{ "schemaVersion": "deck-intelligence.v1", "id": "019dd923-622c-750b-8b99-4fdf89a4b224", "slug": "bcbeb3ac7b21", "title": "Progyny, Inc. (PGNY)", "subtitle": "Spruce Point Capital Management · 2023-02", "author": "Spruce Point Capital Management", "date": "2023-02-07 00:00:00", "pageCount": 100, "kind": "activist-deck", "orientation": "landscape", "aspectRatio": 1.3333334, "targetCompany": "Progyny, Inc.", "targetTicker": "PGNY", "document": { "id": "019dd923-622c-750b-8b99-4fdf89a4b224", "slug": "bcbeb3ac7b21", "title": "Progyny, Inc. 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Used by AIDA, Monroes, Pixar Pitch, Overcoming the Monster." }, "evidence": "The document starts with a disclaimer and a track record of Spruce Point's successful short calls.", "position": 0, "isPrimaryArc": true, "parentBeatType": null, "alignedBlockIds": null, "matchConfidence": 0.8 }, { "to": 20, "arc": { "name": "Overcoming the Monster", "slug": "overcoming-monster", "status": "active", "bestFor": "Competitive positioning, rallying teams", "canonId": "019dd956-6339-76ac-9cbf-4b377c3aa89e", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "The Monster -> The Call -> The Struggle -> The Victory -> The New Order", "description": null, "familyLabel": null, "categoryName": "Booker's 7 Plots", "categorySlug": "booker-s-7-plots" }, "from": 6, "name": "Complication", "beatId": "03536da8-6567-4733-bfa6-135f9da8b71f", "matchId": "58e6ea24-2d1d-42d0-a666-d4b5fc7b7a5d", "beatType": { "name": "Complication", "slug": "complication", "status": "active", "canonId": "019dd9b8-0275-7709-b2d6-4f77c3fc7579", "version": 1, "description": "The point in the narrative where the audience should feel discomfort. Required for argumentative arcs." }, "evidence": "The document outlines several issues with PGNY's reporting, management, and industry position.", "position": 1, "isPrimaryArc": true, "parentBeatType": null, "alignedBlockIds": null, "matchConfidence": 0.8 }, { "to": 40, "arc": { "name": "Overcoming the Monster", "slug": "overcoming-monster", "status": "active", "bestFor": "Competitive positioning, rallying teams", "canonId": "019dd956-6339-76ac-9cbf-4b377c3aa89e", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "The Monster -> The Call -> The Struggle -> The Victory -> The New Order", "description": null, "familyLabel": null, "categoryName": "Booker's 7 Plots", "categorySlug": "booker-s-7-plots" }, "from": 21, "name": "Evidence", "beatId": "efa521e2-cd08-467d-b8d4-34bf61077d48", "matchId": "58e6ea24-2d1d-42d0-a666-d4b5fc7b7a5d", "beatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). 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Common (15/20 arcs) but not universal: Triple-take, AIDA, PAS, Voyage-return and Pixar substitute it with a strong reflection or development beat." }, "alignedBlockIds": null, "matchConfidence": 0.8 }, { "to": 100, "arc": { "name": "Overcoming the Monster", "slug": "overcoming-monster", "status": "active", "bestFor": "Competitive positioning, rallying teams", "canonId": "019dd956-6339-76ac-9cbf-4b377c3aa89e", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "The Monster -> The Call -> The Struggle -> The Victory -> The New Order", "description": null, "familyLabel": null, "categoryName": "Booker's 7 Plots", "categorySlug": "booker-s-7-plots" }, "from": 61, "name": "Resolution", "beatId": "470ad4dd-317c-46c8-baea-551e7894c3b9", "matchId": "58e6ea24-2d1d-42d0-a666-d4b5fc7b7a5d", "beatType": { "name": "Resolution", "slug": "mountain-resolution", "status": "active", "canonId": "019dd9b8-1ac2-777f-9a8f-ac543fee86f7", "version": 1, "description": null }, "evidence": "The document concludes with a detailed analysis of PGNY's valuation and downside risk.", "position": 4, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. Required in 19/20 arcs. The exception (Sparkline) ends with new bliss which is functionally a resolution." }, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 20, "from": 6, "loop": { "name": "03_aha_moment", "slug": "03-aha-moment", "status": "active", "bestFor": "Data-heavy sections, research findings, analytical arguments", "canonId": "019dd956-66f4-7668-ab25-cec9c996c0bc", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Problem/Question -> What the Data Shows -> The Insight", "description": "Establish a tension, present data, then deliver the insight that changes everything", "familyLabel": null, "categoryName": "Narrative", "categorySlug": "narrative" }, "matchId": "29317d8b-0853-47fe-b80c-7bbd608ade0d", "evidence": "The document presents several red flags in PGNY's reporting and management.", "position": 0, "objective": "What are the key issues with PGNY's reporting and management?", "confidence": 0.8, "extraction": { "at": "2026-07-16 22:00:38.916961+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 40, "from": 21, "loop": { "name": "08_analogy", "slug": "08-analogy", "status": "active", "bestFor": "Complex concepts, new markets, technical explanations for non-experts", "canonId": "019dd956-6901-7032-ba44-96eaed94c949", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Familiar Domain -> Key Parallel -> Applied to Our Situation -> Insight", "description": "Explain the unfamiliar through a well-understood parallel domain", "familyLabel": null, "categoryName": "Explanation", "categorySlug": "explanation" }, "matchId": "4e433b19-425e-470c-ae68-d0798fdfcf36", "evidence": "The document uses industry comparisons to highlight PGNY's weaknesses.", "position": 1, "objective": "How does PGNY's business model compare to its competitors?", "confidence": 0.7, "extraction": { "at": "2026-07-16 22:00:38.964382+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 60, "from": 41, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null, "categoryName": "Urgency", "categorySlug": "urgency" }, "matchId": "5bfedd73-ff97-471a-8921-89fcfab889c8", "evidence": "The document highlights significant downside risk to PGNY's stock price.", "position": 2, "objective": "What are the consequences of not addressing PGNY's issues?", "confidence": 0.8, "extraction": { "at": "2026-07-16 22:00:39.014486+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } }, { "to": 100, "from": 61, "loop": { "name": "40_mece_breakdown", "slug": "40-mece-breakdown", "status": "active", "bestFor": "Problem structuring, ensuring completeness, strategic analysis", "canonId": "019dd956-763c-765e-8b68-6ee3ae1ef184", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Whole -> Category A (distinct) -> Category B (distinct) -> Category C (distinct) -> Complete Coverage", "description": "Divide a complex topic into mutually exclusive, collectively exhaustive categories", "familyLabel": null, "categoryName": "Consulting Framework", "categorySlug": "consulting-framework" }, "matchId": "db636762-5e9e-4cb6-8376-e0923a5a5438", "evidence": "The document presents a detailed analysis of PGNY's valuation and downside risk.", "position": 3, "objective": "How do PGNY's issues impact its valuation?", "confidence": 0.7, "extraction": { "at": "2026-07-16 22:00:39.058327+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "tools": [ { "tool": { "name": "CEO quote contradiction", "slug": "ceo-quote-contradiction", "status": "active", "bestFor": "When management credibility is the lever", "canonId": "019dd9e1-52e9-717f-8454-93e627563ed6", "version": 1, "bodyDocId": "019dd9a1-8296-720d-8f51-da76937f9415", "description": "You reproduce management's own words — verbatim, with source and date — and\nthen place them next to the outcome that contradicts them. The CEO built\nthe rope; you put it around their own neck.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "document", "agents": null, "matchId": "41b1ad07-68c6-4b9c-9e26-9ba63e48f501", "evidence": null, "pageRefs": null, "priority": null, "whenToUse": "When management credibility is the lever", "confidence": null, "extraction": { "at": "2026-04-29 12:07:50.073129+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": null, "whyItWorks": "- **Maximum credibility**: no adjective you could write is as damning as the\n target's own prior statement.\n- **No rebuttal path**: management can't argue they didn't say it.\n- **It forces accountability onto a person**, not an institution — even if\n you aren't explicitly naming a villain elsewhere.\n- **Reporters amplify it**. 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The gap is the\npunchline.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "document", "agents": null, "matchId": "df6f2929-6e89-41c9-9d2e-4337f7f3be83", "evidence": null, "pageRefs": null, "priority": null, "whenToUse": "When relative underperformance is the core argument", "confidence": null, "extraction": { "at": "2026-04-29 12:07:50.073129+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": null, "whyItWorks": "- It's the **most credible claim in the deck** because it's arithmetic, not\n opinion.\n- It's immediately **actionable** — close this gap and value accrues.\n- It **pre-empts the \"context is different\" defence** by pitting the target\n against direct peers in the same category.", "antipattern": null, "cardinality": null, "narrativePurpose": null }, { "tool": { "name": "Sum of parts", "slug": "sum-of-parts", "status": "active", "bestFor": "For breakup / spin-off theses", "canonId": "019dd9e1-51e5-73ad-9d1e-e77d4afe3125", "version": 1, "bodyDocId": "019df22a-9ecd-71db-8fa1-5f5eff36697f", "description": "You break the target into its constituent businesses or asset classes, value\neach separately against its own peer set, and show that the total is\nmaterially greater than the current market capitalisation. The \"gap\" is the\nconglomerate discount — or worse, accounting opacity hiding a crown-jewel\nasset.