50%. All unpaid principal and accrued and unpaid interest with respect to each Term Loan is due and payable in full on September 1, 2027. The interest rate applied during the quarter ended March 31, 2024 ranged from 11.82% to 11.85%.

The aggregate proceeds of the Delayed Draw Term Loans drawn on or prior to June 30, 2024 may not exceed $50,000 unless used for permitted acquisitions and may not exceed $35,000 drawn on or after July 1, 2024.

The term loan was subject to a commitment fee of $1,650 and an origination fee of $1,650. The Delayed Draw Term Loans are subject to a commitment fee of $850. We incurred additional debt issuance costs of $1,096 related to attorney fees and other third-party costs. The commitment and origination fees are included within debt issuance costs and were deferred and will be amortized to interest expense over the debt term using the straight line method, which is materially consistent with the effective interest method. The debt issuance costs related to the term loan are presented in the condensed consolidated balance sheet as a direct deduction from the carrying value of the term loan. The debt issuance costs related to the delayed draw term loan are presented in the condensed consolidated balance sheet as other assets.

The Term Loans are jointly and severally guaranteed by Alignment Healthcare, Inc. and certain of our wholly owned subsidiaries and collateralized by all unrestricted assets.

For certain prepayments of the Term Loans prior to the second anniversary of the Effective Date, we will be required to pay a prepayment fee ranging from 1.00% to 2.00% of the principal amount of the Term Loans being prepaid.

The Oxford Loan Agreement includes customary events of default, including, among others, payment defaults, breach of representations and warranties, covenant defaults, judgment defaults, insolvency and bankruptcy defaults, and change of control. The occurrence of an event of default could result in the acceleration of the obligations under the Oxford Loan Agreement, termination of the Term Loan commitments and the right to foreclose on the collateral securing the obligations. During the existence of an event of default, the outstanding Term Loans will accrue interest at a rate per annum equal to 2.00% plus the otherwise applicable interest rate. Additionally, in the event of any contemplated asset sale or series of asset sales yielding net proceeds in excess of $2,500, except those excluded per the Oxford Loan Agreement, we are required to prepay the aggregate outstanding principal balance of the Term Loans in an amount equal to the entire amount of the asset sale net proceeds, plus any accrued and unpaid interest.

The Oxford Loan Agreement includes financial covenants that require the Borrower Parties to (i) maintain minimum liquidity, as defined in the Loan Agreement, of $23,000 and (ii) satisfy a maximum permitted ratio of debt to trailing twelve-month revenue, as set forth in the Loan Agreement. As of March 31, 2024 and December 31, 2023, we were in compliance with the Oxford financial covenants.

Future maturities under the term loan for each of the next five years ending December 31, are as follows:


	Amount
Remainder of 2024	$	—
2025	1,650
2026	1,650
2027	161,700
2028	—
	$	165,000

Commitments and Contingencies (Details) - USD ($) $ in Thousands	Aug. 15, 2023	Mar. 31, 2024	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Settlement amount	$ 913
Accrued for a potential liability		$ 913	$ 913

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Mar. 31, 2024	Mar. 31, 2023
Pay vs Performance Disclosure
Net loss	$ (46,521)	$ (37,284)

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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+ Details

Equity-Based Compensation - Schedule of RSU Transactions (Details) - RSUs	3 Months Ended
	Mar. 31, 2024 $ / shares shares
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested and outstanding, beginning balance (in shares)	10,541,625
Granted (in shares)	6,517,337
Vested (in shares)	(2,385,493)
Cancelled/forfeited (in shares)	(282,972)
Unvested and outstanding, ending balance (in shares)	14,390,497
Weighted-Average Grant Date Fair Value
Unvested and outstanding, beginning balance (in dollars per share) \| $ / shares	$ 11.25
Granted (in dollars per share) \| $ / shares	5.05
Vested (in dollars per share) \| $ / shares	8.25
Cancelled/forfeited (in dollars per share) \| $ / shares	9.36
Unvested and outstanding, ending balance (in dollars per share) \| $ / shares	$ 8.97
Number of shares vested but issuance and delivery deferred (in shares)	107,948

Long-Term Debt (Tables)

3 Months Ended

Mar. 31, 2024

Debt Disclosure [Abstract]

Schedule of Long-Term Debt Outstanding, Net of Unamortized Debt Issuance Costs


	March 31, 2024		December 31, 2023
Long-term debt	$	165,000	$	165,000
Less unamortized debt issuance costs	(2,970)		(3,187)
Long-term debt-net of amortization	162,030		161,813
Less current portion of long-term debt	—		—
Long-term debt - net of current portion	$	162,030	$	161,813

Schedule of Future Maturities Under The Term Loan

Future maturities under the term loan for each of the next five years ending December 31, are as follows:


	Amount
Remainder of 2024	$	—
2025	1,650
2026	1,650
2027	161,700
2028	—
	$	165,000

Summary of Significant Accounting Policies - Schedule of Computation of Diluted Net Loss Per Share (Details) - shares	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Antidilutive securities excluded from computation of earnings per share (in shares)	31,790,378	20,588,969
Stock options
Antidilutive securities excluded from computation of earnings per share (in shares)	9,023,343	10,584,124
Restricted stock units
Antidilutive securities excluded from computation of earnings per share (in shares)	22,767,035	10,004,845

Summary of Significant Accounting Policies - Schedule of Property and Equipment Estimated Useful Lives (Details)	Mar. 31, 2024
Computers and equipment
Property Plant and Equipment [Line Items]
Estimated service lives (years)	5 years
Office equipment and furniture \| Minimum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	5 years
Office equipment and furniture \| Maximum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	7 years
Software \| Minimum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	3 years
Software \| Maximum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	5 years
Leasehold improvements
Property Plant and Equipment [Line Items]
Estimated service lives (years)	15 years

Property and Equipment - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Property Plant and Equipment [Line Items]
Depreciation expense	$ 6,001	$ 4,885
Medical expenses
Property Plant and Equipment [Line Items]
Depreciation expense	$ 52	$ 61

Commitments and Contingencies	3 Months Ended
Commitments and Contingencies	Mar. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Legal Proceedings We record a liability and accrue the costs for a loss when an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. In some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal and regulatory proceedings. While the liability and accrued costs reflect our best estimate, the actual amounts may materially be different. On April 27, 2022, a former employee of the Company filed a purported class action lawsuit (Dabney v. Alignment Healthcare USA, LLC, Orange County Superior Court) alleging that the Company failed to provide hourly employees with required meal and rest breaks or pay such workers a premium equal to an hour of pay for missed meal or rest breaks. Discovery in the matter commenced on June 8, 2022. On September 2, 2022, the court granted a stay of proceedings and discovery in anticipation of mediation scheduled for August 2023. On August 15, 2023, the Company entered into a tentative settlement of the action in consideration of an aggregate payment of $913. The settlement of this matter is subject to approval by the court which is expected in the third quarter of 2024. As a result of the tentative settlement, the Company has accrued for a potential liability of $913 as of March 31, 2024 and December 31, 2023 for this matter, which was recorded within accounts payable and accrued expenses on the consolidated balance sheet and selling, general and administrative expenses on the consolidated statement of operations. We may be involved in various litigation matters in the ordinary course of business. In the opinion of management, the ultimate resolution of legal proceedings is not expected to have a material adverse effect on the condensed consolidated financial statements. Amounts accrued for legal proceedings were not material as of March 31, 2024 and December 31, 2023.

Condensed Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Revenues:
Earned premiums	$ 621,556	$ 434,812
Other	7,045	4,343
Total revenues	628,601	439,155
Expenses:
Medical expenses	573,218	396,315
Selling, general, and administrative expenses	90,512	70,408
Depreciation and amortization	5,977	4,921
Total expenses	669,707	471,644
Loss from operations	(41,106)	(32,489)
Other expenses:
Interest expense	5,427	5,019
Other expenses (income)	42	(138)
Total other expenses	5,469	4,881
Loss before income taxes	(46,575)	(37,370)
Provision for income taxes	0	1
Net loss	(46,575)	(37,371)
Less: Net loss attributable to noncontrolling interest	54	87
Net loss attributable to Alignment Healthcare, Inc.	$ (46,521)	$ (37,284)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic (in shares)	189,005,394	183,113,945
Total weighted-average common shares outstanding, net of restricted shares of common stock - diluted (in shares)	189,005,394	183,113,945
Net loss per share - basic (in dollars per share)	$ (0.25)	$ (0.20)
Net loss per share - diluted (in dollars per share)	$ (0.25)	$ (0.20)

Goodwill and Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Indefinite Lived Intangible Assets By Major Class [Line Items]
Goodwill, Gross Carrying Value	$ 34,826	$ 34,826
Goodwill	34,826	34,826
Gross Carrying Value	43,543	43,543
Accumulated Amortization	(3,493)	(3,465)
Net Carrying Value	40,050	40,078
Plan member relationships
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	2,700	2,700
Accumulated Amortization	(2,700)	(2,700)
Net Carrying Value	$ 0	$ 0
Weighted Average Life	9 years	9 years
Other
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 1,050	$ 1,050
Accumulated Amortization	(793)	(765)
Net Carrying Value	$ 257	$ 285
Minimum \| Other
Indefinite Lived Intangible Assets By Major Class [Line Items]
Weighted Average Life	2 years	2 years
Maximum \| Other
Indefinite Lived Intangible Assets By Major Class [Line Items]
Weighted Average Life	10 years	10 years
License (indefinite lived)
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 4,967	$ 4,967
Net Carrying Value	$ 4,967	$ 4,967

Equity-Based Compensation - Schedule of Stock Option Activity Transactions (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Shares Subject to Options Outstanding
Options outstanding, beginning balance (in shares)	9,135,879
Options granted (in shares)	0
Options exercised (in shares)	0
Options forfeited / expired (in shares)	(112,536)
Options outstanding, ending balance (in shares)	9,023,343	9,135,879
Options outstanding, vested and exercisable (in shares)	6,336,964
Weighted- Average Exercise Price per Option
Options outstanding, beginning balance (in dollars per share)	$ 16.95
Options granted (n dollars per share)	0
Options exercised (in dollars per share)	0
Options forfeited / expired (in dollars per share)	15.41
Options outstanding, ending balance (in dollars per share)	16.97	$ 16.95
Options outstanding, vested and exercisable (in dollars per share)	$ 17.28
Stock Option Activity, Additional Disclosures
Weighted-average remaining contractual terms, outstanding	7 years 14 days	7 years 3 months 14 days
Weighted-average remaining contractual terms, vested and exercisable	7 years
Aggregate intrinsic value		$ 79
Aggregate intrinsic value, vested and exercisable	$ 0

