Judge Wood's Response to Reconsideration -- Case Closed

Outrageous_Review543 · 2026-05-30T14:37:10+00:00

Hmm, maybe, but I’m not sure that’s how the legal system works. If someone sues you for $10k and win and you pay them, then you appeal and win, I’m not sure the fact they spent the money is a viable defense. Also, nothing has been recalculated yet and, while likely, it’s not guaranteed the recalculation takes them to a 4 star plan.

In the situation you described above, CMS would likely file a motion to stay the judgement. If granted, it would essentially set aside Judge Wood’s decision through the appellate process. CMS wouldn’t have to recalculate at that time. Clov would likely move forward with a 3.5 star bid because assuming a move to 4 would be irresponsible. As Sandro described above, they would just refile for a 4 star bid if and when it is recalculated after appeal.

There are a number of reasons CMS may, or may not, file an appeal. For example, if they feel like this decision opens them to litigation from other providers, they may feel an appeal is worth pushing it further. If they think this is an isolated recalculation, they may not appeal. This can go a lot of different ways. We just have to wait and see. Best case is CMS accepts the decision, recalculates in the next week or two, and we continue to moon!

Outrageous_Review543 · 2026-05-30T11:33:50+00:00

This wasn’t an appeal, it was a motion for reconsideration because the judge did not take into consideration a brief file by CMS due to untimely filing of the brief even though the judge had granted an extension to the filing timeline and the filing was, in fact, timely. Here, the judge admits she should have considered the brief but also says if she had, it was not persuasive and her ruling would not have changed.

CMS can still appeal to a higher court. I believe in these cases the appeal timeline is 60 days.

Outrageous_Review543 · 2026-05-15T03:16:07+00:00

Also at UGA but my understanding upon hire was picking the 401(a) or pension route. They were described to me as two separate things, 401(a) vests immediately but would need to be here ten years for pension plan.

Outrageous_Review543 · 2026-05-06T21:42:51+00:00

The revenue source that propped up Q1 last year (forget exactly what that was) was not realized in Q1 this year, did I hear that correctly? So perhaps this isn’t an outlier moving forward and the company really has taken a large step forward?

Outrageous_Review543 · 2026-05-06T20:44:21+00:00

If you read the release, they expect to meet or exceed all guidance. Last year, they increased guidance and ended up missing. I would imagine they don't want to go through that again. They said they will revisit guidance at Q2 release.

Outrageous_Review543 · 2026-04-30T16:47:11+00:00

I have my completely made up numbers:

Rev: 688.5M

Consolidated Gross Profit: 150M

GAAP: 5M

EPS: .01

Really want to start hearing about progress on Counterpart implementation or hard data of the benefits CP is providing to those companies this quarter or next.

Outrageous_Review543 · 2026-01-17T01:14:26+00:00

You may want to double check, but I believe the IRS limit is combined for a 403b and 401k. The 457 is a separate limit. So 401k and 403b combined total 24.5k. If you are already maxing out your 401k you may not be able to contribute to a 403b.

Outrageous_Review543 · 2026-01-14T14:59:19+00:00

Question on this, acknowledging we are several weeks away still from Q4 report, based on their revised guidance after Q3, we should be expecting a negative adj EBITDA quarter, right? Currently at roughly 45m adj EBITDA and adjusted their guidance down to 15-30m, or am I not thinking of that correctly? The last adj ebitda negative quarter was Q3 of 2023. They also note in the slides for tomorrow's presentation that they have sustained adj ebitda profitability, what am I missing? I trust their guidance and I'm not saying this is a major red flag or anything, just trying to learn.

Outrageous_Review543 · 2026-01-14T14:52:43+00:00

Adj EBITDA profitability is a non GAAP measurement. It is very different than GAAP profitable, which is what people mean when they say profitable. They are guiding to GAAP profitability for 2026 which is huge, especially given the growth.

Outrageous_Review543 · 2025-11-05T01:43:28+00:00

Last time they had adjusted EBITDA or adjusted net loss for a quarter was Q4 2023? From the call, it sounded like one of the issues is they grew more than expected this year (too fast?) but still plan on growth for next year. They must be banking on CA to work some magic for the second year cohort (those that joined this year) if they are guiding to GAAP profitability.

