Centene Corporation (CNC, NYSE)
Industry: Healthcare Plans
Annual report, fiscal year 2018






## CENTENE CORPORATION

Centene Corporation, a FORTUNE \( ^{®} $  100 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene operates local health plans and offers a range of health insurance solutions and specialty services.

Table of Contents

1 2018 At a Glance
2 Letter from the Chairman
6 Company and Financial Summary
8 2018 Highlights
12 Providing Greater Healthcare Access with Dignity
15 Better Health Outcomes for Growing Families
16 Using the Latest Technology to Provide the Best Possible Care
17 Board of Directors
18 Quarterly Selected Financial Information
19 Selected Financial Information
20 Corporate Information

## At Centene, we don’t just embrace the future; we take the lead.

Our core beliefs have positioned us to take bold steps forward—through new technologies and innovations—while always remaining true to our purpose of transforming the health of the community, one person at a time.



2018 AT A GLANCE

$60.1 B
IN TOTAL REVENUES

47,300
EMPLOYEES

$1.2 B
OPERATING CASH FLOW

14 M
MEMBERS

$2.26
DILUTED EARNINGS PER SHARE

$3.54
ADJUSTED DILUTED EARNINGS PER SHARE



## LETTER FROM THE CHAIRMAN
2018: A HEALTHCARE COMPANY IN MOTION

In 2018, Centene achieved strong results across our business segments, reflecting the strength of our diversification strategy and our portfolio approach. Centene's ability to execute across our strategic and operational initiatives propelled us to #61 on the Fortune 500 \( ^{®} \)  list of America's largest companies by revenue, and #1 on Fortune's 100 Fastest-Growing Companies list based on revenue growth over a 10-year period. We continued to diversify and add to our capabilities, driving significant revenue and earnings growth and creating greater opportunities for margin expansion. We ended 2018 as a $60 billion enterprise, and our success this past year was punctuated by the two-for-one stock split announced at the end of 2018, effective in the first quarter of 2019.

At Centene, we don’t just embrace the future, we take the lead. We are a company in motion, and we are taking action to build on our competitive strengths to drive further growth. We continued to see our strategic approach yield results in 2018. Centene offers approximately 350 solutions in 32 states, covering more than 14 million members in the U.S. and approximately 600,000 individuals internationally. Our size and scale afford us the necessary resources for further investments in systems, markets, products, and capabilities that are improving our competitive position in both the short and long term.

By combining our strong organic growth and strategic acquisitions, we have become a transformational leader in the government-sponsored healthcare sector. Notably, we completed

Centene is a growth company with expectations of continued margin expansion and strong growth in the top and bottom line.
All percentages as of Dec. 31, 2018

24%
Growth in Total Revenues*

40%
Growth in Adjusted Diluted Earnings per Share \( ^{*} $ 

14%
Total Shareholder Return \( ^{*} $ 

31%
Industry-Leading Five-Year Compounded Total Shareholder Return Annual Growth Rate

 \( ^{*} \) Year Over Year

the acquisition of Fidelis Care, the leading government health plan in New York, establishing Centene as a leader in the nation's four largest Medicaid states. Fidelis has maintained its strong operating performance throughout our successful integration, while the acquisition has expanded our reach in Medicare Advantage and the Health Insurance Marketplace. Looking forward, it is clear that we have an incredibly bright future. We have clear sight on new opportunities. We're expanding our U.S. footprint and we are growing internationally. This positions us to continue delivering results for our members, communities, and shareholders.

## DRIVING GROWTH

Centene drove organic growth in our core products of Medicaid, Medicare, and the Health Insurance Marketplace in 2018. We were successful in procurement and service expansion wins in multiple markets, and in 2019 we are expanding our Medicaid geographical footprint with new contracts in Iowa and New Mexico. In addition, we grew our portfolio of Medicare products, offering Medicare Advantage and D-SNP plans in eight new Centene Medicaid states, which will help bring our Medicare product solutions to a total of 20 states. And we are the number one insurer in the nation on the Health Insurance Marketplace. In 2018, we had strong marketplace enrollment of over 1.6 million members at the peak, representing 35% growth over 2017 open enrollment metrics. We now offer access to the Health Insurance Marketplace in 70% of our markets, having already expanded into four new states for 2019 and exploring additional expansion activities for 2020.