Income Taxes	3 Months Ended
Income Taxes	Mar. 31, 2024
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes For the three months ended March 31, 2024 and 2023, we recorded income tax expense of $0 and $1, respectively. The decrease in tax for the three months ended March 31, 2024 when compared to the three months ended March 31, 2023, is primarily attributable to state tax recorded in the prior year. Our future effective tax rate may vary from the statutory tax rate primarily due to changes in our valuation allowance, state taxes, and excess executive compensation. We have federal and state cumulative net operating losses ("NOLs") as of March 31, 2024 and December 31, 2023. Given the history of losses, and after consideration for the risk associated with estimates of future taxable income, we established a full valuation allowance against net deferred tax assets at March 31, 2024 and 2023. Under the Tax Cuts and Jobs Act (“TCJA”), federal NOLs generated after 2017 will be carried forward indefinitely but are limited to an 80% deduction of taxable income. NOLs generated prior to 2018 have a 20-year carryforward period and can be used to offset 100% of taxable income. An exception to the TCJA federal NOL rule applies to certain of our subsidiaries and requires all NOLs generated from those entities to have a 20-year carryforward period and offset 100% of taxable income. For the year ended December 31, 2023 federal and state NOL carryforwards were $504,097 and $498,933, respectively. $312,446 of the total federal net operating loss carryforwards have an indefinite life while the remaining federal and state net operating loss carryforwards begin to expire in 2033 if not utilized. An “ownership change” as defined under Section 382 of the Internal Revenue Code ("IRC"), could potentially limit the ability to utilize certain tax attributes including the Company’s substantial NOLs. Ownership change is generally defined as any significant change in ownership of more than 50% of its stock over a three-year testing period. If, as a result of current or future transactions involving our common stock, we undergo cumulative ownership changes which exceed 50% over a testing period, our ability to utilize our NOL carryforwards would be subject to additional limitations under IRC Section 382. We continue to monitor changes in ownership with respect to these income tax provisions.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//740/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-14

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-21

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 270
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482526/740-270-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
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-Paragraph 17
-Subparagraph (b)
-Publisher FASB
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
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-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-Publisher FASB
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-Publisher FASB
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

+ Details

Accounts Receivable - Schedule of Accounts Receivable (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Government receivables	$ 70,106	$ 35,529
Pharmacy rebate receivables	84,422	75,894
Other receivables	10,543	8,326
Total accounts receivable	165,071	119,749
Allowance for credit losses	0	0
Accounts receivable, net	$ 165,071	$ 119,749

Organization	3 Months Ended
Organization	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization	Organization Alignment Healthcare, Inc. (collectively, “we” or “us” or “our” or the “Company”), is a next generation, consumer-centric health care platform that is purpose-built to provide seniors with high quality, affordable care with a vastly improved consumer experience. Enabled by our innovative technology and care delivery model, the Company focuses on improving outcomes in the Medicare Advantage sector. The Company’s operations primarily consist of Medicare Advantage Plans in the states of California, North Carolina, Nevada, Arizona, Florida and Texas.

Long-Term Debt - Schedule of Long-Term Debt Outstanding, Net of Unamortized Debt Issuance Costs (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Debt Disclosure [Abstract]
Long-term debt	$ 165,000	$ 165,000
Less unamortized debt issuance costs	(2,970)	(3,187)
Long-term debt-net of amortization	162,030	161,813
Less current portion of long-term debt	0	0
Long-term debt - net of current portion	$ 162,030	$ 161,813

- Definition

Amount, after deduction of unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

Summary of Significant Accounting Policies (Tables)

3 Months Ended

Mar. 31, 2024

Accounting Policies [Abstract]

Schedule of Earned Revenue

Earned premium revenue consisted of premium revenue and capitation revenue for the three months ended March 31, 2024 and 2023 were as follows:


	Three Months Ended March 31,
	2024		2023
Premium	$	619,722	$	399,740
Capitation	1,834		35,072
Total	$	621,556	$	434,812

Schedule of Property and Equipment

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description			Estimated Service Lives (years)
Computer and equipment			5
Office equipment and furniture			5-7
Software			3-5
Leasehold improvements			15 (or lease term, if shorter)

Property and equipment consisted of the following as of March 31, 2024 and December 31, 2023:


	March 31, 2024		December 31, 2023
Computers and equipment	$	11,830	$	11,447
Office equipment and furniture	4,397		4,396
Software	157,305		148,864
Leasehold improvements	6,347		6,347
Construction in progress	6,984		4,532
Subtotal	186,863		175,586
Less accumulated depreciation	(129,652)		(123,685)
Property and equipment-net	$	57,211	$	51,901

Schedule of Computation of Basic and Diluted Net Loss Per Share

The following table sets forth the computation of basic and diluted net loss per share for the three months ended March 31, 2024 and 2023:


	Three Months Ended March 31,
	2024		2023
Numerator:
Net loss	$	(46,575)	$	(37,371)
Less: Net loss attributable to noncontrolling interests	54		87
Net loss attributable to Alignment Healthcare, Inc.	$	(46,521)	$	(37,284)
Denominator:
Total weighted-average common shares outstanding - basic and diluted	189,597,668		187,557,349
Less: Restricted shares of common stock	(592,274)		(4,443,404)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted	189,005,394		183,113,945
Net loss per share:
Net loss per share - basic and diluted	$	(0.25)	$	(0.20)

Schedule of Computation of Diluted Net Loss Per Share

In addition to the restricted shares of common stock, we also excluded the following potential common shares, presented based on amounts outstanding at each period end, from the computation of diluted net loss per share as of March 31, 2024 and 2023:


	March 31,
	2024	2023
Stock options	9,023,343	10,584,124
Restricted stock units	22,767,035	10,004,845
Total	31,790,378	20,588,969

Summary of Significant Accounting Policies - Additional Information (Details)	3 Months Ended		12 Months Ended
	Mar. 31, 2024 USD ($) Entity segment	Mar. 31, 2023 USD ($)	Dec. 31, 2023 USD ($)
Accounting Policies [Line Items]
Number of consolidated variable interest entities \| Entity	3
Number of reporting segments \| segment	1
Number of operating segments \| segment	1
Assets, fair value disclosure	$ 84,809,000		$ 119,092,000
Revenues	7,045,000	$ 4,343,000
Interest income earned	$ 5,443,000	3,717,000
Percentage of consumer discounts on brand name	75.00%
Federal deposit insurance corporation premium expense	$ 300,243,000		316,977,000
Award requisite service period	4 years
Net loss attributable to noncontrolling interest	$ 54,000	87,000
Realizing Equity, Access, and Community Health (REACH) Model
Accounting Policies [Line Items]
Revenues	985,000	$ 32,114,000
Level 3
Accounting Policies [Line Items]
Assets, fair value disclosure	0		0
Liabilities, fair value disclosure	$ 0		$ 0
Minimum
Accounting Policies [Line Items]
Loss ratio	85.00%

Insider Trading Arrangements

3 Months Ended

Mar. 31, 2024

Trading Arrangements, by Individual

Material Terms of Trading Arrangement

Rule 10b5-1 Plans

During the fiscal quarter ended March 31, 2024, our executive officers and directors adopted the following trading arrangements that are intended to satisfy the affirmative defense of Rule 10b5–1(c).


Name & Title	Date of Adoption	Duration of Trading Arrangement	Maximum Number of Securities to be Sold(1)
John Kao(2) Chief Executive Officer	3/14/2024	9/16/24 – 6/13/25	900,000
Thomas Freeman(3) Chief Financial Officer	3/15/2024	6/14/24 – 6/13/25	518,000
Dawn Maroney President, Markets	3/13/2024	6/12/24 – 3/21/25	400,000
Hakan Kardes Chief Experience Officer	3/14/2024	6/13/24 – 4/25/25	125,000
Christopher Joyce Chief Legal & Administrative Officer	3/15/2024	9/16/24 – 3/14/25	50,000
Jeffrey Margolis(4) Director	3/15/2024	6/14/24 – 3/14/25	13,500

(1)Securities reported in this column include securities subject to limit orders and such orders may not fill if limit order conditions are not met.

(2)Plan modification by JEK Trust dated February 8, 2021, of which Mr. Kao is the trustee.

(3)Plan adopted by FCO Holdings LLC, a limited liability company owned by FCO Holdings Trust One, an irrevocable trust.

(4)Plan adopted by the Margolis Family Trust 12/23/98, of which Mr. Margolis is the trustee.

Non-Rule 10b5-1 Arrangement Adopted

false

Rule 10b5-1 Arrangement Terminated

false

Non-Rule 10b5-1 Arrangement Terminated

false

John Kao [Member]

Trading Arrangements, by Individual

Name

John Kao

Title

Chief Executive Officer

Rule 10b5-1 Arrangement Adopted

true

Adoption Date

3/14/2024

Arrangement Duration

270 days

Aggregate Available

900,000

Thomas Freeman [Member]

Trading Arrangements, by Individual

Name

Thomas Freeman

Title

Chief Financial Officer

Rule 10b5-1 Arrangement Adopted

true

Adoption Date

3/15/2024

Arrangement Duration

364 days

Aggregate Available

518,000

Dawn Maroney [Member]

Trading Arrangements, by Individual

Name

Dawn Maroney

Title

President, Markets

Rule 10b5-1 Arrangement Adopted

true

Adoption Date

3/13/2024

Arrangement Duration

282 days

Aggregate Available

400,000

Hakan Kardes [Member]

Trading Arrangements, by Individual

Name

Hakan Kardes

Title

Chief Experience Officer

Rule 10b5-1 Arrangement Adopted

true

Adoption Date

3/14/2024

Arrangement Duration

316 days

Aggregate Available

125,000

Christopher Joyce [Member]

Trading Arrangements, by Individual

Name

Christopher Joyce

Title

Chief Legal & Administrative Officer

Rule 10b5-1 Arrangement Adopted

true

Adoption Date

3/15/2024

Arrangement Duration

179 days

Aggregate Available

50,000

Jeffrey Margolis [Member]

Trading Arrangements, by Individual

Name

Jeffrey Margolis

Title

Director

Rule 10b5-1 Arrangement Adopted

true

Adoption Date

3/15/2024

Arrangement Duration

273 days

Aggregate Available

13,500

Fair Value

3 Months Ended

Mar. 31, 2024

Fair Value Disclosures [Abstract]

Fair Value

The following tables present the carrying value and fair value of these financial instruments as of March 31, 2024 and December 31, 2023:


	March 31, 2024
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	82,489	$	82,414	$	—	$	—
Certificate of deposits	2,320		—		2,320		—
Total	$	84,809	$	82,414	$	2,320	$	—


	December 31, 2023
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	117,337	$	117,310	$	—	$	—
Certificate of deposits	1,755		—		1,755		—
Total	$	119,092	$	117,310	$	1,755	$	—

The carrying value of long-term debt represents the outstanding balance, net of unamortized debt issuance costs. As of March 31, 2024 and December 31, 2023, the fair value of our long-term debt approximates the carrying value.

