Item 2. Management’s Discussion and Analysis
ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The following discussion should be read together with the accompanying Condensed Consolidated Financial Statements and Notes and with our 2022 10-K, including the Consolidated Financial Statements and Notes included in Part II, Item 8, “Financial Statements and Supplementary Data” in that report. Unless the context indicates otherwise, references to the terms “UnitedHealth Group,” the “Company,” “we,” “our” or “us” used throughout this Management’s Discussion and Analysis of Financial Condition and Results of Operations refer to UnitedHealth Group Incorporated and its consolidated subsidiaries.
Readers are cautioned that the statements, estimates, projections or outlook contained in this Management's Discussion and Analysis of Financial Condition and Results of Operations, including discussions regarding financial prospects, economic conditions, trends and uncertainties contained in this Item 2, may constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 (PSLRA). These forward-looking statements involve risks and uncertainties that may cause our actual results to differ materially from the results discussed or implied in the forward-looking statements. A description of some of the risks and uncertainties is set forth in Part I, Item 1A, “Risk Factors” in our 2022 10-K and in the discussion below.
EXECUTIVE OVERVIEW
General
UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone. Our two distinct, yet complementary business platforms — Optum and UnitedHealthcare — are working to help build a modern, high-performing health system through improved access, affordability, outcomes and experiences for the individuals and organizations we are privileged to serve.
We have four reportable segments:
• Optum Health;
• Optum Insight;
• Optum Rx; and
• UnitedHealthcare, which includes UnitedHealthcare Employer & Individual, UnitedHealthcare Medicare & Retirement and UnitedHealthcare Community & State.
Further information on our business is presented in Part I, Item 1, “Business” and Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in our 2022 10-K and additional information on our segments can be found in this Item 2 and in Note 9 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report.
Business Trends
Our businesses participate in the United States, South America and certain other international health markets. We expect overall spending on health care to continue to grow in the future due to inflation, medical technology and pharmaceutical advancement, regulatory requirements, demographic trends in the population and national interest in health and well-being. The rate of market growth may be affected by a variety of factors, including macroeconomic conditions and regulatory changes, which could impact our results of operations, including our continued efforts to control health care costs.
Pricing Trends. To price our health care benefits, products and services, we start with our view of expected future costs, including medical cost trends, inflation and labor market dynamics. We frequently evaluate and adjust our approach in each of the local markets we serve, considering all relevant factors, such as product positioning, price competitiveness and environmental, competitive, legislative and regulatory considerations, including minimum medical loss ratio thresholds and similar revenue adjustments. We will continue seeking to balance growth and profitability across all these dimensions.
The commercial risk market remains highly competitive in the small group, large group and individual segments. We expect broad-based competition to continue as the industry adapts to individual and employer needs.
Government programs in the community and senior sector tend to receive lower rates of increase than the commercial market due to governmental budget pressures and lower cost trends.
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Medical Cost Trends. Our medical cost trends primarily relate to changes in unit costs, care activity and prescription drug costs. During the second quarter, we observed increased care patterns, primarily related to outpatient procedures for seniors, which may continue in future periods. We endeavor to mitigate those increases by engaging physicians and consumers with information and helping them make clinically sound choices, with the objective of helping them achieve quality, affordable care.
Regulatory Trends and Uncertainties
Medicare Advantage Rates. Medicare Advantage rate notices over the years have at times resulted in industry base rates well below industry forward medical trend. For example, the Final Notice for 2024 rates resulted in an industry base rate decrease, well short of what is an increasing industry forward medical cost trend, creating continued pressure in the Medicare Advantage program. Further, substantial revisions to the risk adjustment model, which serves to adjust rates to reflect a patient’s health status and care resource needs, will result in reduced funding and potentially benefits for people, especially those with some of the greatest health and social challenges.
As a result of ongoing Medicare funding pressures, there are adjustments we can make to partially offset these rate pressures and reductions for a particular period. For example, we can seek to intensify our medical and operating cost management, make changes to the size and composition of our care provider networks, adjust member benefits and implement or increase the member premiums supplementing the monthly payments we receive from the government. Additionally, we decide annually on a county-by-county basis where we will offer Medicare Advantage plans.