Beyond these core offerings, we remain the largest provider of managed long-term services and supports, one of the fastest-growing segments in the managed care market. Our Centurion product is the market leader in correctional health by revenue and is widely recognized for its high standards for quality and care and its innovative and transparent approach. In addition, through our TRICARE program, we continued to be one of the nation's largest providers of managed care services for military families.

We also continue to gather international momentum by leveraging our public sector and population health expertise, as well as our technology and analytics capabilities, to advance our position in the Spanish and UK markets. At the end of 2018, Centene acquired an 89% ownership in University Hospital of Torrejón, serving approximately 150,000 people with a broad portfolio of services and facilities. This investment furthers the reach of our successful whole health model.



## BUILDING ON OUR COMPETITIVE ADVANTAGES

Our core beliefs have stood the test of time, and today, as we build on those foundations through new technologies and innovations, we are able to take bold steps forward while remaining true to our purpose of transforming the health of the community, one person at a time.

For example, we are proactively streamlining our organization to achieve efficiencies, protect quality and outcomes, and capture the best of our capabilities and talents. In 2018, we launched Centene Forward, an initiative designed to generate operating and economic efficiencies and accelerate margin expansion. Through Centene Forward, we expect to realize up to $500 million in savings over a multiyear period. In addition to long-term savings, this initiative will provide us with additional capital to invest in capabilities and technologies that better position Centene for long-term growth, increased margins, and enhanced profitability.

We continue to invest in technology, which enhances our ability to scale, coordinate, and deliver care. With our focus on innovation, we deliver the next generation of healthcare services through new IT platforms, enhanced data analytics, and technology-based partnerships. In 2018, we introduced RxAdvance, a solution for pharmacy benefit management (PBM), and have been pleased with its early performance. We will continue this implementation across our health plans throughout 2019 and 2020, and will consistently leverage new technology to improve health outcomes.

We are also driving integrated innovation through our organization. Through our Health Care Enterprises group, highlighted by Casenet's TruCare solutions, we are improving health outcomes by developing more efficient care models and reducing healthcare costs. We also made a significant investment in Interpreta, an innovative health IT company focused on clinical and genomic data and analytics. Interpreta can rapidly identify physiological or laboratory changes by analyzing 12 million medical data points in less than a minute, which allows for continuous interpretation of each patient's past, present, and future care needs.

Our ongoing initiatives build on more than 30 years of experience in applying our local approach to government-sponsored healthcare programs. Centene goes beyond traditional healthcare, partnering with states and other key stakeholders to offer programs and services that address the health and social needs of our country's most vulnerable populations. This commitment is a core piece of Centene's business strategy.

## LEADING THE WAY FORWARD

The healthcare industry is ever-changing as the nation debates the shape and scope of healthcare policy. That said, the midterm elections of 2018 demonstrated that there is bipartisan support to provide high-quality, efficient, and affordable care to all Americans. This goal has been Centene's focus and commitment for more than 30 years. We will continue focusing on what we can control. As an exceptionally local, fully integrated, tech-enabled enterprise, we deliver consistent year-over-year market expansion by strategically optimizing our core business.

Ultimately, Centene’s success is due to the talent, skill, and dedication of our more than 47,000 employees, as well as their commitment to providing the highest quality of care to the vulnerable populations entrusted to us. From the leaders we develop through our leadership training programs at Centene University to the individual employees running local programs to promote healthier lives for our members, it is our workforce that facilitates our growth. I want to thank our employees for their commitment, passion, and innovation, which enable Centene to deliver on our mission to provide better health outcomes at lower costs. I also want to use this opportunity to note my appreciation for the guidance and leadership of our Board of Directors.

We have a clear line of sight into our growth drivers for 2019 and beyond. We will keep building on our momentum to deliver enhanced value to shareholders as we transform the health of our communities, one person at a time.