Our nonfinancial assets and liabilities, which include goodwill, intangible assets, property, and equipment, are not required to be measured at fair value on a recurring basis. However, on a periodic basis, or whenever events or changes in circumstances indicate that their carrying value may not be recoverable, we assess these assets for impairment. There was no such impairment as of March 31, 2024 and December 31, 2023.

U.S. Treasury Securities Investments

As of March 31, 2024 and December 31, 2023, the Company had $62,759 and $115,914, respectively, of investments in U.S. Treasury bills which were classified as held to maturity and carried at amortized cost. These investments are included in short-term investments in the condensed consolidated balance sheets as the original maturities are greater than three months and less than twelve months. The Company has the intent and ability to hold these securities to maturity and gross unrecognized losses were $9.

As of March 31, 2024 and December 31, 2023, the Company had $18,281 and $22,232, respectively, of investments in U.S. Treasury bill money market funds with an original maturity of less than three months. These investments are considered cash equivalents and are included in cash and cash equivalents in the condensed consolidated balances sheets.

Restricted Investments

Restricted investments are composed of investments in U.S. Treasury bills and certificates of deposits and are included within other assets in the condensed consolidated balance sheets. As of March 31, 2024 and December 31, 2023, the Company had $1,449 and $1,423 of restricted investments in U.S. Treasury bills and $2,320 and $1,755 of restricted investments in certificates of deposits, respectively. The Company has the intent and ability to hold these investments until maturity; therefore, these investments are stated at amortized cost. Restricted investments are required to be maintained at a financial institution within certain states. As of March 31, 2024 and December 31, 2023, these investments had maturities with less than 12 months. Due to the nature of the state's requirements, these assets are classified as noncurrent assets regardless of the contractual maturity date.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Equity-Based Compensation

3 Months Ended

Mar. 31, 2024

Share-Based Payment Arrangement [Abstract]

Equity-Based Compensation

Equity Awards

Stock Options

Our outstanding stock options generally vest 25% annually over four years and generally expire 10 years from the date of the grant. The 2021 Equity Incentive Plan provides that stock option grants will be made with an exercise price at no less than the estimated fair value of common stock at the date of the grant.

The following is a summary of the stock option transactions as of and for the three months ended March 31, 2024:


	Stock Options Outstanding
(amounts in thousands, except shares and per share amount)	Shares Subject to Options Outstanding	Weighted- Average Exercise Price per Option		Weighted- Average Remaining Contractual Terms (in years)	Aggregate Intrinsic Value
Balances as of December 31, 2023	9,135,879	$	16.95	7.29	$	79
Options granted	—	—
Options exercised	—	—
Options forfeited / expired	(112,536)	15.41
Balances as of March 31, 2024	9,023,343	$	16.97	7.04	—








Vested and Exercisable as of March 31, 2024	6,336,964	$	17.28	7.00	—

Aggregate intrinsic value represents the difference between the exercise price of the option and the closing price of our common stock. For the three months ended March 31, 2024 and 2023, no options were exercised. No options were granted during the three months ended March 31, 2024.

Restricted Stock Awards

Our outstanding Restricted Stock Awards ("RSA") generally vest 25% annually over four years. RSAs converted from pre-IPO awards generally vest on the later of the fourth anniversary of the original vesting commencement date or 50% annually on the first and second anniversary of the IPO.

The following is a summary of RSA transactions for the three months ended March 31, 2024:


	Restricted Shares	Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2023	683,953	$	5.86
Vested	(140,856)	13.22
Forfeited	(2,799)	5.05
Unvested and outstanding as of March 31, 2024	540,298	$	3.94

Restricted Stock Units

Our outstanding Restricted Stock Units ("RSU") generally vest 25% annually over four years.

The following is a summary of RSU transactions as of and for the three months ended March 31, 2024:


	Restricted Stock Units	Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2023	10,541,625	$	11.25
Granted	6,517,337	5.05
Vested(1)	(2,385,493)	8.25
Cancelled/forfeited	(282,972)	9.36
Unvested and outstanding as of March 31, 2024	14,390,497	$	8.97

(1) Includes 107,948 shares that vested, but the issuance and delivery of the shares was deferred.

Performance-based Restricted Stock Units ("PSUs")

On September 14, 2023, the Board of Directors of the Company approved the grant of performance-based restricted stock units under the Company's 2021 Equity Incentive Plan to its executive management team and other key employees. Each grantee is eligible to vest in a number of PSUs ranging from 0% to 150% of the target number of PSUs granted, based on the aggregated achievement by the Company of certain performance metrics during the performance period beginning on January 1, 2024 and ending on December 31, 2024. The achievement of PSUs relative to the approved target is based on the following performance metrics and relative weighting: Health Plan Revenue Growth Percentage 60%, At-Risk Returning Member Medical Benefit Ratio 20% and Adjusted EBITDA, less Capital Expenditures 20%.

50% of the total number of earned PSUs will become vested upon certification of achievement of the performance metrics by the Compensation Committee on or about March 1, 2025 and the remaining 50% of earned PSUs will be become vested as of December 31, 2025, subject to continued service to the Company through such dates.

On March 13, 2024, the Board of Directors of the Company approved additional grants of PSUs under the Company's 2021 Equity Incentive Plan. Each grantee is eligible to vest in a number of PSUs ranging from 0% to 200% of the target number of PSUs granted, based on the aggregated achievement by the Company of certain performance metrics during the performance period beginning on January 1, 2024 and ending on December 31, 2026. The achievement of PSUs relative to the approved target is based on the following performance metrics and relative weighting: Revenue Growth 50% and Adjusted EBITDA 50%. 100% of the total number of earned PSUs will become vested upon certification of achievement of the performance metrics by the Compensation Committee on or about March 1, 2027.

The following is a summary of PSU transactions for the three months ended March 31, 2024:


	Performance-based restricted stock units	Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2023	7,233,205	$	5.74
Granted	1,160,000	5.00
Vested	—	—
Cancelled/forfeited	(16,667)	5.74
Unvested and outstanding as of March 31, 2024	8,376,538	$	5.64

Equity-Based Compensation Expense

Total equity-based compensation expense was presented on the statement of operations as follows:


	Three Months Ended March 31,
(amounts in thousands)	2024		2023
Selling, general and administrative expenses	$	19,721	$	19,454
Medical expenses	1,133		2,524
Total equity-based compensation expense	$	20,854	$	21,978

As of March 31, 2024, there was $114,406 in unrecognized compensation expense related to all non-vested awards (RSAs, options, RSUs and PSUs) that will be recognized over the weighted-average period of 1.88 years.

Fair Value (Tables)

3 Months Ended

Mar. 31, 2024

Fair Value Disclosures [Abstract]

Schedule of Carrying Value and Fair Value of Financial Instruments

The following tables present the carrying value and fair value of these financial instruments as of March 31, 2024 and December 31, 2023:


	March 31, 2024
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	82,489	$	82,414	$	—	$	—
Certificate of deposits	2,320		—		2,320		—
Total	$	84,809	$	82,414	$	2,320	$	—


	December 31, 2023
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	117,337	$	117,310	$	—	$	—
Certificate of deposits	1,755		—		1,755		—
Total	$	119,092	$	117,310	$	1,755	$	—

Equity-Based Compensation - Schedule of PSUs Transactions (Details)	3 Months Ended
	Mar. 31, 2024 $ / shares shares
RSUs
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested and outstanding, beginning balance (in shares) \| shares	10,541,625
Granted (in shares) \| shares	6,517,337
Vested (in shares) \| shares	(2,385,493)
Cancelled/forfeited (in shares) \| shares	(282,972)
Unvested and outstanding, ending balance (in shares) \| shares	14,390,497
Weighted-Average Grant Date Fair Value
Unvested and outstanding, beginning balance (in dollars per share) \| $ / shares	$ 11.25
Granted (in dollars per share) \| $ / shares	5.05
Vested (in dollars per share) \| $ / shares	8.25
Cancelled/forfeited (in dollars per share) \| $ / shares	9.36
Unvested and outstanding, ending balance (in dollars per share) \| $ / shares	$ 8.97
Performance-based Restricted Stock Units
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested and outstanding, beginning balance (in shares) \| shares	7,233,205
Granted (in shares) \| shares	1,160,000
Vested (in shares) \| shares	0
Cancelled/forfeited (in shares) \| shares	(16,667)
Unvested and outstanding, ending balance (in shares) \| shares	8,376,538
Weighted-Average Grant Date Fair Value
Unvested and outstanding, beginning balance (in dollars per share) \| $ / shares	$ 5.74
Granted (in dollars per share) \| $ / shares	5.00
Vested (in dollars per share) \| $ / shares	0
Cancelled/forfeited (in dollars per share) \| $ / shares	5.74
Unvested and outstanding, ending balance (in dollars per share) \| $ / shares	$ 5.64

Goodwill and Intangible Assets

3 Months Ended

Mar. 31, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

Intangible assets consisted of the following as of March 31, 2024 and December 31, 2023:


	March 31, 2024
	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Life
Goodwill	$	34,826	$	—	$	34,826	—
License (indefinite lived)	4,967		—		4,967		—
Plan member relationships	2,700		(2,700)		—		9 years
Other	1,050		(793)		257		2 - 10 years
Total	$	43,543	$	(3,493)	$	40,050


	December 31, 2023
	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Life
Goodwill	$	34,826	$	—	$	34,826	—
License (indefinite lived)	4,967		—		4,967		—
Plan member relationships	2,700		(2,700)		—		9 years
Other	1,050		(765)		285		2 - 10 years
Total	$	43,543	$	(3,465)	$	40,078

Amortization expense relating to intangible assets for the three months ended March 31, 2024 and 2023, was $28 and $97, respectively. Estimated amortization expense relating to intangible assets for each of the next five years ending December 31, is as follows:


Remainder of 2024	$	54
2025	60
2026	60
2027	60
2028	23

	$	257

There were no impairment charges related to goodwill and intangible assets for the three months ended March 31, 2024 and 2023.