SELECTED OPERATING PERFORMANCE AND OTHER SIGNIFICANT ITEMS
The following summarizes select second quarter 2023 year-over-year operating comparisons to second quarter 2022 and other financial results.
• Consolidated revenues grew 16%, UnitedHealthcare revenues grew 13% and Optum revenues grew 25%.
• UnitedHealthcare served 1.6 million more people, driven by growth across our U.S. businesses.
• Consolidated earnings from operations of $8.1 billion compared to $7.1 billion last year, included growth of 13% at both UnitedHealthcare and Optum.
• Diluted earnings per common share were $5.82.
• Cash flows from operations for the six months ended June 30, 2023 were $27.4 billion.
• Return on equity was 26.8%.
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RESULTS SUMMARY
The following table summarizes our consolidated results of operations and other financial information:
(in millions, except percentages and per share data) Three Months Ended
June 30, Increase/(Decrease) Six Months Ended
June 30, Increase/(Decrease)
2023 2022 2023 vs. 2022 2023 2022 2023 vs. 2022
Revenues:
Premiums $ 72,474 $ 63,896 $ 8,578 13 % $ 145,260 $ 127,966 $ 17,294 14 %
Products 10,651 9,496 1,155 12 20,918 18,836 2,082 11
Services 8,663 6,645 2,018 30 16,743 13,017 3,726 29
Investment and other income 1,115 295 820 278 1,913 662 1,251 189
Total revenues 92,903 80,332 12,571 16 184,834 160,481 24,353 15
Operating costs:
Medical costs 60,268 52,093 8,175 16 120,113 104,616 15,497 15
Operating costs 13,809 11,709 2,100 18 27,434 23,110 4,324 19
Cost of products sold 9,748 8,596 1,152 13 19,153 17,083 2,070 12
Depreciation and amortization 1,021 802 219 27 1,991 1,590 401 25
Total operating costs 84,846 73,200 11,646 16 168,691 146,399 22,292 15
Earnings from operations 8,057 7,132 925 13 16,143 14,082 2,061 15
Interest expense (828) (467) (361) 77 (1,582) (900) (682) 76
Earnings before income taxes 7,229 6,665 564 8 14,561 13,182 1,379 10
Provision for income taxes (1,572) (1,466) (106) 7 (3,130) (2,835) (295) 10
Net earnings 5,657 5,199 458 9 11,431 10,347 1,084 10
Earnings attributable to noncontrolling interests (183) (129) (54) 42 (346) (250) (96) 38
Net earnings attributable to UnitedHealth Group common shareholders $ 5,474 $ 5,070 $ 404 8 % $ 11,085 $ 10,097 $ 988 10 %
Diluted earnings per share attributable to UnitedHealth Group common shareholders $ 5.82 $ 5.34 $ 0.48 $ 11.77 $ 10.61 $ 1.16
Medical care ratio (a) 83.2 % 81.5 % 1.7 % 82.7 % 81.8 % 0.9 %
Operating cost ratio 14.9 14.6 0.3 14.8 14.4 0.4
Operating margin 8.7 8.9 (0.2) 8.7 8.8 (0.1)
Tax rate 21.7 22.0 (0.3) 21.5 21.5 —
Net earnings margin (b) 5.9 6.3 (0.4) 6.0 6.3 (0.3)
Return on equity (c) 26.8 % 27.9 % (1.1) % 27.5 % 27.9 % (0.4) %
(a) Medical care ratio (MCR) is calculated as medical costs divided by premium revenue.
(b) Net earnings margin attributable to UnitedHealth Group shareholders.
(c) Return on equity is calculated as annualized net earnings attributable to UnitedHealth Group common shareholders divided by average shareholders’ equity. Average shareholders’ equity is calculated using the shareholders’ equity balance at the end of the preceding year and the shareholders’ equity balances at the end of each of the quarters in the year presented.