## Miu Mei

MICHAEL F. NEIDORFF
Chairman & Chief Executive Officer



## FINANCIAL HIGHLIGHTS
(in millions)

<table><tr><td></td><td>2018</td><td>2017</td><td>2016</td><td>2015</td><td>2014</td></tr><tr><td>Total Revenues</td><td>$ 60,116</td><td>$ 48,382</td><td>$ 40,607</td><td>$ 22,760</td><td>$ 16,560</td></tr><tr><td>Net Earnings \( ^{(1)} \)</td><td>900</td><td>828</td><td>562</td><td>355</td><td>271</td></tr><tr><td>Adjusted Net Earnings \( ^{(1)} \)</td><td>1,411</td><td>889</td><td>730</td><td>386</td><td>281</td></tr><tr><td>Total Assets</td><td>30,901</td><td>21,855</td><td>20,197</td><td>7,339</td><td>5,824</td></tr></table>



(1) Attributable to Centene Corporation



ALASKA
HAWAII

## MEDICAID/CHIP

Arizona, Arkansas (Private Option), California, Florida, Georgia, Illinois, Indiana, Iowa*, Kansas, Louisiana, Maryland*, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Mexico*, New York, North Carolina*, Ohio, Oregon, New York, North Carolina*, Ohio, Oregon, South Carolina, Texas, Washington, Wisconsin

## ● ABD (NON-DUAL)

Arizona, California, Florida, Illinois, Indiana, Iowa*, Kansas, Louisiana, Maryland*, Mississippi, Nebraska, New Hampshire, New Mexico*, New York, North Carolina*, Ohio, Oregon, South Carolina, Texas, Washington, Wisconsin

## ● ABD (MEDICAID ONLY DUAL-ELIGIBLE)

Arizona, California, Florida, Iowa*, Kansas, Nebraska, New Hampshire, New Mexico*, New York, Ohio, Oregon, Pennsylvania, Texas, Wisconsin

## ● LONG-TERM SERVICES & SUPPORTS

California, Florida, Illinois, Iowa*, Kansas, New Mexico*, New York, North Carolina*, Ohio, Pennsylvania, Texas

## ● FOSTER CARE

California, Florida, Illinois*, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico*, New York, Ohio, Texas, Washington

## ● MEDICARE

Arizona, Arkansas, California, Florida, Georgia, Illinois, Indiana, Kansas, Louisiana, Mississippi, Missouri, New Mexico*, New York, Ohio, Oregon, Pennsylvania, South Carolina, Texas, Wisconsin

## ● MEDICAID-MEDICARE PLANS (INCLUDES LTSS)

California, Illinois, Michigan, New York, Ohio, South Carolina, Texas

## ● CORRECTIONAL HEALTHCARE

Arizona, California, Connecticut, Florida, Georgia, Maryland, Massachusetts, Minnesota, Mississippi, New Hampshire, New Mexico, Pennsylvania, Tennessee, Vermont

## ● HEALTH INSURANCE MARKETPLACE

Arizona, Arkansas, California, Florida, Georgia, Illinois, Indiana, Kansas, Mississippi, Missouri, Nevada, New Hampshire, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Washington

## ● COMMERCIAL INSURANCE

Arizona, California, New York, Oregon

## ● TRICARE

Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas, Utah, Washington, Wyoming

* Maryland is a non-risk Managed Service Organization (MSO) contract. Contracts in Iowa and New Mexico, and the foster care contract in Illinois, commence membership operations in 2019. The contract in North Carolina is expected to commence membership operations in 2020.

## GROUP & PRODUCT SOLUTIONS

## ● INTERNATIONAL

Since our investment in 2014, we continue expanding our international presence in Europe. Our joint venture in Spain, Ribera Salud, is a health management group primarily operating in the tire industry. Accountable Care System sector. Ribera Salud also has other controlling and noncontrolling interests in Spain, Latin America, and Slovakia. In 2018, Centene acquired a controlling interest in University Hospital of Torrejón in Madrid, which is managed by Ribera Salud. In the United Kingdom, Centene UK leverages our local strategic assets to support UK accountable care initiatives based on the blueprint outlined by the National Health Service (NHS), which is the publicly funded national healthcare system for England. We partner with local health and social commissioners on opportunities to support coordination and integration of care.






## 2018 QUARTERLY HIGHLIGHTS



## JANUARY

Centene's New Mexico subsidiary, Western Sky Community Care, is awarded the statewide contract for the Centennial Care 2.0 Program. The program provides integrated Medicaid managed care coverage to nearly 700,000 Medicaid members.

