Alignment Healthcare, Inc. (ALHC) Cash Flow Statement

Operating cash flow has alternated between large positive and negative quarters across the ten-quarter window, with 2025Q3 at $144.6M and 2025Q4 at negative $50.4M. Such swings are more consistent with timing differences between CMS premium receipts and medical claims settlement than with a stable float build. Investors should monitor whether the trailing average of operating cash flow turns durably positive as the membership base matures.

The claims outflow trajectory indicates that cash medical costs have expanded in step with revenue, which is consistent with the thin gross margin profile. Because payment lags on claims affect the timing of cash outflows, any acceleration in utilization could compress operating cash conversion quickly. Investors may wish to track days claims payable alongside quarterly claims outflows to assess reserve adequacy.

Purchases of investments exceeded sales in most recent quarters, indicating modest net deployment of cash into securities rather than liquidation. Investment income contribution is not disclosed in the supplied data, so the portfolio's role in earnings cannot be quantified. The cash position therefore appears to depend primarily on underwriting results rather than portfolio returns.

The gap between net income and operating cash flow in individual quarters suggests that non-cash accruals, reserve changes, and working capital timing dominate reported results. Such divergence reflects estimation sensitivity in medical reserves rather than a durable cash earnings base. Investors should evaluate cumulative cash conversion over multiple quarters rather than relying on any single period.