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "document", "agents": null, "matchId": "4cfa990c-f1c3-41b6-9250-3ed8a583f597", "evidence": null, "pageRefs": null, "priority": null, "whenToUse": "For breakup / spin-off theses", "confidence": null, "extraction": { "at": "2026-04-29 12:07:50.073129+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": null, "whyItWorks": "- It forces the market to confront **mismatched valuation multiples**:\n \"this company trades like X but owns Y, which trades at", "antipattern": null, "cardinality": null, "narrativePurpose": null }, { "tool": { "name": "Villain naming", "slug": "villain-naming", "status": "active", "bestFor": "When governance or specific decisions are the core thesis", "canonId": "019dd9e1-55a4-74db-9314-0ced4cd46cd2", "version": 1, "bodyDocId": "019dd9a1-88f1-72ad-8f4e-56ec29d7b369", "description": "You identify a **specific person** responsible for the target's underperformance\nor the behaviour you want changed — and name them. 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An individual can be removed; an abstraction\n cannot.\n- It **forces the target to respond personally** — and their defensive\n response usually generates more attention for your thesis.", "antipattern": null, "cardinality": null, "narrativePurpose": null }, { "tool": { "name": "Villain slide", "slug": "villain-slide", "status": "active", "bestFor": "In activist decks where the personality matters", "canonId": "019dd9e1-518c-7404-976a-5be5a517b659", "version": 1, "bodyDocId": null, "description": "A dedicated slide presenting the named villain visually", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "document", "agents": null, "matchId": "044af883-db93-4c14-ae27-404194ea19b2", "evidence": null, "pageRefs": null, "priority": null, "whenToUse": "In activist decks where the personality matters", "confidence": null, "extraction": { "at": "2026-04-29 12:07:50.073129+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": null, "whyItWorks": "Makes the antagonist concrete", "antipattern": null, "cardinality": null, "narrativePurpose": null }, { "tool": { "name": "Valuation: Precedent transactions", "slug": "precedent-transactions", "status": "active", "bestFor": null, "canonId": "019df269-22b0-70fc-b5b7-8d6ee69c15dd", "version": 1, "bodyDocId": "019df22a-9e2b-7165-a5f9-f94a9758ce38", "description": "You apply multiples derived from comparable historical M&A transactions", "familyLabel": "valuation-move", "categoryName": "Analysis", "categorySlug": "analysis" }, "agent": "architect", "layer": "slide", "agents": [ "architect" ], "matchId": "b9456cb9-e187-423d-b3ce-b76a8aba94bc", "evidence": "Comparison table of FIGS, HSKA, and PETQ across report date, enterprise value, situation, analysis, and outcome.", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.7, "extraction": { "at": "2026-07-16 23:04:48.6546+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 3, "whyItWorks": null, "antipattern": null, "cardinality": null, "narrativePurpose": null }, { "tool": { "name": "Thesis archetype", "slug": "thesis-archetype", "status": "active", "bestFor": null, "canonId": "019dd9e1-4b0b-7428-9b26-f171d1e753fb", "version": 1, "bodyDocId": null, "description": "A canonical investment / activist thesis shape (breakup, fraud, governance).", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "slide", "agents": null, "matchId": "fabe7641-6d7a-47f5-959f-6a3e861fc376", "evidence": "Spruce Point Issues A “Strong Sell” Opinion On Progyny (PGNY) With 60% - 80% Downside Risk", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.8, "extraction": { "at": "2026-07-16 23:04:48.796405+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 6, "whyItWorks": null, "antipattern": null, "cardinality": "optional", "narrativePurpose": null }, { "tool": { "name": "Storytelling: audience calibration", "slug": "audience", "status": "active", "bestFor": null, "canonId": "019df269-23ea-723a-87c0-af1d78d702d2", "version": 1, "bodyDocId": "019df269-23c5-72ec-8b94-78fc1da7b656", "description": "The same thesis, written for four different audiences, produces four", "familyLabel": "narrative-block", "categoryName": "Narrative & Transformation", "categorySlug": "narrative-transformation" }, "agent": "storyteller", "layer": "slide", "agents": [ "storyteller" ], "matchId": "3198bedc-cd19-4dc6-b17e-25259b8d8d01", "evidence": "We Believe PGNY’s Differentiation Fades As Its Competitive Landscape Becomes Increasingly Crowded", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.7, "extraction": { "at": "2026-07-16 23:04:45.122303+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 52, "whyItWorks": null, "antipattern": null, "cardinality": null, "narrativePurpose": null }, { "tool": { "name": "Audience Definition", "slug": "audience-definition", "status": "active", "bestFor": null, "canonId": "019dd956-7f2a-775d-aeee-ff099bcb7756", "version": 1, "bodyDocId": null, "description": "Six key questions: Who are they? What do they know? What do they believe? What do they care about? What do they fear? 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valuation arguments. Strongest rhetorical devices: (1) the Medical Manager fraud org chart on p.15 visually color-coding indicted executives vs. current PGNY executives; (2) the 'Sarah' before/after reframing on p.86 turning PGNY's own marketing deck against itself; (3) the IVF-vs-IUI cost/efficacy table on p.87. Document is primary material authored by Spruce Point. Campaign phase coded as initial_thesis: although a prior unnamed bearish report existed on PGNY, this is Spruce Point's own first public thesis on the name.", "kpisCited": [ { "detail": "60% to 80% downside, implying $7 to $14 per share vs. $33.43 close on 2/6/2023", "metric": "Downside to share price" }, { "detail": "$3.1 billion at time of report", "metric": "Market capitalization" }, { "detail": "Over $700 million", "metric": "LTM revenue" }, { "detail": "~$142m in 2021, ~40% of medical revenue at an assumed $5,000 per cycle across 28,413 ART cycles", "metric": "PGT revenue concentration" }, { "detail": "Reduced from 52% pre-IPO to 14% per 2021 proxy", "metric": "Insider ownership" }, { "detail": "Up to $52 million of 2023 revenue at risk from announced client layoffs", "metric": "At-risk revenue from layoffs" }, { "detail": "~47% of 2022 incremental revenue came from non-repeatable drivers", "metric": "Incremental 2023 revenue at risk" }, { "detail": "80% Buy / 20% Neutral; average PT $47 (+41% upside) across 6 analysts", "metric": "Sell-side recommendation mix" }, { "detail": "Spruce Point $45m vs consensus $69m", "metric": "2023E Adjusted EBITDA (SBC-adjusted)" }, { "detail": "Growth-healthcare peer average ~18.7x 2023E; insurance peer average ~8.8x", "metric": "EV/Adj. EBITDA multiple" }, { "detail": "IUI ~$2k average vs IVF ~$20k average", "metric": "IUI vs IVF cost per cycle" }, { "detail": "16 executives indicted; fraud spanned 1997-2003", "metric": "Medical Manager fraud scale" } ], "closingAsk": "Investors should sell PGNY given 60%-80% downside to a $7-$14 fair value given management's fraud-adjacent history, disputable marketing, conflicted treatment model and overly optimistic consensus.", "extraction": { "at": "2026-04-22 21:41:40+00", "model": "unknown-legacy", "runId": null, "seconds": 118.458435, "promptVersion": null }, "scqaReward": "Spruce Point's fair value price target is $7 to $14 per share, representing approximately 60% to 80% downside from the $33.43 closing price on February 6, 2023.", "thesisTypes": [ "fraud_exposure", "governance_board", "management_change" ], "top3Reasons": [ "Top PGNY executives held senior roles at Medical Manager/WebMD during a 16-executive accounting fraud", "PGNY's 'direct to IVF' model and PGT push maximize revenue but lack scientific support", "Competitive commoditization, client churn and utilization headwinds make 2023 consensus unachievable" ], "scqaSituation": "Progyny is a $3.1bn Nasdaq-listed fertility benefit manager that sells a structured fertility insurance benefit to self-insured employers, mostly large tech firms, and has grown to over $700m in LTM revenue since its 2019 IPO.", "thesisSummary": "Spruce Point argues Progyny is a Strong Sell with 60%-80% downside to $7-$14 per share. The top three PGNY executives and a director all held senior roles at Medical Manager/WebMD when a 16-executive accounting fraud unfolded, and Spruce Point sees echoes in PGNY's forensic red flags: spiking unbilled receivables, disparity between reported Adjusted EBITDA and operating cash flow, and questionable client/member disclosures. The firm contends PGNY's 'superior outcomes' marketing is methodologically flawed, its direct-to-IVF and preimplantation genetic testing protocols serve revenue rather than science, and its treatment mandates may violate corporate practice of medicine laws. Combined with a commoditizing competitive landscape (Kindbody, Carrot, Maven, WIN), rising CAC, maturing utilization, and pharmacy-price tailwinds rolling off, Spruce Point projects 2023 consensus is too high and insiders have cut their stake from 52% pre-IPO to 14%.", "primaryDemands": [ "Investors should sell PGNY shares given 60%-80% downside risk", "Scrutinize management team's prior association with Medical Manager/WebMD accounting fraud", "Question PGNY's disputable outcomes marketing claims and treatment model conflicts of interest", "Reassess consensus 2023 revenue and EBITDA estimates given mounting headwinds" ], "scqaResolution": "Sell PGNY: reject management's outcomes claims and growth story, apply a discounted healthcare multiple to a realistic Adjusted EBITDA that adds back stock-based compensation, and recognize that 2023 consensus revenue and EBITDA estimates are too high.", "thesisOneLiner": "PGNY is a $3.1bn fertility-benefits manager run by ex-WebMD/Medical Manager 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However, we find that PGNY’s marketing claims, and its outcomes data in particular, are highly problematic, and that PGNY’s treatment model is so popular with the fertility industrial complex because it maximizes revenue for all parties involved despite clear conflicts of interest and questionable support from existing scientific research. Beyond PGNY management's past proximity to a massive accounting fraud, we are struck by the team’s extremely limited healthcare expertise and the unsavory parallels in healthcare conflicts of interest between WebMD and PGNY. To top it off, we believe Wall Street analysts have wrongly compared PGNY to high-margin, technology-related healthcare companies when the Company is nothing of the sort. 