## FEBRUARY

Centene signs a definitive agreement to acquire MHM Services, Inc., a national provider of healthcare and staffing services to correctional systems and other government agencies.

## MARCH

Centene announces it has agreed to acquire Community Medical Holdings Corp., a leading at-risk primary care provider, serving over 70,000 Medicaid, Medicare Advantage, and Health Insurance Marketplace program patients in Miami-Dade County, Florida.

Centene makes an initial investment in RxAdvance, a full-service pharmacy benefit manager. The partnership includes both a customer relationship and strategic investment in RxAdvance.



## MAY

Centurion Detention Health Services, a Centene subsidiary, is selected by the Pima County Arizona Board of Supervisors to provide comprehensive healthcare services to detainees of the county's adult and juvenile detention facilities in Tucson, Arizona.

Centene's Iowa subsidiary, Iowa Total Care, is tentatively awarded a statewide contract for the IA Health Link Program, which provides integrated Medicaid managed care coverage to over 600,000 Medicaid members in the state. Pending regulatory approval, the contract is expected to commence on July 1, 2019.

Coordinated Care, Centene's subsidiary in Washington state, is chosen to provide managed care services to Apple Health's Integrated Managed Care Medicaid beneficiaries in the King, Pierce, North Sound, Greater Columbia, and North Central Regional Service Areas.

## JUNE

Centene announces a partnership with the National Council on Independent Living on an initiative to increase the accessibility of provider medical offices and services for people with disabilities. Centene's Provider Accessibility Initiative launches the company's Barrier Removal Fund in three pilot states, Illinois, Texas and Ohio, as well as educational and compliance components that will be implemented in all Centene markets nationwide.

Centene's Kansas subsidiary, Sunflower Health Plan, is chosen to provide managed care services to KanCare beneficiaries statewide. KanCare provides medical and behavioral health benefits, as well as long-term services and supports, to approximately 400,000 members.



## JULY

Centene completes its acquisition of Fidelis Care, expanding Centene's national leadership in government-sponsored healthcare and giving Centene a presence in New York, the country's second largest managed care state by membership.

Health Net Federal Services, a Centene subsidiary, is awarded the next generation Military & Family Life Counseling Program contract through its MHN Government Services (MHNSG) company. Under the contract, MHNGS will deploy highly skilled and licensed behavioral health counselors on assignments throughout the United States, U.S. territories, and countries where the U.S. military is deployed.

Centene and Ascension, the nation's largest Catholic and nonprofit health system, announce they will explore a joint venture to establish a leading Medicare Advantage plan. The plan is expected to be implemented in multiple geographic markets beginning in 2020.

## AUGUST

Centurion Detention Health Services is selected to provide comprehensive healthcare services to detainees of Volusia County's detention facilities located near Daytona, Florida.



## OCTOBER

Centurion Detention Health Services is selected to provide comprehensive healthcare services to detainees at the Metropolitan Detention Center in Albuquerque, New Mexico.

Centene's Arizona subsidiary, Health Net Access, begins providing physical and behavioral healthcare services through the Arizona Health Care Cost Containment System Complete Care program in the central and southern regions.

## DECEMBER

Centene's Mississippi subsidiary, Magnolia Health, completes implementation of a transformative pharmacy benefit management model using RxAdvance's Collaborative PBM Cloud \( ^{™} \)  platform, covering 240,000 Mississippi Medicaid members.

Centene's Florida subsidiary, Sunshine Health, begins providing physical and behavioral healthcare services through Florida's Statewide Medicaid Managed Care Program under its new five-year contract, which was implemented for all 11 regions by February 2019.

Centene Corporation, which owns 50% of the Ribera Salud Group in Spain, announces it has purchased Sanitas' and Asisa's stake of the Torrejón Salud company, concessionaire of the University Hospital of Torrejón de Ardoz in Madrid. With this transaction, Centene owns 89% of the University Hospital, and Ribera Salud will assume management of the center.



Centene continues to gain national recognition for growth and innovation, as well as for our commitment to diversity and inclusion.