Medical Expenses Payable - Schedule of Medical Expenses Payable (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023	Mar. 31, 2023	Dec. 31, 2022
Insurance [Abstract]
Claims incurred but not paid	$ 129,245	$ 95,664	$ 83,113	$ 88,813
Capitation and risk-sharing payable	71,946	50,894
Other	75,273	58,841
Medical expenses payable	$ 276,464	$ 205,399	$ 185,670

Equity-Based Compensation - Schedule of Equity-based Compensation Expense on Statement of Operations (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 20,854	$ 21,978
Selling, general and administrative expenses
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	19,721	19,454
Medical expenses
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 1,133	$ 2,524

Accounts Receivable - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Credit loss related to accounts receivable	$ 0	$ 1

Medical Expenses Payable - Schedule of Components of Change in Medical Expenses Payable (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Claims incurred but not paid - beginning balance	$ 95,664	$ 88,813
Incurred related to:
Current year	198,675	116,992
Prior years	(4,969)	(5,809)
Total incurred, net of reinsurance	193,706	111,183
Payments related to:
Current year	91,486	57,500
Prior years	68,639	59,383
Total payments, net of reinsurance	160,125	116,883
Claims incurred but not paid - ending balance	129,245	83,113
Capitation payable, risk-sharing payable, and other	147,219	102,557
Medical expenses payable	$ 276,464	$ 185,670	$ 205,399

Equity-Based Compensation (Tables)

3 Months Ended

Mar. 31, 2024

Share-Based Payment Arrangement [Abstract]

Schedule of Stock Option Activity Transactions

The following is a summary of the stock option transactions as of and for the three months ended March 31, 2024:


	Stock Options Outstanding
(amounts in thousands, except shares and per share amount)	Shares Subject to Options Outstanding	Weighted- Average Exercise Price per Option		Weighted- Average Remaining Contractual Terms (in years)	Aggregate Intrinsic Value
Balances as of December 31, 2023	9,135,879	$	16.95	7.29	$	79
Options granted	—	—
Options exercised	—	—
Options forfeited / expired	(112,536)	15.41
Balances as of March 31, 2024	9,023,343	$	16.97	7.04	—








Vested and Exercisable as of March 31, 2024	6,336,964	$	17.28	7.00	—

Schedule of Restricted Stock Transactions

The following is a summary of RSA transactions for the three months ended March 31, 2024:


	Restricted Shares	Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2023	683,953	$	5.86
Vested	(140,856)	13.22
Forfeited	(2,799)	5.05
Unvested and outstanding as of March 31, 2024	540,298	$	3.94

The following is a summary of RSU transactions as of and for the three months ended March 31, 2024:


	Restricted Stock Units	Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2023	10,541,625	$	11.25
Granted	6,517,337	5.05
Vested(1)	(2,385,493)	8.25
Cancelled/forfeited	(282,972)	9.36
Unvested and outstanding as of March 31, 2024	14,390,497	$	8.97

(1) Includes 107,948 shares that vested, but the issuance and delivery of the shares was deferred.

Schedule of PSUs Transactions

The following is a summary of PSU transactions for the three months ended March 31, 2024:


	Performance-based restricted stock units	Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2023	7,233,205	$	5.74
Granted	1,160,000	5.00
Vested	—	—
Cancelled/forfeited	(16,667)	5.74
Unvested and outstanding as of March 31, 2024	8,376,538	$	5.64

Schedule of Equity-Based Compensation Expense of Operation

Total equity-based compensation expense was presented on the statement of operations as follows:


	Three Months Ended March 31,
(amounts in thousands)	2024		2023
Selling, general and administrative expenses	$	19,721	$	19,454
Medical expenses	1,133		2,524
Total equity-based compensation expense	$	20,854	$	21,978

Accounts Receivable (Tables)

3 Months Ended

Mar. 31, 2024

Accounts Receivable, after Allowance for Credit Loss [Abstract]

Schedule of Accounts Receivable

Accounts receivable consisted of the following as of March 31, 2024 and December 31, 2023:


	March 31, 2024		December 31, 2023
Government receivables	$	70,106	$	35,529
Pharmacy rebate receivables	84,422		75,894
Other receivables	10,543		8,326
Total accounts receivable	165,071		119,749
Allowance for credit losses	—		—
Accounts receivable, net	$	165,071	$	119,749

Summary of Significant Accounting Policies (Policies)

3 Months Ended

Mar. 31, 2024

Accounting Policies [Abstract]

Basis of Presentation

The accompanying condensed consolidated financial statements and accompanying notes have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). The balance sheet as of December 31, 2023, included herein, was derived from audited financial statements, but does not include all disclosures required by GAAP. In accordance with the rules and regulations of the U.S. Securities and Exchange Commission ("SEC"), the Company has omitted certain footnote disclosures that would substantially duplicate the disclosures contained in its annual audited consolidated financial statements. Therefore, these condensed consolidated financial statements should be read in conjunction with the Company's Annual Report on Form 10-K for the year-ended December 31, 2023 as filed with the SEC. Furthermore, the condensed consolidated financial statements include the accounts of the Company, our subsidiaries, and three immaterial variable interest entities in which we are the primary beneficiary. All intercompany transactions have been eliminated in consolidation. Noncontrolling interest is presented within the equity section of the condensed consolidated balance sheets.

We have no components of other comprehensive income (loss), and accordingly, comprehensive income (loss) is the same as the net income (loss) for all periods presented.

Use of Estimates

The preparation of the condensed consolidated financial statements requires management to make estimates and judgments that affect the amounts reported in the condensed consolidated financial statements. Our significant estimates include, but are not limited to, the determination of medical expenses payable; the impact of risk adjustment provisions related to our Medicare contracts; collectability of receivables; valuation of related impairment recognition of long-lived assets, including goodwill and intangible assets; equity-based compensation expense; and contingent liabilities. Estimates and judgments are based upon historical information and on various other assumptions that are believed to be reasonable under the circumstances. Actual results could differ materially from those estimates and the impact of any change in estimates is included in earnings in the period in which the estimate is adjusted.

Segments

We have determined that our chief executive officer is the chief operating decision maker (“CODM”) who regularly reviews financial operating results on a consolidated basis for purposes of allocating resources and evaluating financial performance. We operate and manage the business as one reportable segment and one operating segment, which is to provide healthcare services to our seniors. Factors used in determining the reportable segment include the nature of operating activities, our organizational and reporting structure, and the type of information reviewed by the CODM to allocate resources and evaluate financial performance. All of our assets are located in the United States.

Fair Value Measurements

Fair value is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Our current assets and current liabilities approximate fair value because of the

short-term nature of these financial instruments. Financial instruments measured at fair value on a recurring basis were based upon a three-tier hierarchy as follows:

Level 1 - Quoted prices in active markets for identical assets or liabilities

Level 2 - Other inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the asset or liability

Level 3 - Unobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date

The fair value of cash, cash equivalents, restricted cash and U.S. Treasury bills was determined based on Level 1 inputs. The fair value of certificate of deposits, which are recorded in other assets in the condensed consolidated balance sheets, was determined based on Level 2 inputs. There were no assets or liabilities measured at fair value using Level 3 inputs as of March 31, 2024 and December 31, 2023. Our long-term debt was reported at carrying value.

Revenue and Accounts Receivable

Premium revenue is derived monthly from the federal government based on our contracts with the Centers for Medicare and Medicaid Services (“CMS”). In accordance with these arrangements, we assume the responsibility for the outcomes and the economic risk of funding our members’ health care, supplemental benefits and related administration costs. We recognize premium revenue in the month that members are entitled to receive health care services, and premiums collected in advance are deferred. The monthly reimbursement includes a fixed payment per member per month (“PMPM”), which is adjusted based on certain risk factors derived from medical diagnoses and conditions of our members. The adjustments are estimated by projecting the ultimate annual premium and are recognized ratably during the year, with adjustments each period to reflect changes in the estimated ultimate premium. Premiums are also recorded net of estimated uncollectible amounts and retroactive membership adjustments.

Capitation revenue consists primarily of capitated fees for medical care services provided by us under arrangements with third-party payors. In 2023, capitation revenue consisted primarily of revenue from CMS related to our participation in the CMS "ACO Realizing Equity, Access, and Community Health Model” or “ACO REACH” model, as discussed below.

Under those arrangements with third-party payors, we receive a PMPM payment for a defined member population, and we are responsible for providing health care services to the member population over the contract period. We are solely responsible for the cost of health care services related to the member population and in some cases, we are financially responsible for the supplemental benefits provided by us to the members. We act as a principal in arranging for and controlling the services provided by our provider network and we are at risk for arranging and providing health care services.

The premium and capitation payments we receive monthly from CMS for our members are determined from our annual bid or similarly from third-party payors under our capitation arrangement. These payments represent revenues for providing health care coverage, including Medicare Part D benefits. Under the Medicare Part D program, our members and the members of the third-party payors receive standard drug benefits. We may also provide enhanced benefits at our own expense. We recognize premium or capitation revenue for providing this insurance coverage in the month that members are entitled to receive health care services and any premium or capitation collected in advance is deferred. Our CMS payment related to Medicare Part D is subject to risk sharing through the Medicare Part D risk corridor provisions.

We also participate in the CMS ACO REACH program, formerly the Direct Contracting Model ("DCE"). CMS serves as the claim adjudicator for institutional and specialists care, and directly pays for such fee for service claims. The ACO REACH entity ("ACO") is responsible for the cost of health care services related to the patient population attributed to the ACO by participating in 100% savings/losses via the risk share model and in some cases, are financially responsible for the supplemental benefits provided to the patients. In 2024, we entered into a management services and risk management agreement with a third-party healthcare company. The third party will be responsible for arranging and controlling the health care services provided to the ACO members, and for providing certain management and support services with respect to ACO operations. The third party will also assume specified upside and downside financial risk relative to the ACO’s performance. As a result of this arrangement, revenue is recorded on a net basis within other revenue on the condensed consolidated statement of operations for the three months ended March 31, 2024. Revenue recognized by the ACO for the three months ended March 31, 2024 was $985.