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2023 RESULTS OF OPERATIONS COMPARED TO 2022 RESULTS OF OPERATIONS
Consolidated Financial Results
Revenues
The increases in revenues were primarily driven by growth in the number of people served through Medicare Advantage and Medicaid, pricing trends and growth across the Optum businesses. Revenues also increased due to increased investment income, primarily driven by increased interest rates.
Medical Costs and MCR
Medical costs increased primarily due to growth in people served through Medicare Advantage and Medicaid. The MCR increased as a result of elevated care activity, primarily relating to outpatient care for seniors, and business mix. For the three months ended June 30, 2023, the MCR also increased due to decreased favorable reserve development.
Operating Cost Ratio
The operating cost ratio increased primarily due to business mix and investments to support future growth, partially offset by continued productivity advances.
Reportable Segments
See Note 9 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report for more information on our segments. We utilize various metrics to evaluate and manage our reportable segments, including people served by UnitedHealthcare by major market segment and funding arrangement, people served by Optum Health and adjusted scripts for Optum Rx. These metrics are the main drivers of revenue, earnings and cash flows at each business. The metrics also allow management and investors to evaluate and understand business mix, including the level and scope of services provided to people, and pricing trends when comparing the metrics to revenue by segment.
The following table presents a summary of the reportable segment financial information:
Three Months Ended
June 30, Increase/
(Decrease) Six Months Ended
June 30, Increase/(Decrease)
(in millions, except percentages) 2023 2022 2023 vs. 2022 2023 2022 2023 vs. 2022
Revenues
UnitedHealthcare $ 70,231 $ 62,105 $ 8,126 13 % $ 140,699 $ 124,700 $ 15,999 13 %
Optum Health 23,917 17,583 6,334 36 46,921 34,265 12,656 37
Optum Insight 4,674 3,282 1,392 42 9,170 6,501 2,669 41
Optum Rx 28,646 24,805 3,841 15 56,064 48,716 7,348 15
Optum eliminations (893) (588) (305) 52 (1,752) (1,141) (611) 54
Optum 56,344 45,082 11,262 25 110,403 88,341 22,062 25
Eliminations (33,672) (26,855) (6,817) 25 (66,268) (52,560) (13,708) 26
Consolidated revenues $ 92,903 $ 80,332 $ 12,571 16 % $ 184,834 $ 160,481 $ 24,353 15 %
Earnings from operations
UnitedHealthcare $ 4,358 $ 3,850 $ 508 13 % $ 8,701 $ 7,648 $ 1,053 14 %
Optum Health 1,525 1,399 126 9 3,301 2,765 536 19
Optum Insight 968 839 129 15 1,875 1,686 189 11
Optum Rx 1,206 1,044 162 16 2,266 1,983 283 14
Optum 3,699 3,282 417 13 7,442 6,434 1,008 16
Consolidated earnings from operations $ 8,057 $ 7,132 $ 925 13 % $ 16,143 $ 14,082 $ 2,061 15 %
Operating margin
UnitedHealthcare 6.2 % 6.2 % — % 6.2 % 6.1 % 0.1 %
Optum Health 6.4 8.0 (1.6) 7.0 8.1 (1.1)
Optum Insight 20.7 25.6 (4.9) 20.4 25.9 (5.5)
Optum Rx 4.2 4.2 — 4.0 4.1 (0.1)
Optum 6.6 7.3 (0.7) 6.7 7.3 (0.6)
Consolidated operating margin 8.7 % 8.9 % (0.2) % 8.7 % 8.8 % (0.1) %
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UnitedHealthcare
The following table summarizes UnitedHealthcare revenues by business:
Three Months Ended June 30, Increase/(Decrease) Six Months Ended June 30, Increase/(Decrease)
(in millions, except percentages) 2023 2022 2023 vs. 2022 2023 2022 2023 vs. 2022
UnitedHealthcare Employer & Individual - Domestic $ 16,759 $ 15,567 $ 1,192 8 % $ 33,303 $ 31,389 $ 1,914 6 %
UnitedHealthcare Employer & Individual - Global 2,325 2,247 78 3 4,488 4,380 108 2
UnitedHealthcare Employer & Individual - Total 19,084 17,814 1,270 7 37,791 35,769 2,022 6
UnitedHealthcare Medicare & Retirement 32,440 28,625 3,815 13 65,446 57,725 7,721 13
UnitedHealthcare Community & State 18,707 15,666 3,041 19 37,462 31,206 6,256 20
Total UnitedHealthcare revenues $ 70,231 $ 62,105 $ 8,126 13 % $ 140,699 $ 124,700 $ 15,999 13 %
The following table summarizes the number of people served by our UnitedHealthcare businesses, by major market segment and funding arrangement:
June 30, Increase/(Decrease)
(in thousands, except percentages) 2023 2022 2023 vs. 2022
Commercial - Domestic:
Risk-based 8,035 8,010 25 — %
Fee-based 19,140 18,480 660 4
Total Commercial - Domestic 27,175 26,490 685 3
Medicare Advantage 7,590 6,945 645 9
Medicaid 8,355 7,990 365 5
Medicare Supplement (Standardized) 4,330 4,355 (25) (1)
Total Community and Senior 20,275 19,290 985 5
Total UnitedHealthcare - Domestic Medical 47,450 45,780 1,670 4
Commercial - Global 5,385 5,465 (80) (1)
Total UnitedHealthcare - Medical 52,835 51,245 1,590 3 %
Supplemental Data:
Medicare Part D stand-alone 3,355 3,330 25 1 %
UnitedHealthcare’s revenues increased due to growth in the number of people served through individual and group Medicare Advantage plans; growth in existing Medicaid markets, including a greater mix of people with higher acuity needs; and an increase in the number of people served through commercial offerings. Earnings from operations increased due to increased investment income and the factors impacting revenue, partially offset by elevated care activity, primarily relating to outpatient care for seniors.
Optum
Total revenues and earnings from operations increased due to growth across the Optum businesses. The results by segment were as follows:
Optum Health
Revenues at Optum Health increased primarily due to organic growth in patients served under value-based care arrangements and business combinations. Earnings from operations increased due to increased investment income and cost management initiatives, partially offset by higher senior outpatient and behavioral health care activity and costs associated with serving newly added patients under value-based care arrangements. Optum Health served approximately 103 million people as of June 30, 2023 compared to 101 million people as of June 30, 2022.
Optum Insight
Revenues and earnings from operations at Optum Insight increased due to growth in business services as a result of business combinations and growth in technology services.
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Optum Rx
Revenues and earnings from operations at Optum Rx increased due to growth in specialty pharmacy offerings and higher script volumes from growth in people served. Earnings from operations also increased as a result of continued supply chain management initiatives. Optum Rx fulfilled 381 million and 357 million adjusted scripts in the second quarters of 2023 and 2022, respectively.
LIQUIDITY, FINANCIAL CONDITION AND CAPITAL RESOURCES
Liquidity
Summary of our Major Sources and Uses of Cash and Cash Equivalents
Six Months Ended June 30, Increase/(Decrease)
(in millions) 2023 2022 2023 vs. 2022
Sources of cash:
Cash provided by operating activities $ 27,359 $ 12,190 $ 15,169
Issuances of short-term borrowings and long-term debt, net of repayments 7,695 6,162 1,533
Proceeds from common stock issuances 628 756 (128)
Customer funds administered 4,069 5,786 (1,717)
Total sources of cash 39,751 24,894
Uses of cash:
Common stock repurchases (5,000) (5,000) —
Cash paid for acquisitions, net of cash assumed (8,161) (7,150) (1,011)
Purchases of investments, net of sales and maturities (1,574) (3,366) 1,792
Purchases of property, equipment and capitalized software (1,589) (1,212) (377)
Cash dividends paid (3,284) (2,908) (376)
Other (1,801) (2,078) 277
Total uses of cash (21,409) (21,714)
Effect of exchange rate changes on cash and cash equivalents 106 57 49
Net increase in cash and cash equivalents $ 18,448 $ 3,237 $ 15,211
2023 Cash Flows Compared to 2022 Cash Flows
Increased cash flows provided by operating activities were primarily driven by an increase in unearned revenue due to the June receipt of our July CMS premium payment of $11.8 billion and changes in working capital accounts. Other significant changes in sources or uses of cash year-over-year included increased net issuances of short-term borrowings and long-term debt and decreased net purchases of investments, partially offset by decreased customer funds administered and increased cash paid for acquisitions.