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The Company offers a structured fertility insurance benefit targeting self-insured employers. The Company does not operate its own fertility clinics or provide any medical services. 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We highlight additional accounting concerns related to revenue and expense recognition, as well as significant inconsistencies related to the Company’s client and member disclosures. We find that member churn is greater than PGNY implies and that revenue from its two largest clients, Amazon and Alphabet, likely declined last quarter. Moreover, we have identified numerous headwinds to PGNY’s growth in 2023 which suggest the Company will likely miss current Street expectations. These include several non-recurring revenue sources from 2022, macroeconomic factors such as layoffs, downward pressure on benefit utilization, and an increasingly competitive environment as the fertility marketplace quickly becomes commoditized. Further, we believe that pharmacy benefit outperformance, which has counteracted medical revenue disappointments, will cease in 2023. 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We believe the research was both compelling and consistent with our own findings. 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We find that, if anything, it is these other players that have the most competitive differentiation in terms of business model (Kindbody, with owned clinics), payer relationships (WIN Fertility, with strong payer links), international scope (Carrot, with arguably the leading solution for employees outside the US), and breadth of solution (Maven, taking a more holistic view of women's health), and several of these players have innovated in areas such as payments and personal technology leverage (such as apps and wearables).", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "21d2b733-bf31-4dc6-910a-b1ae4f0b99af", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.96, "x": 0.02, "y": 0.91 }, "kind": "paragraph", "text": "We believe PGNY has glossed over the threats to its client base and has likely understated client churn. We find high profile examples of lost clients such as Activision provide a reality check on the PGNY marketing pitch. We identify specific risks at three major PGNY clients (in particular that Google Ventures is an investor in Kindbody) and note that nearly half of PGNY existing clients will roll-off their initial contracts in the coming two years.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2e656996-bd0d-43fb-b01b-bec6b961c687", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Technology companies were early adopters of fertility benefits, but benefits consultants with whom we spoke generally consider the market for large tech clients nearing saturation. Importantly, our analysis of fertility benefit coverage indicates that newer PGNY clients, more often outside knowledge worker sectors, are offering less generous (averaging a half cycle lower) benefits, meaning that new customers offer lower potential revenue per member.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6f066734-5b55-47b3-a12c-fe5b486d400f", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.96, "x": 0.02, "y": 0.29 }, "kind": "paragraph", "text": "At the same time, in contradiction to management's claims of improved marketing and sales efficiency, we find that PGNY's cost of customer acquisition has skyrocketed since 2019, and the Company's increasing reliance on smaller clients will likely exacerbate these pressures.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8a828e77-6805-4b57-b4b4-bc098e6a53e4", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.96, "x": 0.02, "y": 0.82 }, "kind": "paragraph", "text": "Just as PGNY's differentiation fades, two large competitive threats will likely loom. First, given their existing infrastructure and clinic relationships, we believe the large payers have an easy path to market entry, as developing a specialized fertility benefit is relatively easy. Second, given the aforementioned role of private equity in the clinic sector, we wouldn't be surprised to see a major clinic network offer their own fertility benefit to regional employers emulating the Kindbody model.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b414401b-16c8-4993-8333-f29c164a1d60", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.96, "x": 0.02, "y": 0.75 }, "kind": "paragraph", "text": "We believe investors have wrongly discounted PGNY's competitors since they are all private companies with minimal visibility. However, Google search trends, employee growth, member adds, and competitor financing trends highlight PGNY's deteriorating competitive position and the significantly greater pressures the Company will face.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b59fce89-6c75-4d57-8964-e57c9fac94de", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.96, "x": 0.02, "y": 0.36 }, "kind": "paragraph", "text": "We also believe that PGNY will face increasing cost pressures from its clinic network. Constrained clinic capacity in the face of increasing benefit manager competition and member adds means that clinics are likely gaining negotiating leverage, and PGNY clinic contracts are typically for only one-year terms, facilitating frequent repricing of economic splits. Moreover, the fertility landscape has been an area of significant consolidation by firms under private equity ownership, so we expect that larger, more financially sophisticated clinic networks will be able to exert materially greater financial pressure in contract negotiations with PGNY.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e829eda6-2659-4109-a4f8-44570e0a6374", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.96, "x": 0.02, "y": 0.55 }, "kind": "paragraph", "text": "Despite being the largest pure play, PGNY offers only modest differentiation or sustainable competitive advantage. The PGNY approach to fertility (for better or worse) has essentially become the standard of care among the focused fertility benefit managers. And since PGNY's relationships with its clinics are non-exclusive, PGNY lacks both operational control over costs and quality and any differentiation as it regards its clinic network.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f3345781-aec3-43e4-b6d7-3d110b31df12", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.65, "x": 0.31, "y": 0.05 }, "kind": "title", "text": "PGNY Has Little Competitive Advantage And New Entrants Have Gained Ground In A Rapidly Commoditizing Industry", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "73bd740d-2c9a-4fb7-8fb9-fda8c794ed8e", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "0175e68c-38ad-4c90-be6f-fd37ecc3d24f", "evidence": "The slide systematically breaks down competitive threats, market commoditization, and loss of differentiation.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:31:09.87+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 8, "frameworkName": "competitive-analysis" } ], "arcBeats": [ { "to": 20, "arc": { "name": "Overcoming the Monster", "slug": "overcoming-monster", "status": "active", "bestFor": "Competitive positioning, rallying teams", "canonId": "019dd956-6339-76ac-9cbf-4b377c3aa89e", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "The Monster -> The Call -> The Struggle -> The Victory -> The New Order", "description": null, "familyLabel": null }, "from": 6, "name": "Complication", "beatId": "03536da8-6567-4733-bfa6-135f9da8b71f", "matchId": "58e6ea24-2d1d-42d0-a666-d4b5fc7b7a5d", "beatType": { "name": "Complication", "slug": "complication", "status": "active", "canonId": "019dd9b8-0275-7709-b2d6-4f77c3fc7579", "version": 1, "description": "The point in the narrative where the audience should feel discomfort. 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We contend that such a claim is practically meaningless since its clinic relationships are non-exclusive.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.043+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3976ffca-2cf3-4942-83e0-d8642e4bf220", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.92, "x": 0.05, "y": 0.22 }, "kind": "list", "text": "PGNY heavily markets its pregnancy outcomes versus both national averages and those of non-members at PGNY in-network clinics. We believe these comparisons are so misguided as to make PGNY’s claims invalid.