Prior to 2024, the ACO acted as a principal in arranging for and controlling services provided directly by their contracts with primary care physicians, as well as services provided by preferred institutional care providers and specialists. Capitation payments for the ACO program were determined from an annual benchmark established by CMS. These payments, which were adjusted for variable considerations, represented revenue for providing health care services, including primary care as well as institutional and specialist care. The ACO recognized capitation revenue for providing these services in the period in which the performance obligations were satisfied by transferring services to the members. Revenue recognized by the ACO for the three months ended March 31, 2023 was $32,114.

Interest income earned on our cash deposits and short-term investments is included within other revenue on the condensed consolidated statements of operations.

Part D Subsidies

We also receive advance payments each month from CMS related to Catastrophic Reinsurance, Coverage Gap Discount, and the Low-Income Member Cost Sharing Subsidy (“Subsidies”). Reinsurance subsidies represent funding from CMS for our portion of prescription drug costs, which exceed the member’s out-of-pocket threshold or the catastrophic coverage level. Low-income cost subsidies represent funding 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. Additionally, the Health Care Reform Law mandates consumer discounts of 75% on brand-name prescription drugs for Part D plan participants in the coverage gap. The majority of the discounts are funded by the pharmaceutical manufacturers, while we fund a smaller portion and administer the application of the total discount.

These Subsidies represent cost reimbursements under the Medicare Part D program and are recorded as deposits or payables. These Subsidies received in excess of, or less than, actual subsidized benefits paid are refundable to or recoverable from CMS through an annual reconciliation process following the end of the contract year.

Revenue Adjustments

Payments by CMS to health plans are determined via a competitive bidding process with CMS and are based upon the cost of care in a local market and the average utilization of services by the member enrolled. These payments are subject to periodic adjustments under CMS’ “risk adjustment model,” which compensates health plans based on the health severity and certain demographic factors of each individual member. Members diagnosed with certain conditions are paid at a higher monthly payment than members who are healthier. Under this risk adjustment model, CMS calculates the risk adjustment payment using diagnosis data from hospital inpatient, hospital outpatient, and physician treatment settings. The Company and health care providers collect, capture, and submit the necessary and available diagnosis data to CMS within prescribed deadlines. Both premium and capitation revenues (including Medicare Part D) are subject to adjustments under the risk adjustment model.

Throughout the year, we estimate risk adjustment payments based upon the diagnosis data submitted and expected to be submitted to CMS. Those estimated risk adjustment payments are recorded as an adjustment to premium and capitation revenue. Our risk adjustment data is also subject to review by the government, including audit by regulators.

Our recognized premium revenue for our Medicare Advantage Plans in California, North Carolina, Nevada, Arizona, Texas and Florida are each subject to a minimum annual medical loss ratio (“MLR”) of 85%. The MLR represents medical costs as a percentage of premium revenue. The Code of Federal Regulations defines what constitutes medical costs and premium revenue, including certain additional expenses related to improving the quality of care provided, and the exclusion of certain taxes and fees, in each case as permitted or required by CMS and applicable regulatory requirements. If the minimum MLR is not met, we are required to remit a portion of the premiums back to the federal government. The amount remitted, if any, is recognized as an adjustment to premium revenues in the condensed consolidated statements of operations. The amounts payable under this provision were immaterial at March 31, 2024 and December 31, 2023.

Medicare Part D payments are also subject to a federal risk corridor program, which limits a health plan’s overall losses or profit if actual spending for basic Medicare Part D benefits is much higher or lower than what was anticipated. Risk corridor is recorded within premium revenue. The risk corridor provisions compare costs targeted in our bids or third-party payors’ bids to actual prescription drug costs, limited to actual costs that would have been incurred under the standard coverage as defined by CMS. Variances exceeding certain thresholds may result in CMS or third-party payors making additional payments to us or require us to refund a portion of the premiums we received. We estimate and recognize an adjustment to premium revenue related to these provisions based upon pharmacy claims experience. We record a receivable or payable at the contract level and classify the amount as current or long-term in our condensed consolidated balance sheet based on the timing of expected settlement.

Variable consideration estimates related to ACO contract revenue are based on the most likely outcome method and that a significant reversal in the amount of cumulative revenue recognized would not occur.

Receivables, including risk adjusted premium due from the government or through third-party payors, pharmacy rebates, and other receivables, are shown net of allowances for credit losses and retroactive membership adjustments.

Property and Equipment—Net

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description			Estimated Service Lives (years)
Computer and equipment			5
Office equipment and furniture			5-7
Software			3-5
Leasehold improvements			15 (or lease term, if shorter)

Depreciation expense related to property and equipment used to service our members or at our clinics are included within medical expenses in the condensed consolidated statements of operations

Medical Expenses and Medical Expenses Payable

Medical Expenses

Medical expenses include claim payments, capitation payments, pharmacy costs net of rebates, allocations of certain centralized expenses, internal care delivery expenses and various other costs incurred to provide health insurance coverage and care to members, as well as estimates of future payments to hospitals and others for medical care and other supplemental benefits provided.

We have contracts with a network of hospitals, physicians, and other providers and compensate those providers and ancillary organizations based on contractual arrangements or CMS Medicare compensation guidelines. We pay these contracting providers either through fee-for-service arrangement in which the provider is paid negotiated rates for specific services provided or a capitation payment, which represent monthly contractual fees disbursed for each member regardless of medical services provided to the member. We are responsible for the entirety of the cost of health care services related to the member population, in addition to supplemental benefits provided by us to our seniors. In 2023, we also recorded claims expenses related to our institutional and specialist care related to our ACO program with CMS as we acted as the principal in the transaction. As discussed above, beginning in 2024, claims expense related to the ACO program is netted against ACO revenue as we act as the agent in these transactions.

Capitation-related expenses are recorded on an accrual basis during the coverage period. Expenses related to fee-for-service contracts are recorded in the period in which the related services are dispensed.

Pharmacy costs represent payments for members’ prescription drug benefits, net of rebates from drug manufacturers. Receivables for such pharmacy rebates are included in accounts receivable in the condensed consolidated balance sheet.

In August 2022, the Inflation Reduction Act ("IRA") was signed into law. The law intends to increase tax revenue and reduce Medicare costs through lower prescription drug prices, inflation rebates, and capping annual Medicare Part D out of pocket expenses. The provisions of the law are set to take effect over the next seven years. There was no material impact on our consolidated financial statements at March 31, 2024, and we do not anticipate a material impact to operations for the remainder of fiscal year 2024. We are in the process of evaluating the impact the IRA will have on our business for fiscal years beyond 2024.

Medical Expenses Payable

Medical expenses payable includes estimates of our obligations for medical care services that have been rendered on behalf of our members and the members of the third-party payors, but for which claims have either not yet been received or processed, loss adjustment expense reserve for the expected costs of settling these claims, and for liabilities related to physician, hospital, and other medical cost disputes.

We develop estimates for medical expenses incurred but not yet paid (“IBNP”), which includes an estimate for claims incurred but not reported (“IBNR”) and a payable for adjudicated claims. IBNR is estimated using an actuarial process that is consistently applied and centrally controlled. Medical expenses payable also includes an estimate for the costs necessary to process unpaid claims at the end of each period. We estimate the IBNR liability using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors, such as cost trends and completion factors that are assessed based on historical data for payment patterns, product mix, seasonality, utilization of health care services, and other relevant factors. Each period, we re-examine previously established IBNR estimates based on actual claim submissions and other changes in facts and circumstances. As the IBNR estimates recorded in prior periods develop, we adjust the amount of the estimates and include the changes in estimates in medical expenses in the period in which the change is identified.

Actuarial Standards of Practice generally require that the IBNP estimates be adequate to cover obligations under moderately adverse conditions. Moderately adverse conditions are situations in which the actual claims are expected to be higher than the otherwise estimated value of such claims at the time of estimate. In many situations, the claims amount ultimately settled will be different than the estimate that satisfies the Actuarial Standards of Practice. We include in our IBNP an estimate for medical claims liability under moderately adverse conditions, which represents the risk of adverse deviation of the estimates in our actuarial method of reserving. We believe that medical expenses payable is adequate to cover future claims payments required. However, such estimates are based on knowledge of current events and anticipated future events. Therefore, the actual liability could differ materially from the amounts provided.

We reassess the profitability of contracts for providing coverage to members when current operating results or forecasts indicate probable future losses. A premium deficiency reserve is established in current operations to the extent that the sum of expected future costs, claim adjustment expenses, and maintenance costs exceed related future premiums under contracts without consideration of investment income. For purposes of determining premium deficiencies, contracts are grouped in a manner consistent with the method of acquiring, servicing, and measuring the profitability of such contracts. Losses recognized as a premium deficiency result in a beneficial effect in subsequent periods as operating losses under these contracts are charged to the liability previously established.

Part D Subsidies

Interest income earned on our cash deposits and short-term investments is included within other revenue on the condensed consolidated statements of operations.

Part D Subsidies

Shared Risk Reserve Arrangements

We established a fund (also referred to as “a pool”) for risk and profit-sharing with various independent physician associations (“IPAs”). The pool enables us and our IPAs to share in the financial responsibility and/or upside associated with providing covered medical expenses to our members. The risk pool is based on a contractually agreed upon medical budget, typically based upon a percentage of revenue. If actual medical expenses are less than the budgeted amount, this results in a surplus. Conversely, if actual medical expenses are greater than the budgeted amount, this results in a deficit. We will distribute the surplus, or a portion thereof, to each IPA based upon contractual terms. Deficits are charged to shared risk providers’ risk pool as per the contractual term and evaluated for collectability at each reporting period.

We record risk-sharing receivables and payables on a gross basis on the condensed consolidated balance sheet. Throughout the year, we evaluate expected losses on risk-sharing receivables and record the resulting expected losses to the reserve. We systematically build and release reserves based on adequacy and its assessment of expected losses on a monthly basis. Credit loss associated with risk share deficit receivables are recorded within medical expense in the condensed consolidated statements of operations. As of March 31, 2024 and December 31, 2023, we recorded a valuation allowance for

substantially all of the risk-sharing receivable balance due to collection risk related to the balance. The risk-sharing payable is included within medical expenses payable on the condensed consolidated balance sheet.