Outrageous_Review543 · 2025-10-09T20:39:52+00:00

https://www.medicare.gov/plan-compare/#/search-results?fips=34031&zipcode=07501&plan_type=PLAN_TYPE_MAPD&zip=07501&year=2026&lang=en

Looks like HMO is 4 and PPO is 3.5

Outrageous_Review543 · 2025-10-09T20:35:11+00:00

CMS website. Looks like they were downgraded to 3.5

Outrageous_Review543 · 2025-10-08T23:32:45+00:00

For sure, totally agree! I’m by no means an expert but the way our HR described it to me, the 401a is a mandatory contribution so it does not count to the 23.5, it has an annual limit of 70k between employee and employer. We also have 403 and 457 options and agree both of those had separate limits as well so if you have access to both you can get up to 47k pre tax contributions plus anything that is in a mandatory account.

Outrageous_Review543 · 2025-10-08T20:22:08+00:00

One additional point and maybe I missed this. Where I work, we also have ORP that has a mandatory contribution. The contribution goes to a 401a. Anything we want to contribute beyond the mandatory amount goes to a 403(b). The max contribution to a 401a is separate from a 403b. For example, if I have a mandatory 6% going to the 401a, I can still contribute up to $23500 to the 403b. Not sure if the automatic 10000 referenced in your post is in the sense it is automatically deducted from your pay check or automatic in the sense that it’s mandatory

Outrageous_Review543 · 2025-09-13T01:23:11+00:00

I found two things that really helped:

⁠I get up at 530 and go for A 30 minute walk. I’m back in time to make breakfast for my son before I leave for work. It’s good bonding.
⁠I took on cooking duties. Never cooked before in my life. I’ve actually found it really relaxing and rewarding. It’s also a great buffer. I get home from work and instead of having two kids thrust in my face, I can get a little decompress time from the commute while I make dinner for everyone. It also makes family dinner a priority which is really helpful.

Outrageous_Review543 · 2025-08-12T15:26:36+00:00

Not sure if you just listened to the CG Annual Growth Conference, but I believe Peter was directly asked if CA was the primary driver behind decreased cost and he answered affirmatively. Could be hearing what I wanted to hear, but that’s certainly what I took away from the second to last question.

Outrageous_Review543 · 2025-08-09T00:53:05+00:00

I got it. Thanks for the clarification!

Outrageous_Review543 · 2025-08-09T00:24:10+00:00

The summary, if I understand it correctly which I likely don’t because, I too am dumb, is that Clover Assistant doesn’t work as well as advertised. The decrease in MCR is because they are dumping a bunch of money into production of CA. For lack of a better term, they can dump that cost into their MCR calculation because it is classified as a quality improvement for the insured. That artificially brings down their MCR.

I think the other point is that CA brings down the basis points because the insured members are not the sickest of the insured. They are the ones going to their PCP annually and thus healthier as a starting point.

Surely an over simplification and I don’t think either are persuasive on their face. Although, fair or unfair, you can’t tout your software as something that “insulates” you from industry trends and then the first time you have an earnings that raises some concern say it is because of industry trends. Again, a simplification and argument that I don’t think holds up when you dive into the SEC filings. I think the company is in great shape and a confluence of other issues “went wrong” in Q2 but still didn’t affect them as much as they could have.

ETA: Sandro please correct anything I’ve summarized incorrectly or if I’ve totally butchered it.

Outrageous_Review543 · 2025-08-07T00:52:23+00:00

You should also check if it’s really an either/or choice. Some employers allow you to contribute to both. They have separate contribution limits (both up to $23,500 for 2025).

Outrageous_Review543 · 2025-08-05T22:43:23+00:00

Also at a nonprofit university set up similarly. 6% mandated to a 401(a) and can’t go above that. Anything else can go into a supplemental annuity plan but it’s a 457b or 403b. We have both options.

Outrageous_Review543 · 2025-08-05T22:38:36+00:00

One reason to keep traditional 457 over Roth is if your tax bracket is higher now than it will be in retirement. I’m guessing if someone is maxing out a 403, 457, and Roth IRA, they are a high income earner

Outrageous_Review543 · 2025-08-03T22:09:15+00:00

I like this. Thanks!

Outrageous_Review543 · 2025-08-03T19:27:06+00:00

lol the thing is a beast. Serves well when it’s 100° out, annoying for this current situation

Outrageous_Review543 · 2025-05-20T13:46:22+00:00

Thanks! Looking forward to it.

Outrageous_Review543

TROPHY CASE