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.043+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "57a67cf3-d732-4337-9794-85811a86e59b", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.92, "x": 0.05, "y": 0.82 }, "kind": "list", "text": "Second, numerous studies have called into question the utility of preimplantation genetic testing. Thus, we question whether its aggressive embrace by PGNY is simply a revenue grab. For reference, we estimate that such tests contributed $142 million of revenue in 2021, representing 40% of medical revenue.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.043+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7823b44f-4039-4af7-a27d-9907a87bdbd3", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.92, "x": 0.05, "y": 0.67 }, "kind": "list", "text": "Finally, we highlight examples of where PGNY exaggerates the scope of its fertility benefit and the potential savings to employers.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.043+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "90ab0860-2090-4911-8704-abdbd09b9d5c", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.92, "x": 0.05, "y": 0.45 }, "kind": "list", "text": "While PGNY management has touted superior trends relative to national averages, we find those claims to be disputable. More concerning, we find that PGNY’s miscarriage rates have increased sharply since 2019.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:09.043+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a46eaa6e-d5e3-4d38-ac83-97c54a9fbf8f", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.92, "x": 0.05, "y": 0.61 }, "kind": "list", "text": "PGNY’s other major marketing point is that it offers members individualized care and guidance by offering access to a 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The Company went public in 1997 and embarked on an aggressive roll-up strategy, eventually acquiring ~135 companies in the following three years. In July 1999, Medical Manager was acquired for $1.4 billion by Synetic, a supplier of plastic/filtration products whose e-commerce subsidiary CareInsite was later spun-off. The combined company took the Medical Manger name, and most senior management roles went to former Medical Manager executives. WebMD merged with Healtheon in 1999 and subsequently acquired Medical Manager (including its publicly traded internet subsidiary CareInsite) in a $2.1 billion deal that closed in September 2000. In 2005, ten executives from Medical Manager were indicted for conspiracy and money laundering related to a wide range of fraudulent accounting practices related to acquired companies designed to inflate earnings between 1997 and 2003. 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Schlanger first evaluated Medical Manager as the primary deal executive in 1999 and later evaluated and executed additional deals as part of Medical Manager and WebMD during an additional four years that the scheme was perpetrated.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:14.493+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7c39a8fd-8513-4e61-ad90-d59e039154dd", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.84, "x": 0.08, "y": 0.00175 }, "kind": "callout", "text": "PGNY Executive Chairman and former CEO David Schlanger was the primary M&A executive evaluating Medical Manager while at Synetic. Later, he was SVP of Corporate Development at Medical Manager and WebMD, executing numerous transactions during a period when acquired companies were used as an instrument of accounting fraud.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:14.493+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "985ce128-afd9-41b3-957e-83b034b24368", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.5, "x": 0.48, "y": 0.35 }, "kind": "image", "text": "LinkedIn profile screenshot showing work history at WebMD and Medical Manager Corp.", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:14.493+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2338336f-e26e-45e0-8f75-f136be4350a6", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.46, "x": 0.02, "y": 0.35 }, "kind": "paragraph", "text": "According to his LinkedIn profile, Schlanger was SVP Corporate Development at Medical Manager from Jan 1995 to Sep 2001 and maintained that role at WebMD through Dec 2011. He was originally SVP Corporate Development at Synetic, which acquired Medical Manager. An article regarding the deal in the Tampa Bay Times included the following statement by Schlanger: \"Medical Manager has done a great job in creating an electronic infrastructure that we can use to deploy our e-commerce network in doctors' offices,\" said David Schlanger, senior vice president at Synetic. \"It's a combination that makes great sense.\" We note that, given his role as SVP Corporate Development at Synetic, Schlanger may have been responsible for assessing the Medical Manager business over two years into its fraudulent scheme. 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activities.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:05+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ed-84713d58ec54", "parentComponentId": null }, { "bbox": { "h": 0.21, "w": 0.47, "x": 0.51, "y": 0.39 }, "kind": "image", "text": "LinkedIn profile screenshot for Mark Livingston", "attrs": null, "canon": { "kind": { "name": "Image", 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Spruce Point has identified only one senior finance executive that was hired in 2019, Mark Livingston who worked at WebMD from 1999 to 2006.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dc8a76b1-93c4-4199-9beb-2a090a91b83c", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Although, we could debate whether Livingston had the requisite background to remediate a material weakness, we do note that Livingston's previous work experience included 7 years at WebMD from 1999 to 2006 which overlapped with Anevski and Schlanger.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:06+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ed-bb15da7fdd54", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.41, "x": 0.11, "y": 0.0034500000000000004 }, "kind": "image", "text": "Excerpt from PGNY Draft Prospectus regarding material weakness", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cb657c13-e60e-49a1-9ee8-b16083daeeb6", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.35, "x": 0.56, "y": 0.00495 }, "kind": "paragraph", "text": "Mark Livingston, Current CFO of PGNY, was hired in May 2019 as an EVP of Finance. Although, we could debate whether Livingston had the requisite background to remediate a material weakness, we do note that Livingston's previous work experience included 7 years at WebMD from 1999 to 2006 which overlapped with Anevski and Schlanger.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "617dc920-b89a-454e-bd83-d29e8f0c70eb", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.38, "x": 0.01, "y": 0.97 }, "kind": "source-note", "text": "Source: PGNY Draft Prospectus, Source: Mark Livingston Bio -- LinkedIn", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8d64b717-fd97-4d32-ae8f-7d76a0cd24d0", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.65, "x": 0.31, "y": 0.02 }, "kind": "title", "text": "PGNY Disclosed A Material Weakness In Its FY18 Financials", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8e73ddae-c541-4e3e-a75d-1ab5a178184d", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "be0cb45b-9a91-4230-a394-69861e49a919", "evidence": "The slide explicitly links a material weakness disclosure to a questionable remediation hire to imply potential governance failure.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:31:13.351+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 18, "frameworkName": "fraud-exposure" } ], "arcBeats": [ { "to": 20, "arc": { "name": "Overcoming the Monster", "slug": "overcoming-monster", "status": "active", "bestFor": "Competitive positioning, rallying teams", "canonId": "019dd956-6339-76ac-9cbf-4b377c3aa89e", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "The Monster -> The Call -> The Struggle -> The Victory -> The New Order", "description": null, "familyLabel": null }, "from": 6, "name": "Complication", "beatId": "03536da8-6567-4733-bfa6-135f9da8b71f", "matchId": "58e6ea24-2d1d-42d0-a666-d4b5fc7b7a5d", "beatType": { "name": "Complication", "slug": "complication", "status": "active", "canonId": "019dd9b8-0275-7709-b2d6-4f77c3fc7579", "version": 1, "description": "The point in the narrative where the audience should feel discomfort. Required for argumentative arcs." }, "evidence": "The document outlines several issues with PGNY's reporting, management, and industry position.", "position": 1, "isPrimaryArc": true, "parentBeatType": null, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 20, "from": 6, "loop": { "name": "03_aha_moment", "slug": "03-aha-moment", "status": "active", "bestFor": "Data-heavy sections, research findings, analytical arguments", "canonId": "019dd956-66f4-7668-ab25-cec9c996c0bc", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Problem/Question -> What the Data Shows -> The Insight", "description": "Establish a tension, present data, then deliver the insight that changes everything", "familyLabel": null }, "matchId": "29317d8b-0853-47fe-b80c-7bbd608ade0d", "evidence": "The document presents several red flags in PGNY's reporting and management.", "position": 0, "objective": "What are the key issues with PGNY's reporting and management?", "confidence": 0.8, "extraction": { "at": "2026-07-16 22:00:38.916961+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 19, "type": "tension", "title": "The slide uses a red flag icon to signal a warning or 'red flag' regarding management's past conduct.