Concentrations of Credit Risk

Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash deposits and current and restricted investments with financial institutions. Accounts at each financial institution are insured by the Federal Deposit Insurance Corporation (“FDIC”) up to certain limits.

Equity-Based Compensation

Equity-based compensation expense is measured and recognized based on the grant date fair value of the awards. The grant date fair value of stock options is estimated using the Black-Scholes option pricing model. The grant date fair value of restricted stock units (“RSUs”) and restricted stock awards (“RSAs”) is estimated based on the fair value of our underlying common stock.

The Black-Scholes option pricing model requires the use of highly subjective assumptions, including the award’s expected term, the fair value of the underlying common stock, the expected volatility of the price of the common stock, risk-free interest rates, and the expected dividend yield of the common stock. The assumptions used to determine the fair value of the stock-based awards are management’s best estimates and involve inherent uncertainties and the application of judgment. The expected term represents the period the stock-based awards are expected to be outstanding. As we do not have sufficient historical experience for determining the expected term of the stock option awards granted, we utilize the simplified method available under U.S. GAAP. As we do not have a substantial trading history, volatility assumptions were developed using a combination of the Company's historical volatility and the historical volatilities of a set of peer companies, adjusted for debt-equity leverage. Equity-based compensation expense for awards with service-based vesting only is recognized on a graded vesting schedule over the requisite service period of the awards, which is generally four years.

Equity-based compensation expense for RSU awards with performance-based vesting is recognized over the requisite service period on a graded vesting schedule and is only recognized when the Company concludes that it is probable that the performance condition(s) will be achieved. At each reporting period, the Company reassesses the probability of achieving the performance criteria. Determining whether the performance criteria will be achieved involves judgment, and the estimate of share-based compensation expense may be revised periodically based on changes in the probability of achieving the performance criteria. Revisions are reflected in the period in which the estimate is changed. We account for forfeitures as they occur.

Equity-based compensation is recorded within selling, general and administrative expenses, and medical expenses based on the function of the applicable employee and non-employee.

Noncontrolling Interest

Noncontrolling interest

In October 2022, the Company acquired a subsidiary and recorded a noncontrolling interest for the portion of equity ownership not attributable to Alignment Healthcare, Inc. The noncontrolling interest in the subsidiary was initially recognized at estimated fair value on October 1, 2022 and is presented within total equity in the Company's condensed consolidated balance sheet.

Net Loss per Share

Net loss per share is calculated based on net loss attributable to Alignment Healthcare, Inc.'s stockholders. The following table sets forth the computation of basic and diluted net loss per share for the three months ended March 31, 2024 and 2023:


	Three Months Ended March 31,
	2024		2023
Numerator:
Net loss	$	(46,575)	$	(37,371)
Less: Net loss attributable to noncontrolling interests	54		87
Net loss attributable to Alignment Healthcare, Inc.	$	(46,521)	$	(37,284)
Denominator:
Total weighted-average common shares outstanding - basic and diluted	189,597,668		187,557,349
Less: Restricted shares of common stock	(592,274)		(4,443,404)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted	189,005,394		183,113,945
Net loss per share:
Net loss per share - basic and diluted	$	(0.25)	$	(0.20)

Basic net loss per share is the same as diluted net loss per share for periods presented as the inclusion of all potentially dilutive shares would have been anti-dilutive.

Recent Accounting Pronouncements Issued

In November 2023, the FASB issued a new accounting standard around segment disclosures. The new standard requires a public entity to disclose significant segment expenses and other segment items on an annual and interim basis and provide, in interim periods, all disclosures about a reportable segment’s profit or loss and assets that are currently required annually. Additionally, it requires a public entity to disclose the title and position of the Chief Operating Decision Maker. The ASU does not change how a public entity identifies its operating segments, aggregates them, or applies the quantitative thresholds to determine its reportable segments. The new standard is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. A public entity should apply the amendments in this ASU retrospectively to all prior periods presented in the financial statements. We expect this ASU to only impact our disclosures with no impacts to our results of operations, cash flows and financial condition.

Medical Expenses Payable

3 Months Ended

Mar. 31, 2024

Insurance [Abstract]

Medical Expenses Payable

The following table is a detail of medical expenses payable as of March 31, 2024 and December 31, 2023:


	March 31, 2024		December 31, 2023
Claims incurred but not paid	$	129,245	$	95,664
Capitation and risk-sharing payable	71,946		50,894
Other	75,273		58,841
Medical expenses payable	$	276,464	$	205,399

Each period, we re-examine previously established outstanding claims reserve estimates based on actual claims submissions and other changes in facts and circumstances. As more complete claim information becomes available, we adjust the amount of the estimates and include the changes in estimates in claim costs in the period in which the change is identified. Substantially, all of the total claims paid by us are known and settled within the first year from the date of service, and substantially, all remaining claim amounts are paid within a three-year period.

The following table presents components of the change in medical expenses payable as of March 31, 2024 and 2023:


	March 31, 2024		March 31, 2023
Claims incurred but not paid - beginning balance	$	95,664	$	88,813
Incurred related to:
Current year	198,675		116,992
Prior years	(4,969)		(5,809)
Total incurred, net of reinsurance	193,706		111,183
Payments related to:
Current year	91,486		57,500
Prior years	68,639		59,383
Total payments, net of reinsurance	160,125		116,883
Claims incurred but not paid - ending balance	129,245		83,113
Capitation payable, risk-sharing payable, and other	147,219		102,557
Total medical expenses payable	$	276,464	$	185,670

We re-examine previously established outstanding claims reserve estimates based on actual claims submissions and other changes in facts and circumstances. We recognized a favorable prior year development, excluding provision for adverse deviation, of $871 for the three months ended March 31, 2024. The favorable prior year development was primarily due to better-than-expected claims recoveries and actual claims expense being less than expected.

Goodwill and Intangible Assets - Additional Information (Details) - USD ($)	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 28,000	$ 97,000
Impairment charges	$ 0	$ 0

Summary of Significant Accounting Policies - Schedule of Computation of Basic and Diluted Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Numerator:
Net loss	$ (46,575)	$ (37,371)
Less: Net loss attributable to noncontrolling interest	54	87
Net loss attributable to Alignment Healthcare, Inc.	$ (46,521)	$ (37,284)
Denominator:
Total weighted-average common shares outstanding - basic (in shares)	189,597,668	187,557,349
Total weighted-average common shares outstanding - diluted (in shares)	189,597,668	187,557,349
Less: Restricted shares of common stock (in shares)	(592,274)	(4,443,404)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic (in shares)	189,005,394	183,113,945
Total weighted-average common shares outstanding, net of restricted shares of common stock - diluted (in shares)	189,005,394	183,113,945
Net loss per share:
Net loss per share - basic (in dollars per share)	$ (0.25)	$ (0.20)
Net loss per share - diluted (in dollars per share)	$ (0.25)	$ (0.20)

Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2024

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Basis of Presentation

We have no components of other comprehensive income (loss), and accordingly, comprehensive income (loss) is the same as the net income (loss) for all periods presented.

Use of Estimates

Segments

Fair Value Measurements

short-term nature of these financial instruments. Financial instruments measured at fair value on a recurring basis were based upon a three-tier hierarchy as follows:

Level 1 - Quoted prices in active markets for identical assets or liabilities

Level 2 - Other inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the asset or liability

Level 3 - Unobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date

Revenue and Accounts Receivable

Earned premium revenue consisted of premium revenue and capitation revenue for the three months ended March 31, 2024 and 2023 were as follows:


	Three Months Ended March 31,
	2024		2023
Premium	$	619,722	$	399,740
Capitation	1,834		35,072
Total	$	621,556	$	434,812

Interest income earned on our cash deposits and short-term investments is included within other revenue on the condensed consolidated statements of operations. Interest income for the three months ended March 31, 2024 and 2023 was $5,443 and $3,717, respectively.

Revenue Adjustments

Property and Equipment—Net

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description			Estimated Service Lives (years)
Computer and equipment			5
Office equipment and furniture			5-7
Software			3-5
Leasehold improvements			15 (or lease term, if shorter)

Depreciation expense related to property and equipment used to service our members or at our clinics are included within medical expenses in the condensed consolidated statements of operations.

Medical Expenses

Medical Expenses Payable

Part D Subsidies

Shared Risk Reserve Arrangements

Concentrations of Credit Risk

Equity-Based Compensation

Equity-based compensation is recorded within selling, general and administrative expenses, and medical expenses based on the function of the applicable employee and non-employee.

Noncontrolling interest

Net Loss per Share


	Three Months Ended March 31,
	2024		2023
Numerator:
Net loss	$	(46,575)	$	(37,371)
Less: Net loss attributable to noncontrolling interests	54		87
Net loss attributable to Alignment Healthcare, Inc.	$	(46,521)	$	(37,284)
Denominator:
Total weighted-average common shares outstanding - basic and diluted	189,597,668		187,557,349
Less: Restricted shares of common stock	(592,274)		(4,443,404)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted	189,005,394		183,113,945
Net loss per share:
Net loss per share - basic and diluted	$	(0.25)	$	(0.20)

Basic net loss per share is the same as diluted net loss per share for periods presented as the inclusion of all potentially dilutive shares would have been anti-dilutive.


	March 31,
	2024	2023
Stock options	9,023,343	10,584,124
Restricted stock units	22,767,035	10,004,845
Total	31,790,378	20,588,969

Recent Accounting Pronouncements Issued

Property and Equipment

3 Months Ended

Mar. 31, 2024

Property, Plant and Equipment [Abstract]

Property and Equipment

Property and equipment consisted of the following as of March 31, 2024 and December 31, 2023:


	March 31, 2024		December 31, 2023
Computers and equipment	$	11,830	$	11,447
Office equipment and furniture	4,397		4,396
Software	157,305		148,864
Leasehold improvements	6,347		6,347
Construction in progress	6,984		4,532
Subtotal	186,863		175,586
Less accumulated depreciation	(129,652)		(123,685)
Property and equipment-net	$	57,211	$	51,901

Depreciation expense for the three months ended March 31, 2024 and 2023 was $6,001 and $4,885, respectively, of which $52 and $61, respectively, were included in medical expenses.