## Ranked No. 61 on FORTUNE \( ^{®} $ 500 List (2018):

Centene ranked No. 61 on the 2018 FORTUNE 500 \( ^{®} \)  list of largest U.S. corporations by revenue, up from No. 66 in 2017. Since first entering the list in 2010, Centene has climbed 425 spots.



## Ranked No. 210 on

FORTUNE \( ^{®} \)  Global 500 List (2018):
Centene ranked No. 210 on the 2018 FORTUNE Global 500 \( ^{®} \)  list of the world's largest corporations by revenue. Centene first appeared on the list in 2016 at No. 470.



## Gender-Equality Index:

Centene is listed on Bloomberg's 2019 Gender-Equality Index for our strong dedication to gender equality and the advancement of women in the workplace.

## Patriot Award:

Centene received the Patriot Award from the Office of the Secretary of Defense in recognition of our company's support of the National Guard, Reserve Forces, and their families.



From FORTUNE Magazine, February 2019, ©2019 Fortune Media IP Limited. FORTUNE and The World's Most Admired Companies are registered trademarks of Fortune Media IP Limited and are used under license. FORTUNE and Fortune Media IP Limited are not affiliated with, and do not endorse the products or services of, Centene Corporation.



## FORTUNE World's Most Admired Companies:

In 2018, Centene was selected as one of FORTUNE World's Most Admired Companies, a recognition chosen by healthcare industry executives, directors, and analysts asked to rate enterprises in their own industry on nine criteria, from investment value and quality of management and products to social responsibility and ability to attract talent.

## Disability Equality:

Centene was again recognized as a top employer by the American Association of People with Disabilities (AAPD).



100% DISABILITY EQUALITY INDEX

Supported by our solid foundation, we are continuously developing new ways to help our members get—and stay—healthy.

Through innovative ideas and programs, combined with cutting-edge technology, we continue to enhance access to high-quality care. With each step forward, we remain committed to the principles upon which our company was founded.



## PROVIDING GREATER HEALTHCARE ACCESS WITH DIGNITY

From the beginning, Centene has believed in removing barriers that may prevent our members from accessing quality healthcare. For those living with disabilities, physical barriers may serve as literal obstacles, deterring them from receiving the care they deserve. Centene’s partnership with the National Council on Independent Living aims to change that.

In keeping with our company’s history of removing healthcare barriers, Centene launched its Provider Accessibility Initiative to assist those living with disabilities in accessing quality healthcare. Designed in collaboration with the National Council on Independent Living (NCLI), the initiative aims to transition healthcare delivery into a fully accessible system for everyone.

As part of the initiative, Centene established a Barrier Removal Fund that invites participating providers to submit projects that focus on the removal of architectural barriers and the purchase of medical equipment, such as adjustable examination tables and weight scales. Proposals selected by local review committees made up of representatives from Centene health plans, health plan members, and disability advocacy organizations award grant money to fund each project, directly benefiting those with disabilities in their communities.

The initiative also expands the level of disability-inclusion information that Centene shares with members, including details about physical access to healthcare facilities, accessible equipment, and providers' programmatic access, such as the capability to communicate with patients who have hearing, vision, intellectual, or developmental disabilities.

In 2018, the initiative awarded more than 50 grants to participating network providers in three states—Illinois, Ohio, and Texas—where Centene operates health plans. Centene will expand the Provider Accessibility Initiative into additional states where the company operates subsidiaries. Centene also incorporated standardized disability access surveys as part of its provider credentialing process to gather more information about barriers to healthcare. Improving the accuracy and transparency of disability access data in provider directories is a top priority. Centene has long been committed to providing equal access to quality healthcare and services across our membership.

“Centene is leading the way on removing barriers to healthcare. The disabled community has just lived with these barriers to healthcare for so long. That’s what makes Centene’s program so important; it’s changing the landscape.”

— Kelly Buckland, Executive Director of the NCLI and member of Centene's National Disability Advisory Council
Centene's Provider Access Initiative received the 2019 Health Equity Award by the Centers for Medicare & Medicaid Services. The award recognizes organizations that close gaps in healthcare quality and access.







## BETTER HEALTH OUTCOMES FOR GROWING FAMILIES

By providing valuable health resources and information, Centene empowers our members to make healthy decisions that benefit themselves and their families.