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 76, "componentCount": 8, "textChars": 2809, "nDataPoints": 0, "notes": "The slide uses a red flag icon to signal a warning or 'red flag' regarding management's past conduct.", "elementsJson": [ "headline_text", "callout_box", "section_divider", "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:31:10.104+00", "seconds": 3.682, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-4fdf89a4b224/19", "deck": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224", "deckAnchor": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224#slide-19", "deckJson": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224.json" }, "components": [ { "bbox": { "h": 0.15, "w": 0.88, "x": 0.11, "y": 0.0017 }, "kind": "callout", "text": "WebMD generated revenue through advertising (essentially what we view as medical clickbait) and sponsored content for pharma, biotech, medical device, and other healthcare related companies. During the tenures of Schlanger and Anevski, WebMD was clouded by several scandals that called into question the credibility of information posted on the site, business model conflicts of interest, and the ethics of senior management.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5951c068-d489-429a-91e8-d644a41a761b", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "WebMD generated revenue through advertising (essentially what we view as medical clickbait) and sponsored content for pharma, biotech, medical device, and other healthcare related companies.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:06+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-32cdef644311", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.98, "x": 0.02, "y": 0.0031 }, "kind": "paragraph", "text": "Conflicts of Interest and Trust Issues at WebMD", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "155bc296-723d-4bd1-83cd-5a81313b5ca7", "parentComponentId": null }, { "bbox": { "h": 0.4, "w": 0.98, "x": 0.02, "y": 0.0044 }, "kind": "paragraph", "text": "Recent troubles at WebMD date back to early 2010 when a very public scandal surfaced—one that may have permanently tarnished WebMD's image for a significant number of customers—that ended with a formal investigation by the US Senate in which a letter from Senator Charles Grassley of the US Senate Finance Committee stated that he was \"concerned about the independence between WebMD and industry since many people access WebMD seeing it as an independent, objective medical resource.\" The concern focused on a \"rigged\" online test for depression that was created so that even if the user answered \"no\" to all of the 10 questions (which are all framed so that the \"yes\" answer indicates depressed behavior) the test's response would include the phrase that \"You may be at risk for major depression.\" At issue is the complicated relationship between the user and WebMD's online information and the user's awareness of WebMD's ties to pharmaceutical companies. For instance, from WebMD's general depression information page, an editorial link to a \"Depression Quiz\" takes you to a depression screening page, funded by Lilly, which makes the antidepressant Cymbalta. Worse, a banner ad from the same depression home page takes you directly to a Cymbalta-sponsored page titled Learning to Treat Depression, whose layout and design are hard to distinguish from non-sponsored content.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "31c50e28-3ab3-406c-b96f-136dd3d18553", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.98, "x": 0.02, "y": 0.0038 }, "kind": "paragraph", "text": "The Pharma-Funded Health Survey Scandal", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.104+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5eb0c86d-5c15-41fe-b5b4-0b0a6d322721", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Recent troubles at WebMD date back to early 2010 when a very public scandal surfaced—one that may have permanently tarnished WebMD’s image for a significant number of customers—that ended with a formal investigation by the US Senate in which a letter from Senator Charles Grassley of the US Senate Finance Committee stated that he was “concerned about the independence between WebMD and industry since many people access WebMD seeing it as an independent, objective medical resource.” — Excerpt from “Has WebMD become Synonymous with Big Pharma?”, Business Insider, 10/31/12", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:06+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-366563fc632b", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.5, "x": 0.02, "y": 0.0085 }, "kind": "source-note", "text": "- Excerpt from \"Has WebMD become Synonymous with Big Pharma?\", Business Insider, 10/31/12", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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As a result, in some cases, consumers have been denied access to the drugs of competing manufacturers. In addition, the merger has made it possible for Medco to share with Merck sensitive pricing information it gets from Merck's competitors, which could foster collusion among drug manufacturers.\"", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.599+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1c52d78b-f13b-4a3f-a2a8-484a2c90551d", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.35, "x": 0.08, "y": 0.74 }, "kind": "callout", "text": "\"Medco...submitted false claims to the government, solicited and accepted kickbacks from pharmaceutical manufacturers to favor their drugs, and paid kickbacks to health plans to obtain business\"", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.599+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f51483cc-7a2e-4410-8f0f-47d533d9d345", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Holstein claims that he \"helped create the business of prescription benefit management\". We note that years later, Medco was subsequently the target of several government judgements.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:06+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-4e52d982b850", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.47, "x": 0.45, "y": 0.74 }, "kind": "image", "text": "Department of Justice press release regarding $155 million settlement", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.599+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "32ffee65-d80f-4046-93b8-85c6891b27da", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.47, "x": 0.45, "y": 0.38 }, "kind": "image", "text": "Merck Settles FTC Charges that Its Acquisition of Medco Could Cause Higher Prices and Reduced Quality for Prescription Drugs", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.599+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7302168b-ebc4-4194-8d66-8754000413ad", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.84, "x": 0.08, "y": 0.17 }, "kind": "paragraph", "text": "Holstein claims that he \"helped create the business of prescription benefit management\". We note that years later, Medco was subsequently the target of several government judgements. In fact, the entire PBM sector has been targeted for government evaluation of rampant unfair business practices. Holstein has never been implicated by any federal agency for his role in the industry he claims to have helped create.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.599+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2d27587e-50e9-4939-937c-c2b98e85506d", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"We have found that Medco has given favorable treatment to Merck drugs. As a result, in some cases, consumers have been denied access to the drugs of competing manufacturers. In addition, the merger has made it possible for Medco to share with Merck sensitive pricing information it gets from Merck's competitors, which could foster collusion among drug manufacturers.\" — Federal Trade Commission", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:06+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-530eff67598f", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.02, "y": 0.97 }, "kind": "source-note", "text": "Source: FTC press release, DOJ press release", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.599+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2707e2f2-a5bc-4459-8504-1579dd1fd295", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.65, "x": 0.31, "y": 0.03 }, "kind": "title", "text": "Is This The Business Model That Holstein \"Created\"?", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.599+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3e10aed6-c5ad-4e23-b881-a22b2c345dcb", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.84, "x": 0.08, "y": 0.31 }, "kind": "title", "text": "Government Judgments Against Medco Based on Actions During Holstein's Tenure", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Subtitle", "slug": "subtitle", "status": "active", "canonId": "019de52c-fb09-739d-900c-815b0d9ac526", "version": 1, "description": null }, "framework": null }, "subkind": "subtitle", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:10.599+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8b85c303-3082-47d2-a9f9-ca44a60312bf", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "d5c6eb0d-5317-487b-b3fd-408fb0bbf257", "evidence": "Contrasting subject's claim with legal evidence of misconduct", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:31:10.599+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 23, "frameworkName": "fraud-exposure" } ], "arcBeats": [ { "to": 40, "arc": { "name": "Overcoming the Monster", "slug": "overcoming-monster", "status": "active", "bestFor": "Competitive positioning, rallying