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Operating Activities:
Net loss	$ (46,575)	$ (37,371)
Adjustments to reconcile net loss to net cash (used in) provided by operating activities:
Provision for credit loss	0	1
Loss on right of use assets	143	0
Depreciation and amortization	6,029	4,982
Amortization-investment discount	(1,153)	(351)
Amortization-debt issuance costs	520	305
Equity-based compensation	20,854	21,978
Non-cash lease expense	472	717
Changes in operating assets and liabilities:
Accounts receivable	(45,322)	(32,387)
Prepaid expenses and other current assets	(8,886)	(15,786)
Other assets	(114)	4
Medical expenses payable	71,065	15,535
Accounts payable and accrued expenses	48	(9,211)
Deferred premium revenue	(59)	140,773
Accrued compensation	(2,505)	(2,966)
Lease liabilities	(755)	(1,113)
Net cash (used in) provided by operating activities	(6,238)	85,110
Investing Activities:
Purchase of investments	(21,564)	(104,243)
Maturities of investments	75,390	1,100
Acquisition of property and equipment	(11,121)	(7,285)
Net cash provided by (used in) investing activities	42,705	(110,428)
Financing Activities:
Payment of employment taxes related to release of restricted stock	(350)	0
Contributions from noncontrolling interest holders	15	30
Net cash (used in) provided by financing activities	(335)	30
Net increase (decrease) in cash	36,132	(25,288)
Cash, cash equivalents and restricted cash at beginning of period	204,954	411,299
Cash, cash equivalents and restricted cash at end of period	241,086	386,011
Supplemental disclosure of cash flow information:
Cash paid for interest	5,175	4,277
Supplemental non-cash investing and financing activities:
Acquisition of property in accounts payable	156	10
Reconciliation of cash, cash equivalents and restricted cash as shown in the statement of cash flows:
Cash and cash equivalents	238,903	384,261
Restricted cash in other assets	2,183	1,750
Total	$ 241,086	$ 386,011

Goodwill and Intangible Assets (Tables)

3 Months Ended

Mar. 31, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Intangible Assets

Intangible assets consisted of the following as of March 31, 2024 and December 31, 2023:


	March 31, 2024
	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Life
Goodwill	$	34,826	$	—	$	34,826	—
License (indefinite lived)	4,967		—		4,967		—
Plan member relationships	2,700		(2,700)		—		9 years
Other	1,050		(793)		257		2 - 10 years
Total	$	43,543	$	(3,493)	$	40,050


	December 31, 2023
	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Life
Goodwill	$	34,826	$	—	$	34,826	—
License (indefinite lived)	4,967		—		4,967		—
Plan member relationships	2,700		(2,700)		—		9 years
Other	1,050		(765)		285		2 - 10 years
Total	$	43,543	$	(3,465)	$	40,078

Schedule of Estimated Amortization Expense Related to Intangible Assets

Estimated amortization expense relating to intangible assets for each of the next five years ending December 31, is as follows:


Remainder of 2024	$	54
2025	60
2026	60
2027	60
2028	23

	$	257

Medical Expenses Payable (Tables)

3 Months Ended

Mar. 31, 2024

Insurance [Abstract]

Schedule of Medical Expenses Payable

The following table is a detail of medical expenses payable as of March 31, 2024 and December 31, 2023:


	March 31, 2024		December 31, 2023
Claims incurred but not paid	$	129,245	$	95,664
Capitation and risk-sharing payable	71,946		50,894
Other	75,273		58,841
Medical expenses payable	$	276,464	$	205,399

Schedule of Components of Change in Medical Expenses Payable

The following table presents components of the change in medical expenses payable as of March 31, 2024 and 2023:


	March 31, 2024		March 31, 2023
Claims incurred but not paid - beginning balance	$	95,664	$	88,813
Incurred related to:
Current year	198,675		116,992
Prior years	(4,969)		(5,809)
Total incurred, net of reinsurance	193,706		111,183
Payments related to:
Current year	91,486		57,500
Prior years	68,639		59,383
Total payments, net of reinsurance	160,125		116,883
Claims incurred but not paid - ending balance	129,245		83,113
Capitation payable, risk-sharing payable, and other	147,219		102,557
Total medical expenses payable	$	276,464	$	185,670

Fair Value - Additional Information (Details) - USD ($)	3 Months Ended	12 Months Ended
Fair Value - Additional Information (Details) - USD ($)	Mar. 31, 2024	Dec. 31, 2023
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Asset impairment charges	$ 0	$ 0
US Treasury Bill Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Gross unrecognized loss	9,000
Restricted investments	1,449,000	1,423,000
US Treasury Bill Securities \| Short-Term Investments
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Treasury securities investments	62,759,000	115,914,000
US Treasury Bill Securities \| Cash and Cash Equivalents
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Treasury securities investments	18,281,000	22,232,000
Certificate of deposits
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Restricted investments	$ 2,320,000	$ 1,755,000

Property and Equipment - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Property Plant and Equipment [Line Items]
Subtotal	$ 186,863	$ 175,586
Less accumulated depreciation	(129,652)	(123,685)
Property and equipment-net	57,211	51,901
Computers and equipment
Property Plant and Equipment [Line Items]
Subtotal	11,830	11,447
Office equipment and furniture
Property Plant and Equipment [Line Items]
Subtotal	4,397	4,396
Software
Property Plant and Equipment [Line Items]
Subtotal	157,305	148,864
Leasehold improvements
Property Plant and Equipment [Line Items]
Subtotal	6,347	6,347
Construction in progress
Property Plant and Equipment [Line Items]
Subtotal	$ 6,984	$ 4,532

Condensed Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Accumulated Deficit	Noncontrolling Interest
Beginning Balance (in shares) at Dec. 31, 2022		187,280,015
Beginning Balance at Dec. 31, 2022	$ 239,302	$ 187	$ 970,180	$ (732,241)	$ 1,176
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(37,371)			(37,284)	(87)
Issuance of common stock upon vesting of restricted stock units (in shares)		1,204,777
Issuance of common stock upon vesting of restricted stock units	1	$ 1
Forfeitures (in shares)		(9,514)
Equity-based compensation	21,978		21,978
Noncontrolling interest attributable to subsidiary	30				30
Ending Balance (in shares) at Mar. 31, 2023		188,475,278
Ending Balance at Mar. 31, 2023	$ 223,940	$ 188	992,158	(769,525)	1,119
Beginning Balance (in shares) at Dec. 31, 2023	188,951,643	188,951,643
Beginning Balance at Dec. 31, 2023	$ 158,071	$ 189	1,037,015	(880,258)	1,125
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(46,575)			(46,521)	(54)
Issuance of common stock upon vesting of restricted stock units (in shares)		2,277,545
Issuance of common stock upon vesting of restricted stock units	2	$ 2
Forfeitures (in shares)		(2,799)
Shares withheld related to net restricted stock settlement (in shares)		(69,820)
Shares withheld related to net restricted stock settlement	(350)		(350)
Equity-based compensation	20,854		20,854
Noncontrolling interest attributable to subsidiary	$ 15				15
Ending Balance (in shares) at Mar. 31, 2024	191,156,569	191,156,569
Ending Balance at Mar. 31, 2024	$ 132,017	$ 191	$ 1,057,519	$ (926,779)	$ 1,086

Summary of Significant Accounting Policies - Schedule of Earned Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Disaggregation of Revenue [Line Items]
Earned premiums	$ 621,556	$ 434,812
Premium
Disaggregation of Revenue [Line Items]
Earned premiums	619,722	399,740
Capitation
Disaggregation of Revenue [Line Items]
Earned premiums	$ 1,834	$ 35,072

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

Regulatory Requirements and Restricted Funds	3 Months Ended
Regulatory Requirements and Restricted Funds	Mar. 31, 2024
Regulated Operations [Abstract]
Regulatory Requirements and Restricted Funds	Regulatory Requirements and Restricted Funds Our health plans or risk-bearing entities are required to maintain minimum capital requirements prescribed by various regulatory authorities in each of the states in which it operates. Risk-Based Capital Regulatory The National Association of Insurance Commissioners has adopted rules, which, if implemented by the states, set minimum capitalization requirements for insurance companies, health maintenance organizations ("HMOs"), and other entities bearing risk for health care coverage. The requirements take the form of risk-based capital (“RBC”) rules, which may vary from state to state. Certain states in which our health plans or risk bearing entities operate have adopted the RBC rules. Our health plans or risk-bearing entities were in compliance with the minimum capital requirements as of March 31, 2024. Tangible Net Equity Our health plan in California is required to comply with the tangible net equity (“TNE”) requirements. The required amount is the larger of: (1) $1,000; (2) 2% of the first $150,000 of annualized premium revenue, plus 1% of annualized premium revenue in excess of $150,000; or (3) 8% of the first $150,000 of annualized health care expenditures, except for those paid on a capitated or managed hospital payment basis, plus 4% of the annualized health care expenditures in excess of $150,000, except those paid on a capitated or managed hospital payment basis, plus 4% of annualized hospital expenditures paid on a managed hospital payment basis. We were in compliance with the TNE requirement as of March 31, 2024. We have the ability to provide additional capital to each of our health plans or risk-bearing entities when necessary to ensure that the RBC and TNE requirements are met. Certain states regulate the payment of dividends, loans, or other cash transfers from our regulated subsidiaries to our non-regulated subsidiaries and parent company. Such payments may require approval by state regulatory authorities and are limited based on certain financial criteria, such as the entity’s level of statutory income and statutory capital and surplus, or the entity’s level of tangible net equity or net worth, amongst other measures. These regulations vary by state. We were in compliance with the RBC and TNE requirements as of March 31, 2024. Restricted Assets Pursuant to the regulations governing our subsidiaries, we maintain certain deposits required by the government authorities in the form of cash, certificate of deposit and Treasury bills as protection in the event of insolvency. The use of funds from these investments is limited as required by regulation in the various states in which we operate, or as needed in the event of insolvency. Therefore, these deposits are reported within other assets on the condensed consolidated balance sheets. We hold these assets until maturity, at which time these assets will renew or are invested in a similar type of investment instrument. Given the regulatory requirements, we expect to hold these investments for long-term. As a result, we do not expect the value of these investments to decline significantly due to a sudden change in market interest rates. These investments are carried at amortized cost, which approximates fair value. See note 3, Fair Value, for further discussion.