Financial Condition
As of June 30, 2023, our cash, cash equivalent, available-for-sale debt securities and equity securities balances of $90.1 billion included approximately $41.8 billion of cash and cash equivalents (of which $1.2 billion was available for general corporate use), $44.1 billion of debt securities and $4.2 billion of investments in equity securities. Given the significant portion of our portfolio held in cash and cash equivalents, we do not anticipate fluctuations in the aggregate fair value of our financial assets to have a material impact on our liquidity or capital position. Our available-for-sale debt securities portfolio had a weighted-average duration of 3.9 years and a weighted-average credit rating of “Double A” as of June 30, 2023. When multiple credit ratings are available for an individual security, the average of the available ratings is used to determine the weighted-average credit rating.
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Capital Resources and Uses of Liquidity
In addition to cash flows from operations and cash and cash equivalent balances available for general corporate use, our capital resources and uses of liquidity are as follows:
Cash Requirements. A summary of our cash requirements as of December 31, 2022 was disclosed in Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in our 2022 10-K. During the six months ended June 30, 2023, there were no material changes to this previously disclosed information outside the ordinary course of business. We believe our capital resources are sufficient to meet future, short-term and long-term, liquidity needs. We continually evaluate opportunities to expand our operations, including through internal development of new products, programs and technology applications and business combinations.
Short-Term Borrowings. Our revolving bank credit facilities provide liquidity support for our commercial paper borrowing program, which facilitates the private placement of unsecured debt through independent broker-dealers, and are available for general corporate purposes. For more information on our commercial paper and bank credit facilities, see Note 5 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report and Note 8 of Notes to the Consolidated Financial Statements included in Part II, Item 8, “Financial Statements and Supplementary Data” in our 2022 10-K.
Our revolving bank credit facilities contain various covenants, including covenants requiring us to maintain a defined debt to debt-plus-shareholders’ equity ratio of not more than 60%. As of June 30, 2023, our debt to debt-plus-shareholders’ equity ratio, as defined and calculated under the credit facilities, was approximately 40%.
Long-Term Debt. Periodically, we access capital markets and issue long-term debt for general corporate purposes, such as, to meet our working capital requirements, to refinance debt, to finance acquisitions or for share repurchases. For more information on our long-term debt, see Note 5 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report and Note 8 of Notes to the Consolidated Financial Statements included in Part II, Item 8, “Financial Statements and Supplementary Data” in our 2022 10-K.
Credit Ratings. Our credit ratings as of June 30, 2023 were as follows:
Moody’s (a) S&P Global Fitch A.M. Best
Ratings Outlook Ratings Outlook Ratings Outlook Ratings Outlook
Senior unsecured debt A3 Positive A+ Stable A Stable A Stable
Commercial paper P-2 n/a A-1 n/a F1 n/a AMB-1+ n/a
(a) On July 27, 2023, Moody’s upgraded the credit rating on our senior unsecured debt to A2 with an outlook of Stable and the credit rating on our commercial paper to P-1.
The availability of financing in the form of debt or equity is influenced by many factors, including our profitability, operating cash flows, debt levels, credit ratings, debt covenants and other contractual restrictions, regulatory requirements and economic and market conditions. A significant downgrade in our credit ratings or adverse conditions in the capital markets may increase the cost of borrowing for us or limit our access to capital.
Share Repurchase Program. During the six months ended June 30, 2023, we repurchased approximately 10 million shares at an average price of $483.78 per share. As of June 30, 2023, we had Board of Directors’ authorization to purchase up to 21 million shares of our common stock.
Dividends. In June 2023, the Company’s Board of Directors increased our quarterly cash dividend to shareholders to an annual rate of $7.52 compared to $6.60 per share. For more information on our dividend, see Note 6 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report.
Pending Acquisitions. As of June 30, 2023, we have entered into agreements to acquire companies in the health care sector, subject to regulatory approval and other customary closing conditions. The total anticipated consideration required for these acquisitions, excluding the payoff of acquired indebtedness, is approximately $5 billion.