teams", "canonId": "019dd956-6339-76ac-9cbf-4b377c3aa89e", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "The Monster -> The Call -> The Struggle -> The Victory -> The New Order", "description": null, "familyLabel": null }, "from": 21, "name": "Evidence", "beatId": "efa521e2-cd08-467d-b8d4-34bf61077d48", "matchId": "58e6ea24-2d1d-42d0-a666-d4b5fc7b7a5d", "beatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "evidence": "The document presents various evidence to support its claims, including financial data and industry comparisons.", "position": 2, "isPrimaryArc": true, "parentBeatType": null, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 40, "from": 21, "loop": { "name": "08_analogy", "slug": "08-analogy", "status": "active", "bestFor": "Complex concepts, new markets, technical explanations for non-experts", "canonId": "019dd956-6901-7032-ba44-96eaed94c949", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Familiar Domain -> Key Parallel -> Applied to Our Situation -> Insight", "description": "Explain the unfamiliar through a well-understood parallel domain", "familyLabel": null }, "matchId": "4e433b19-425e-470c-ae68-d0798fdfcf36", "evidence": "The document uses industry comparisons to highlight PGNY's weaknesses.", "position": 1, "objective": "How does PGNY's business model compare to its competitors?", "confidence": 0.7, "extraction": { "at": "2026-07-16 22:00:38.964382+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 24, "type": "tension", "title": "Uses a red flag icon to signal a warning/contradiction.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 88, "componentCount": 11, "textChars": 2870, "nDataPoints": 0, "notes": "Uses a red flag icon to signal a warning/contradiction.", "elementsJson": [ "headline_text", "callout_box", "bullet_list", "screenshot", "paragraph" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:31:12.476+00", "seconds": 5.325, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-4fdf89a4b224/24", "deck": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224", "deckAnchor": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224#slide-24", "deckJson": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224.json" }, "components": [ { "bbox": { "h": 0.15, "w": 0.46, "x": 0.02, "y": 0.65 }, "kind": "callout", "text": "Why doesn't Copperman prominently disclose his relationship with PGNY on the website? You have to click on his curriculum vitae to see his Progyny affiliation. Shouldn't patients be made aware of potential conflicts of interest more prominently?", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.476+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d7ea17d8-9fde-4fb8-9681-e90e230f7929", "parentComponentId": null }, { "bbox": { "h": 0.09, "w": 0.9, "x": 0.05, "y": 0.17 }, "kind": "callout", "text": "In a Company stacked with internet marketing executives, one would assume PGNY would employ a full-time fertility doctor to guide its decisions that impact treatment protocols. However, we found that PGNY's Medical Director, Alan Copperman, is a full-time physician who faced two lawsuits for medical malpractice.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.476+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d93e7648-2e8e-4c0a-b41c-935565ace88c", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.4, "x": 0.03, "y": 0.45 }, "kind": "list", "text": "Member, American Medical Association\nFellow, American College of Obstetricians and Gynecologists\nFellow, American Society of Reproductive Medicine\nMember, American Association of Gynecological Laparoscopy\nMember, New York Society of Reproductive Medicine\nBoard of Directors, RESOLVE", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.476+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1cf5e807-aae4-4151-9a2e-9d063ade053e", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.46, "x": 0.52, "y": 0.55 }, "kind": "paragraph", "text": "These medical malpractice actions were brought separately by couples seeking damages for \"wrongful birth.\" The couples were treated for infertility by Dr. Alan Copperman at Reproductive Medicine Associates of New York (RMA), and underwent in vitro fertilization using donated eggs. Both couples allege that RMA and Copperman negligently failed to test the egg donors for a chromosomal abnormality known as \"fragile X,\" which can produce intellectual disability and other injuries, until after their children were born. When tests were conducted months after the births, the donors were found to be fragile X carriers and a child born to each couple had the full fragile X mutation.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.476+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0f99e484-39c1-430f-9b87-956e97e932e0", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.46, "x": 0.52, "y": 0.84 }, "kind": "paragraph", "text": "New York Court of Appeals Ruled Against Copperman", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.476+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "461508a6-aade-467a-9b93-c61d8627fd0f", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.46, "x": 0.52, "y": 0.28 }, "kind": "paragraph", "text": "Dr. Copperman Faced Two Malpractice Lawsuits After Seeking Dismissal Under the Statute of Limitations", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.476+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "47b1dc39-a7d0-40c1-a7e3-64a1981dbd90", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.46, "x": 0.52, "y": 0.71 }, "kind": "paragraph", "text": "RMA and Copperman moved to dismiss both lawsuits as untimely under CPLR 214-a, which requires that a medical malpractice claim be filed within two and a half years \"of the act, omission or failure complained of or last treatment where there is continuous treatment for the same illness, injury or condition which gave rise to the said act, omission or failure.\" The outcome depends on whether the limitations period began to run when the defendants ended their treatment of the plaintiffs or when the children were born. In Case No. 126, embryos produced by the donated eggs were implanted in January", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.476+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "badd3d55-f247-4d8c-ad6c-ba02f53ced03", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.25, "x": 0.73, "y": 0.35 }, "kind": "paragraph", "text": "Summaries of cases before the Court of Appeals are prepared by the Public Information Office for background purposes only. The summaries are based on briefs filed with the Court. For further information contact Gary Spencer at (518) 455-7711 or gspencer@nycourts.gov.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.476+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bc73b9a6-4538-40c8-9e38-df75f8678aee", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.46, "x": 0.02, "y": 0.28 }, "kind": "paragraph", "text": "Dr. Copperman Doesn't Prominently Disclose His Affiliation With PGNY in His RMA Biography", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.476+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e876228b-215c-491c-9915-d103f7159b85", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.9, "x": 0.02, "y": 0.95 }, "kind": "source-note", "text": "Source: Alan Copperman RMA biography, Curriculum Vitae, PGNY website, State of New York Court of Appeals Case Summaries November 14-17, 2017, medicalmalpracticelawyers.com", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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We find it hard to believe that revenue from its nine new clients that increased the member base by 4% in 3Q22 would be responsible for 22% of fertility benefits revenue in 3Q22.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.954+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "022142d0-72ec-4b55-b550-85d23aa77672", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.9, "x": 0.05, "y": 0.55 }, "kind": "list", "text": "PGNY's CEO and Chairman were both granted substantial equity grants on January 1, 2022, that vest based on undisclosed revenue targets.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.954+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0e520519-8e48-432e-b928-fd06c7dce9de", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.9, "x": 0.05, "y": 0.6 }, "kind": "list", "text": "We are unable to reconcile management's commentary about member additions from PGNY's 2022 selling season and believe that PGNY's selling season may have been overstated. We can't account for ~200,000 member lives in PGNY's lives under coverage. Is it possible that PGNY inflated the amount of member lives that would be added from the 2022 selling season to cover up for an underwhelming selling season?", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.954+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3575fa9b-0209-4b64-b8fa-ff263a87e9f7", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.9, "x": 0.05, "y": 0.69 }, "kind": "list", "text": "Our work also suggests that PGNY could be over-charging its members for fertility medication. We estimate that PGNY may be charging on average as much as $8,000 for fertility medication versus industry levels in the range of $5,000 to $6,000.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.954+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3abb13dc-69fe-4cc5-9783-907355d05eac", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.9, "x": 0.05, "y": 0.75 }, "kind": "list", "text": "We believe that consensus estimates are not accounting for material headwinds that will likely appear in 2023 from reduced utilization and lower member counts, and the absence of major price increases for its Pharmacy Solution benefit. We illustrate that the aging of the fertility benefit within PGNY's aggregate member base will reduce utilization. 