Goodwill and Intangible Assets - Schedule of Estimated Amortization Expense Related to Intangible Assets (Details) $ in Thousands	Mar. 31, 2024 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2024	$ 54
2025	60
2026	60
2027	60
2028	23
Estimated amortization expense related to intangible assets, total	$ 257

Accounts Receivable

3 Months Ended

Mar. 31, 2024

Accounts Receivable, after Allowance for Credit Loss [Abstract]

Accounts Receivable

Accounts receivable consisted of the following as of March 31, 2024 and December 31, 2023:


	March 31, 2024		December 31, 2023
Government receivables	$	70,106	$	35,529
Pharmacy rebate receivables	84,422		75,894
Other receivables	10,543		8,326
Total accounts receivable	165,071		119,749
Allowance for credit losses	—		—
Accounts receivable, net	$	165,071	$	119,749

The allowance for expected credit losses for accounts receivable is based primarily on past collections experience relative to the length of time receivables are past due. However, when available evidence reasonably supports an assumption that future economic conditions will differ from current and historical payment collections, an adjustment is reflected in the allowance for expected credit losses. We record pharmacy rebates and other receivables based on contractual terms and expected collections and our estimation process for contractual allowances for such balances generally results in an allowance for balances outstanding greater than 90 days or if expected credit risks are known.

Receivables and any associated allowance are written off only when all collection attempts have failed and such amounts are determined unrecoverable. We regularly review the adequacy of these allowances based on a variety of factors, including age of the outstanding receivable and collection history. When circumstances related to specific collection patterns change, estimates of the recoverability of receivables are adjusted. Because substantially all of our receivable amounts are readily determinable and a large portion of our creditors are governmental authorities, our allowance for credit losses is insignificant.

We recorded credit loss related to accounts receivable of $0 and $1 during the three months ended March 31, 2024 and 2023, respectively. The amounts were recorded in selling general, and administrative expenses in the condensed consolidated statements of operations.

Property and Equipment (Tables)

3 Months Ended

Mar. 31, 2024

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description			Estimated Service Lives (years)
Computer and equipment			5
Office equipment and furniture			5-7
Software			3-5
Leasehold improvements			15 (or lease term, if shorter)

Property and equipment consisted of the following as of March 31, 2024 and December 31, 2023:


	March 31, 2024		December 31, 2023
Computers and equipment	$	11,830	$	11,447
Office equipment and furniture	4,397		4,396
Software	157,305		148,864
Leasehold improvements	6,347		6,347
Construction in progress	6,984		4,532
Subtotal	186,863		175,586
Less accumulated depreciation	(129,652)		(123,685)
Property and equipment-net	$	57,211	$	51,901

Cover - shares	3 Months Ended
Cover - shares	Mar. 31, 2024	Apr. 29, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2024
Document Transition Report	false
Entity File Number	001-40295
Entity Registrant Name	ALIGNMENT HEALTHCARE, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	46-5596242
Entity Address, Address Line One	1100 W. Town and Country Road
Entity Address, Address Line Two	Suite 1600
Entity Address, City or Town	Orange
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92868
City Area Code	844
Local Phone Number	310-2247
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	ALHC
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (in shares)		191,198,265
Amendment Flag	false
Document Fiscal Period Focus	Q1
Current Fiscal Year End Date	--12-31
Entity Central Index Key	0001832466
Document Fiscal Year Focus	2024

Long-Term Debt - Schedule of Future Maturities Under The Term Loan (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Debt Disclosure [Abstract]
Remainder of 2024	$ 0
2025	1,650
2026	1,650
2027	161,700
2028	0
Total	$ 165,000	$ 165,000

Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended
Income Taxes (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Operating Loss Carryforwards [Line Items]
Income tax expense	$ 0	$ 1
NOL carryforwards indefinite life			$ 312,446
NOL carryforwards expiration year	2033
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
Taxable income deduction limit percentage	80.00%
Carryforward offset percentage of taxable income	100.00%
NOL carryforwards			504,097
Domestic Tax Authority \| Subsidiaries
Operating Loss Carryforwards [Line Items]
Carryforward offset percentage of taxable income	100.00%
State and Local Jurisdiction
Operating Loss Carryforwards [Line Items]
NOL carryforwards			$ 498,933

Equity-Based Compensation - Schedule of RSAs Transactions (Details) - Restricted Stock Awards - $ / shares	3 Months Ended	9 Months Ended
	Mar. 31, 2024	Sep. 30, 2023
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested and outstanding, beginning balance (in shares)	683,953
Vested (in shares)		(140,856)
Cancelled/forfeited (in shares)		(2,799)
Unvested and outstanding, ending balance (in shares)		540,298
Weighted-Average Grant Date Fair Value
Unvested and outstanding, beginning balance (in dollars per share)	$ 5.86
Vested (in dollars per share)		$ 13.22
Cancelled/forfeited (in dollars per share)		5.05
Unvested and outstanding, ending balance (in dollars per share)		$ 3.94

Long-Term Debt - Additional Information (Details) - USD ($) $ in Thousands				3 Months Ended
	Jul. 01, 2024	Jun. 30, 2024	Sep. 02, 2022	Mar. 31, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Long-term debt				$ 165,000	$ 165,000
Secured Debt \| Oxford Term Loan
Debt Instrument [Line Items]
Debt instrument, face amount			$ 250,000
Long-term debt			165,000
Additional term loan amount			$ 85,000
Debt interest floor rate			6.50%
Commitment fee			$ 1,650
Debt instrument origination fee			1,650
Accrual interest rate on default				2.00%
Repayment limit on net proceeds from sale of asset				$ 2,500
Minimum liquidity in the loan agreement			23,000
Secured Debt \| Delayed Draw Term Loan
Debt Instrument [Line Items]
Commitment fee			850
Additional debt issuance costs			$ 1,096
Secured Debt \| Scenario Forecast \| Delayed Draw Term Loan
Debt Instrument [Line Items]
Proceeds from issuance of long-term debt	$ 35,000	$ 50,000
Secured Debt \| Base Rate \| Oxford Term Loan
Debt Instrument [Line Items]
Debt interest floor rate			1.00%
Secured Debt \| Minimum
Debt Instrument [Line Items]
Prepayment fee			1.00%
Secured Debt \| Minimum \| Oxford Term Loan
Debt Instrument [Line Items]
Interest rate during period				11.82%
Secured Debt \| Maximum
Debt Instrument [Line Items]
Prepayment fee			2.00%
Secured Debt \| Maximum \| Oxford Term Loan
Debt Instrument [Line Items]
Interest rate during period				11.85%

Medical Expenses Payable - Additional Information (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($)
Insurance [Abstract]
Remaining claim amounts payment period	3 years
Claims reserve estimates, excluding provision	$ 871

Fair Value - Schedule of Carrying Value and Fair Value of Financial Instruments (Details) - USD ($)	Mar. 31, 2024	Dec. 31, 2023
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	$ 84,809,000	$ 119,092,000
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	82,414,000	117,310,000
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	2,320,000	1,755,000
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
U.S. Treasury bills
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
U.S. Treasury bills	82,489,000	117,337,000
U.S. Treasury bills \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
U.S. Treasury bills	82,414,000	117,310,000
U.S. Treasury bills \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
U.S. Treasury bills	0	0
U.S. Treasury bills \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
U.S. Treasury bills	0	0
Certificate of deposits
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Certificate of deposits	2,320,000	1,755,000
Certificate of deposits \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Certificate of deposits	0	0
Certificate of deposits \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Certificate of deposits	2,320,000	1,755,000
Certificate of deposits \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Certificate of deposits	$ 0	$ 0

Equity-Based Compensation - Additional Information (Details) - USD ($)						3 Months Ended
	Mar. 01, 2027	Dec. 31, 2025	Mar. 01, 2025	Mar. 13, 2024	Sep. 14, 2023	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2026	Dec. 31, 2024
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Aggregate intrinsic value, options exercised						$ 0	$ 0
Options granted, fair value						0
Share based compensation expense, unrecognized						$ 114,406,000
Stock Options
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage						25.00%
Award vesting period						4 years
Award expiration period						10 years
Restricted Stock Awards
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage						25.00%
Award vesting period						4 years
Pre-IPO Awards Converted RSAs
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage						50.00%
RSUs
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage						25.00%
Award vesting period						4 years
Performance-based Restricted Stock Units \| Scenario Forecast
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage	100.00%	50.00%	50.00%
Performance target, health plan revenue growth percentage								50.00%	60.00%
Performance target, returning member medical benefit ratio									0.20
Performance target, adjusted earnings before interest, less capital expenditures									20.00%
Performance target, adjusted earnings before interest								50.00%
Performance-based Restricted Stock Units \| Minimum
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage					0.00%
Performance-based Restricted Stock Units \| Maximum
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage				200.00%	150.00%
Non-vested awards RSAs, options and RSUs
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Weighted average contractual term						1 year 10 months 17 days

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Current Assets:
Cash and cash equivalents	$ 238,903	$ 202,904
Accounts receivable (less allowance for credit losses of $0 at March 31, 2024 and December 31, 2023)	165,071	119,749
Investments - current	62,809	115,914
Prepaid expenses and other current assets	53,856	44,970
Total current assets	520,639	483,537
Property and equipment, net	57,211	51,901
Right of use asset, net	8,549	9,959
Goodwill	34,826	34,826
Intangible Assets, net	5,224	5,252
Other assets	6,781	6,405
Total assets	633,230	591,880
Current Liabilities:
Medical expenses payable	276,464	205,399
Accounts payable and accrued expenses	22,671	23,511
Accrued compensation	31,607	34,112
Total current liabilities	330,742	263,022
Long-term debt, net of debt issuance costs	162,030	161,813
Long-term portion of lease liabilities	8,441	8,974
Total liabilities	501,213	433,809
Commitments and Contingencies (Note 12)
Stockholders' Equity:
Preferred stock, $.001 par value; $100,000,000 shares authorized as of March 31, 2024 and December 31, 2023, respectively; no shares issued and outstanding as of March 31, 2024 and December 31, 2023	0	0
Common stock, $.001 par value; $1,000,000,000 shares authorized as of March 31, 2024 and December 31, 2023; $191,156,569 and $188,951,643 shares issued and outstanding as of March 31, 2024 and December 31, 2023, respectively	191	189
Additional paid-in capital	1,057,519	1,037,015
Accumulated deficit	(926,779)	(880,258)
Total Alignment Healthcare, Inc. stockholders' equity	130,931	156,946
Noncontrolling interest	1,086	1,125
Total stockholders' equity	132,017	158,071
Total liabilities and stockholders' equity	$ 633,230	$ 591,880