For over 10 years, Start Smart for Your Baby \( ^{®} \) , Centene's award-winning education and outreach program, has helped pregnant members achieve healthy pregnancies while preventing premature births, low birthweight deliveries, and infant disease. One of the essential components of the program is the Notification of Pregnancy process, which identifies pregnant members and their risk factors as early as possible in order to establish a relationship between the member, provider, and health plan staff. Centene health plans manage over 200,000 deliveries each year.

## Start Smart for Your Baby Program Features

: Outreach activities such as baby showers connect members with clinical teams, care coordinators, and community partners in a fun and engaging setting.

Educational materials and incentives encourage prenatal, postpartum, and well-child visits.

Access to a personal nursing staff and advice line provides 24/7 healthcare support.

: Robust text and email campaigns provide tips on pregnancy and newborn care, including information on 2, 4, 6, 9, and 12-month milestones.






Centene has long leveraged innovative ideas to shape how healthcare is provided. That innovative spirit extends to technology, where Centene is using the latest tools to develop new methods of improving healthcare outcomes.

To better help the underserved, Centene utilizes cutting-edge technology to analyze crucial healthcare data and turn it into meaningful results for our members.

Developing complex algorithms through machine learning to better predict human behavior means that we can proactively deliver specialized programs and targeted interventions to populations most in need. Our powerful analytics engine, Interpreta, uses a robust database that can reveal which segments of the population are more susceptible to important health concerns. TruCare is our case management system for critically ill members who need more comprehensive management. And through our relationship with the pharmacy benefit manager RxAdvance, providers will be able to identify potential lower-cost drug options within therapeutic categories. Our investment in the latest technology allows us to move beyond simply responding to illness and enhances our ability to help our members take charge of their health.

Our continued investments in new technology have significantly enhanced our ability to scale, coordinate, and deliver care. While we embrace technological progress, we never lose sight of our purpose: transforming the health of the community, one person at a time.



Centene's Board of Directors provides exceptional business and healthcare insight that has helped shape our corporate culture of accountability, ethics, and integrity.

By analyzing 12 million medical data points in less than a minute, Interpreta can identify physiological or laboratory changes that could signal trouble.

Michael F. Neidorff
Chairman and Chief Executive Officer,
Centene Corporation

Orlando Ayala
Retired Chairman and Corporate Vice President of Emerging Businesses for Microsoft Corporation

Jessica L. Blume
Retired Vice Chairman of Deloitte LLP

Robert K. Ditmore
Retired Director, President and Chief Operating Officer of United Healthcare Corporation

Frederick H. Eppinger
Retired Director, President and Chief Executive Officer of The Hanover Insurance Group, Inc.

Michael F. Neidorff
Chairman and Chief Executive Officer,
Centene Corporation

Orlando Ayala
Retired Chairman and Corporate Vice President of Emerging Businesses for Microsoft Corporation

Jessica L. Blume
Retired Vice Chairman of Deloitte LLP

Robert K. Ditmore
Retired Director, President and Chief Operating Officer of United Healthcare Corporation

Frederick H. Eppinger
Retired Director, President and Chief Executive Officer of The Hanover Insurance Group, Inc.

BOARD OF DIRECTORS



Richard A. Gephardt
Chief Executive Officer and President of Gephardt Group, LLC; Former Majority Leader of the U.S. House of Representatives

John R. Roberts
Retired Regional Managing Partner,
Arthur Andersen LLP

David L. Steward
Founder and Chairman of World Wide Technology, Inc.

Tommy G. Thompson
Chairman and Chief Executive Officer of Thompson Holdings; Retired Partner of Akin Gump Strauss Hauer & Feld LLP; Former Governor of the State of Wisconsin; Former Health and Human Services Secretary