For additional liquidity discussion, see Note 10 of Notes to the Consolidated Financial Statements included in Part II, Item 8, “Financial Statements and Supplementary Data” and “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in Part II, Item 7 in our 2022 10-K.
RECENTLY ISSUED ACCOUNTING STANDARDS
There are no recently issued accounting standards that are expected to have a material impact on our Condensed Consolidated Financial Statements.
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CRITICAL ACCOUNTING ESTIMATES
In preparing our Condensed Consolidated Financial Statements, we are required to make judgments, assumptions and estimates, which we believe are reasonable and prudent based on the available facts and circumstances. These judgments, assumptions and estimates affect certain of our revenues and expenses and their related balance sheet accounts and disclosure of our contingent liabilities. We base our assumptions and estimates primarily on historical experience and consider known and projected trends. On an ongoing basis, we re-evaluate our selection of assumptions and the method of calculating our estimates. Actual results, however, may materially differ from our calculated estimates, and this difference would be reported in our current operations.
Our critical accounting estimates include medical costs payable and goodwill. For a detailed description of our critical accounting estimates, see “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in Part II, Item 7 in our 2022 10-K. For a detailed discussion of our significant accounting policies, see Note 2 of Notes to the Consolidated Financial Statements included in Part II, Item 8, “Financial Statements and Supplementary Data” in our 2022 10-K.
FORWARD-LOOKING STATEMENTS
The statements, estimates, projections, guidance or outlook contained in this document include “forward-looking” statements which are intended to take advantage of the “safe harbor” provisions of the federal securities law. The words “believe,” “expect,” “intend,” “estimate,” “anticipate,” “forecast,” “outlook,” “plan,” “project,” “should” and similar expressions identify forward-looking statements. These statements may contain information about financial prospects, economic conditions and trends and involve risks and uncertainties. Actual results could differ materially from those that management expects, depending on the outcome of certain factors including: our ability to effectively estimate, price for and manage medical costs; new or changes in existing health care laws or regulations, or their enforcement or application; reductions in revenue or delays to cash flows received under government programs; changes in Medicare, the CMS star ratings program or the application of risk adjustment data validation audits; the DOJ’s legal action relating to the risk adjustment submission matter; our ability to maintain and achieve improvement in quality scores impacting revenue; failure to maintain effective and efficient information systems or if our technology products do not operate as intended; cyberattacks, other privacy/data security incidents, or our failure to comply with related regulations; risks and uncertainties associated with our businesses providing pharmacy care services; competitive pressures, including our ability to maintain or increase our market share; changes in or challenges to our public sector contract awards; failure to achieve targeted operating cost productivity improvements; failure to develop and maintain satisfactory relationships with health care payers, physicians, hospitals and other service providers; the impact of potential changes in tax laws and regulations; increases in costs and other liabilities associated with litigation, government investigations, audits or reviews; failure to complete, manage or integrate strategic transactions; risks associated with public health crises arising from large-scale medical emergencies, pandemics, natural disasters and other extreme events; failure to attract, develop, retain, and manage the succession of key employees and executives; our investment portfolio performance; impairment of our goodwill and intangible assets; failure to protect proprietary rights to our databases, software and related products; downgrades in our credit ratings; and our ability to obtain sufficient funds from our regulated subsidiaries or from external financings to fund our obligations, maintain our debt to total capital ratio at targeted levels, maintain our quarterly dividend payment cycle, or continue repurchasing shares of our common stock.
This above list is not exhaustive. We discuss these matters, and certain risks that may affect our business operations, financial condition and results of operations, more fully in our filings with the SEC, including our reports on Forms 10-K, 10-Q and 8-K. By their nature, forward-looking statements are not guarantees of future performance or results and are subject to risks, uncertainties and assumptions that are difficult to predict or quantify. Actual results may vary materially from expectations expressed or implied in this document or any of our prior communications. You should not place undue reliance on forward-looking statements, which speak only as of the date they are made. We do not undertake to update or revise any forward-looking statements, except as required by law.
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