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Further employee counts at existing clients have been a significant tailwind that will turn into a headwind with the recent layoffs and hiring freezes thus far announced throughout PGNY's client base.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.954+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bf36c8e3-13fd-4ed2-a4cb-1413160ab1e1", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.9, "x": 0.05, "y": 0.29 }, "kind": "paragraph", "text": "Spruce Point's forensic review has also identified incremental accounting issues, unaccounted for missing member lives, reduced run-rate revenue at Amazon and Google, as well as our take that PGNY is potentially overcharging members for fertility medication. Additionally, PGNY's CEO and Chairman were recently awarded substantial equity grants that vest based on undisclosed revenue targets. 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Major accounting issues addressed by the report included the manipulation of gross margins by as much as 900 bps, use of aggressive revenue recognition stemming from unbilled and accrued revenues, and the magnitude of PGNY's bad debt expense.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.954+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e07cd80e-ff61-4b68-a5cf-5a712d67a88b", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.9, "x": 0.05, "y": 0.05 }, "kind": "title", "text": "Spruce Point's Analysis Is Incremental To Other Issues Identified at PGNY", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.954+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f8519310-a698-445a-a5bb-d45664ea991b", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 40, "arc": { "name": "Overcoming the Monster", "slug": "overcoming-monster", "status": "active", "bestFor": "Competitive positioning, rallying teams", "canonId": "019dd956-6339-76ac-9cbf-4b377c3aa89e", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "The Monster -> The Call -> The Struggle -> The Victory -> The New Order", "description": null, "familyLabel": null }, "from": 21, "name": "Evidence", "beatId": "efa521e2-cd08-467d-b8d4-34bf61077d48", "matchId": "58e6ea24-2d1d-42d0-a666-d4b5fc7b7a5d", "beatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). 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"componentCount": 9, "textChars": 1943, "nDataPoints": 66, "notes": "Uses a three-part table structure to demonstrate the impact of unbilled A/R on revenue performance.", "elementsJson": [ "headline_text", "callout_box", "data_table", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:31:17.733+00", "seconds": 9.908, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-4fdf89a4b224/27", "deck": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224", "deckAnchor": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224#slide-27", "deckJson": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224.json" }, "components": [ { "bbox": { "h": 0.06, "w": 0.9, "x": 0.05, "y": 0.36 }, "kind": "callout", "text": "We note that issues with unbilled receivables have been a central elements of predicting shareholder disappointment at previous recent Spruce Point research targets such as C3.ai (AI) and Leidos (LDOS).(2)", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:17.733+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c15a3b92-572a-4b81-834d-c96b6fffede5", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.12, "x": 0.86, "y": 0.45 }, "kind": "callout", "text": "Unbilled A/Rs at all-time highs and the increase in 3Q22 was substantial.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:17.733+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ddfc62e8-11c0-425c-a0a5-b3d78a2b3156", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.12, "x": 0.86, "y": 0.65 }, "kind": "callout", "text": "The three most recent beats (and six times in PGNY's public history) relied on revenue recognized from increased unbilled A/R in order to surpass Wall Street revenue estimates.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": 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"019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:07+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-95e820ff3492", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.84, "x": 0.08, "y": 0.16 }, "kind": "paragraph", "text": "We believe a lever that PGNY may be using to accelerate revenue recognition is unbilled accounts receivable and corresponding unbilled revenues. PGNY's use of unbilled accounts receivables (revenues that have been recognized but not yet billed to a customer) are at historic highs. By adjusting revenues for changes in unbilled A/R, PGNY would have missed revenue expectations on six occasions and in all three quarters in 2022. 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Has the use of unbilled revenues thus far in FY22 put management on track to trigger further compensation?", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:30:46.874+00", "model": "google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "777ea2e6-ffb8-4035-80c3-4950e14d4796", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.85, "x": 0.11, "y": 0.17 }, "kind": "callout", "text": "Schlanger and Anevski were recently issued PSUs on January 1, 2022 that vest upon a “rigorous revenue target” over any four consecutive fiscal quarters until 2027. We are puzzled why revenue targets would be permitted over four consecutive quarters rather than being based on annual audited financials. Does this allow management to use the revenue recognition levers we have noted in this report? Given the past and present accounting irregularities we have identified in this report, we think the compensation committee needs to reevaluate any management compensation tied to revenues.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:30:46.874+00", "model": "google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "da2c6816-7819-4008-8ce4-a1f3188cde89", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.65, "x": 0.18, "y": 0.37 }, "kind": "paragraph", "text": "Excerpt from PGNY FY21 Proxy Regarding Equity and Option Grant Vesting", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": "description", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:30:46.874+00", "model": "google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "eb71b92c-4638-4496-8623-243968f295e1", "parentComponentId": null }, { "bbox": { "h": 0.48, "w": 0.73, "x": 0.05, "y": 0.42 }, "kind": "paragraph", "text": "Messrs. Schlanger and Anevski did not receive any equity awards during fiscal 2021 and had not received any equity awards since 2019. Rather, in connection with the transition of their roles and in order to continue to retain and incentivize these key executives given that the significant majority of their outstanding equity awards were fully vested, on January 1, 2022 Messrs. Schlanger and Anevski received grants of 333,000 and 1,000,000 options at an exercise price of $50.35, 84,000 and 250,000 restricted stock units, and 83,000 and 250,000 PSUs, respectively. Each such option and restricted stock unit award vests as to 25% on the first anniversary of the vesting commencement date of January 1, 2022 with the remaining 75% of such award vesting in equal quarterly installments on each quarterly anniversary thereafter over the next three years, subject to the executive’s continued service through each applicable vesting date. The PSUs vest and are earned, if at all, in two tranches in the event that specified sustained revenue targets are achieved (as determined by the compensation committee). The first tranche of PSUs vests if a certain “rigorous revenue target amount is sustained over any four consecutive fiscal quarters between the grant date and the fifth anniversary of the grant date and the second tranche of PSUs vests if a certain “stretch” revenue goal target amount is sustained over any four consecutive quarters between the grant date and the fifth anniversary of the grant date, in each case subject to the executive’s continued service through each applicable vesting date. Each tranche of PSUs may be earned at any point prior to the fifth anniversary of the grant date; provided that if either or both tranches have not been earned prior to such date they will be forfeited for no consideration. The design of the PSUs serves to align certain of our key executives’ interests with those of long-term stockholders, incentivize the achievement of sustained and strong Company financial performance and create retentive value.