## QUARTERLY SELECTED
FINANCIAL INFORMATION

<table><tr><td rowspan="2"></td><td colspan="4">For the Quarter Ended, 2018 (in millions, except per share data in dollars) (unaudited)</td></tr><tr><td>March 31</td><td>June 30</td><td>September 30</td><td>December 31</td></tr><tr><td>Total revenues</td><td>$ 13,194</td><td>$ 14,181</td><td>$ 16,182</td><td>$ 16,559</td></tr><tr><td>Net earnings attributable to Centene Corporation</td><td>$ 340</td><td>$ 300</td><td>$ 19</td><td>$ 241</td></tr><tr><td>Net earnings per common share attributable to Centene Corporation:</td><td></td><td></td><td></td><td></td></tr><tr><td>Basic earnings per common share</td><td>$ 0.98</td><td>$ 0.77</td><td>$ 0.05</td><td>$ 0.59</td></tr><tr><td>Diluted earnings per common share</td><td>$ 0.96</td><td>$ 0.75</td><td>$ 0.05</td><td>$ 0.57</td></tr></table>

<table><tr><td rowspan="2"></td><td colspan="4">For the Quarter Ended, 2017 (in millions, except per share data in dollars) (unaudited)</td></tr><tr><td>March 31</td><td>June 30</td><td>September 30</td><td>December 31</td></tr><tr><td>Total revenues</td><td>$ 11,724</td><td>$ 11,954</td><td>$ 11,898</td><td>$ 12,806</td></tr><tr><td>Net earnings attributable to Centene Corporation</td><td>$ 139</td><td>$ 254</td><td>$ 205</td><td>$ 230</td></tr><tr><td>Net earnings per common share attributable to Centene Corporation:</td><td></td><td></td><td></td><td></td></tr><tr><td>Basic earnings per common share</td><td>$ 0.40</td><td>$ 0.74</td><td>$ 0.59</td><td>$ 0.67</td></tr><tr><td>Diluted earnings per common share</td><td>$ 0.39</td><td>$ 0.72</td><td>$ 0.58</td><td>$ 0.65</td></tr></table>

## SELECTED FINANCIAL INFORMATION

<table><tr><td rowspan="2"></td><td colspan="5">Year Ended December 31 (in millions, except share data in dollars and membership data)</td></tr><tr><td>2018</td><td>2017</td><td>2016</td><td>2015</td><td>2014</td></tr><tr><td>Income Statement Data:</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Total revenues</td><td>$ 60,116</td><td>$ 48,382</td><td>$ 40,607</td><td>$ 22,760</td><td>$ 16,560</td></tr><tr><td>Net earnings attributable to Centene Corporation</td><td>$ 900</td><td>$ 828</td><td>$ 562</td><td>$ 355</td><td>$ 271</td></tr><tr><td>Per Share Data:</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Net income attributable to Centene:</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Basic</td><td>$ 2.31</td><td>$ 2.40</td><td>$ 1.76</td><td>$ 1.49</td><td>$ 1.16</td></tr><tr><td>Diluted</td><td>$ 2.26</td><td>$ 2.34</td><td>$ 1.71</td><td>$ 1.44</td><td>$ 1.12</td></tr><tr><td>Other Information (unaudited):</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Health benefits ratio (1)</td><td>85.9%</td><td>87.3%</td><td>86.5%</td><td>88.9%</td><td>89.3%</td></tr><tr><td>Selling, general, and administrative expense ratio (2)</td><td>10.7%</td><td>9.7%</td><td>9.8%</td><td>8.5%</td><td>8.3%</td></tr><tr><td>Membership</td><td>14,019,600</td><td>12,207,100</td><td>11,441,800</td><td>5,107,900</td><td>4,060,900</td></tr><tr><td>Consolidated Balance Sheet Data:</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Cash and cash equivalents, Investments and restricted deposits</td><td>$ 13,480</td><td>$ 10,050</td><td>$ 9,118</td><td>$ 3,978</td><td>$ 3,167</td></tr><tr><td>Total assets</td><td>30,901</td><td>21,855</td><td>20,197</td><td>7,339</td><td>5,824</td></tr><tr><td>Medical claims liability</td><td>6,831</td><td>4,286</td><td>3,929</td><td>2,298</td><td>1,723</td></tr><tr><td>Long-term debt</td><td>6,648</td><td>4,695</td><td>4,651</td><td>1,216</td><td>874</td></tr><tr><td>Total stockholders&#x27; equity</td><td>11,013</td><td>6,864</td><td>5,909</td><td>2,168</td><td>1,743</td></tr></table>

(1) Health benefits ratio represents medical costs as a percentage of premium revenue.
(2) Selling, general, and administrative (SG&A) expense ratio represents SG&A expenses as a percentage of premium and service revenues.



## CORPORATE INFORMATION

The graph on the right compares the cumulative total stockholder return on our common stock for the period from December 31, 2013, to December 31, 2018, with the cumulative total return of the New York Stock Exchange Composite Index, the Standard & Poor's Supercomposite Managed Healthcare Index, and the Standard & Poor's 500 over the same period. The graph assumes an investment of $100 on December 31, 2013, in our common stock (at the last reported sale price on such day), the New York Stock Exchange Composite Index, the Standard & Poor's 500, and the Standard & Poor's Supercomposite Managed Healthcare Index, and assumes the reinvestment of any dividends.



<table><tr><td rowspan="2"></td><td colspan="5">Year Ended December 31</td></tr><tr><td>2018</td><td>2017</td><td>2016</td><td>2015</td><td>2014</td></tr><tr><td>GAAP net earnings attributable to Centene</td><td>$ 900</td><td>$ 828</td><td>$ 562</td><td>$ 355</td><td>$ 271</td></tr><tr><td>Amortization of acquired intangible assets</td><td>211</td><td>156</td><td>147</td><td>24</td><td>16</td></tr><tr><td>Acquisition related expenses</td><td>425</td><td>20</td><td>234</td><td>27</td><td>—</td></tr><tr><td>Other adjustments \( ^{(1)} \)</td><td>30</td><td>(7)</td><td>(134)</td><td>—</td><td>—</td></tr><tr><td>Income tax effects of adjustments \( ^{(2)} \)</td><td>(155)</td><td>(108)</td><td>(79)</td><td>(20)</td><td>(6)</td></tr><tr><td>Adjusted net earnings</td><td>$ 1,411</td><td>$ 889</td><td>$ 730</td><td>$ 386</td><td>$ 281</td></tr><tr><td>GAAP diluted earnings per share (EPS) attributable to Centene</td><td>$ 2.26</td><td>$ 2.34</td><td></td><td></td><td></td></tr><tr><td>Amortization of acquired intangible assets \( ^{(3)} \)</td><td>0.41</td><td>0.28</td><td></td><td></td><td></td></tr><tr><td>Acquisition related expenses \( ^{(4)} \)</td><td>0.81</td><td>0.04</td><td></td><td></td><td></td></tr><tr><td>Other adjustments \( ^{(1)} \)</td><td>0.06</td><td>(0.14)</td><td></td><td></td><td></td></tr><tr><td>Adjusted Diluted EPS</td><td>$ 3.54</td><td>$ 2.52</td><td></td><td></td><td></td></tr></table>

(1) Other adjustments include the following items:

2018 — the impact of retroactive changes to the California minimum medical loss ratio (MLR) of $30 million of expense or $0.06 per diluted share, net of an income tax benefit of $0.02;

2017 — (a) the Penn Treaty assessment expense of $56 million or $0.10 per diluted share, net of an income tax benefit of $0.06; (b) the cost sharing reduction (CSR) expense of $32 million or $0.04 per diluted share, net of an income tax benefit of $0.02; (c) the charitable contribution of $40 million or $0.07 per diluted share, net of an income tax benefit of $0.03; and (d) the benefit associated with income tax reform of $125 million or $0.35 per diluted share; and

2016 — (a) the impact of retroactive changes to the California minimum medical loss ratio (MLR) of a $95 million benefit or $0.38 per diluted share, net of an income tax expense of $0.21; (b) the charitable contribution of $30 million or $0.09 per diluted share, net of an income tax benefit of $0.06; and (c) the debt extinguishment cost of $1 million or $0.02 per diluted share, net of the income tax benefit of $0.01.

(2) The income tax effects of adjustments are based on the effective income tax rates applicable to adjusted (non-GAAP) results. There is no additional income tax effect from income tax reform.

(3) Amortization of acquired intangible assets per diluted share is net of an income tax benefit of $0.12 and $0.16 for the years ended December 31, 2018, and 2017, respectively.

(4) Acquisition related expenses per diluted share are net of an income tax benefit of $0.25 and $0.02 for the years ended December 31, 2018, and 2017, respectively.