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": "description", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:30:46.874+00", "model": "google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f0a45b4e-67c6-4088-8a57-4a42aa6f67da", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.15, "x": 0.05, "y": 0.96 }, "kind": "source-note", "text": "Source: PGNY FY21 Proxy", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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11, "textChars": 2511, "nDataPoints": 45, "notes": "Includes a specific callout box questioning the math behind new client revenue contribution.", "elementsJson": [ "headline_text", "paragraph", "callout_box", "data_table", "comparison_table", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:31:12.932+00", "seconds": 4.758, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-4fdf89a4b224/29", "deck": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224", "deckAnchor": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224#slide-29", "deckJson": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224.json" }, "components": [ { "bbox": { "h": 0.07, "w": 0.97, "x": 0.02, "y": 0.81 }, "kind": "callout", "text": "“Additionally, given the large number of new clients and lives on boarded during the last couple of quarters, cash flow also reflects that short-term negative impact that we typically see with these new launches, as it can take a quarter or so to get the integrations with the newest clients and their carriers running efficiently.” -- Mark Livingston, CFO, 3Q22 Transcript", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "af56a2b6-9836-435c-979f-86179e57ee2d", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.21, "x": 0.78, "y": 0.49 }, "kind": "callout", "text": "How did new clients that represented 4% of average member lives during 3Q22 represent 23% of total fertility revenues?", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b4656d5d-cdbc-4b25-8ab5-2eb3b2d5d456", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.22, "x": 0.02, "y": 0.49 }, "kind": "callout", "text": "Weighted average covered lives increased by more than 200,000 driven by the launch of nine new clients at various points during the quarter. -- Mark Livingston, CFO, 3Q22 Transcript", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f3dca570-e269-484d-aa8c-734b36b5cd6f", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Said differently, how could new member lives have a utilization that was +6x versus the legacy member lives? This does not pass our sanity check and we call on PGNY management for an explanation.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:07+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-bee14b439898", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Unbilled A/R: $65.7", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:07+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-c4f5880d1443", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.88, "x": 0.11, "y": 0.17 }, "kind": "paragraph", "text": "The short report published in December attributed the recent increase in unbilled A/R to an intentional delay in billing by PGNY. We have a different take where we believe that the recent spike could potentially be attributable to accelerated revenue recognition from new client additions. PGNY noted a negative cash flow impact to new client additions on its 3Q22 conference call, which we believe is directly correlated to the anomalistic increase in non-cash revenues associated with the increased 3Q22 unbilled A/R balance. New launches, of which there were nine in 3Q22, can take a “quarter or so” to integrate thus delaying collections. We find it suspect that adding 200,000 member lives which represented 4% of the average lives in 3Q22 could have contributed 23% of the total fertility revenues. Said differently, how could new member lives have a utilization that was +6x versus the legacy member lives? This does not pass our sanity check and we call on PGNY management for an explanation.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "30f7a06c-388f-444b-b246-d0876335395d", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Weighted average covered lives increased by more than 200,000 driven by the launch of nine new clients at various points during the quarter.” -- Mark Livingston, CFO, 3Q22 Transcript", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:07+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-c0b51771f85e", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.97, "x": 0.02, "y": 0.89 }, "kind": "source-note", "text": "Sources: PGNY FY19 10-K, 1Q20 10-Q, 2Q20 10-Q, 3Q20 10-Q, FY20 10-K, 1Q21 10-Q, 2Q21 10-Q, 3Q21 10-Q, FY21 10-K, 1Q22 10-Q, 2Q22 10-Q, 3Q22 10-Q, 3Q22 Press Release, 3Q22 Transcript", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d2b8615d-27cd-48e9-8386-e71de5dfa997", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.54, "x": 0.23, "y": 0.51 }, "kind": "table", "text": "Spruce Point Estimated Fertility Benefit Breakout (New Members vs. Legacy Members)", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6195e7d7-ee58-4b91-bad2-8d6297d5d635", "parentComponentId": null }, { "bbox": { "h": 0.11, "w": 0.97, "x": 0.02, "y": 0.69 }, "kind": "table", "text": "PGNY Fertility Benefits Revenue Detail, Unbilled A/R Balance and Impact to Operating Cash Flow", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "66b2a6bf-934c-4b05-b41f-ef95a717603e", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.65, "x": 0.31, "y": 0.05 }, "kind": "title", "text": "We Cannot Reconcile The Large Increase in Q3 Unbilled A/R With Management Disclosures", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "860affd7-06f6-48db-b3a1-b71e31d5c38d", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "e9eba67f-1b08-4b7e-909b-0793de7a2335", "evidence": "The slide explicitly challenges management's explanation for financial anomalies to suggest potential revenue recognition issues.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:31:12.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 29, "frameworkName": "fraud-exposure" } ], "arcBeats": [ { "to": 40, "arc": { "name": "Overcoming the Monster", "slug": "overcoming-monster", "status": "active", "bestFor": "Competitive positioning, rallying teams", "canonId": "019dd956-6339-76ac-9cbf-4b377c3aa89e", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "The Monster -> The Call -> The Struggle -> The Victory -> The New Order", "description": null, "familyLabel": null }, "from": 21, "name": "Evidence", "beatId": "efa521e2-cd08-467d-b8d4-34bf61077d48", "matchId": "58e6ea24-2d1d-42d0-a666-d4b5fc7b7a5d", "beatType": { "name": "Evidence", "slug": "evidence", "status": "active", "canonId": "019dd9b8-03f9-772a-b84a-4f07b415b77a", "version": 1, "description": "A dedicated proof beat exists in only ~4 arcs (Gambit, Sequoia, AIDA, Monroes). Other arcs embed evidence inline within development." }, "evidence": "The document presents various evidence to support its claims, including financial data and industry comparisons.", "position": 2, "isPrimaryArc": true, "parentBeatType": null, "alignedBlockIds": null, "matchConfidence": 0.8 } ], "loops": [ { "to": 40, "from": 21, "loop": { "name": "08_analogy", "slug": "08-analogy", "status": "active", "bestFor": "Complex concepts, new markets, technical explanations for non-experts", "canonId": "019dd956-6901-7032-ba44-96eaed94c949", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Familiar Domain -> Key Parallel -> Applied to Our Situation -> Insight", "description": "Explain the unfamiliar through a well-understood parallel domain", "familyLabel": null }, "matchId": "4e433b19-425e-470c-ae68-d0798fdfcf36", "evidence": "The document uses industry comparisons to highlight PGNY's weaknesses.", "position": 1, "objective": "How does PGNY's business model compare to its competitors?", "confidence": 0.7, "extraction": { "at": "2026-07-16 22:00:38.964382+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 30, "type": "tension", "title": "Uses red underlining in the source text to emphasize specific problematic phrases.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 59, "componentCount": 6, "textChars": 1451, "nDataPoints": 4, "notes": "Uses red underlining in the source text to emphasize specific problematic phrases.", "elementsJson": [ "headline_text", "callout_box", "data_table" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:31:11.485+00", "seconds": 3.165, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-4fdf89a4b224/30", "deck": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224", "deckAnchor": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224#slide-30", "deckJson": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224.json" }, "components": [ { "bbox": { "h": 0.25, "w": 0.86, "x": 0.1, "y": 0.17 }, "kind": "callout", "text": "PGNY's own auditor comments on PGNY's revenue recognition regarding fertility treatment revenues. As disclosed in its 10-K, PGNY accrues revenues based on member appointments scheduled. Our work indicates that some fertility treatments may require 10+ appointments over a three-month duration. Is PGNY recognizing revenue prematurely before the performance obligation has been satisfied? We have never seen a situation where scheduling a member appointment would permit revenue to be recognized. Issues surrounding the revenue recognition related to this dynamic has been disclosed as a critical audit matter in both FY20 and FY21. We question why PGNY would just not practice conservatism and recognize revenue when the full service is complete?", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:11.485+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f779a86e-2e25-4f84-9f88-369d1a0acfba", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "We question why PGNY would just not practice conservatism and recognize revenue when the full service is complete?", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:07+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-ab0dbd265a56", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Auditing the Company's estimates of accrued receivables and the related accrued claims payable was complex and required significant judgment as the estimates were sensitive to changes in the significant assumptions, including management's assumptions regarding the lag between authorization date and service date, service changes and cancellations. — PGNY FY2021 10-K", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:07+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ee-ad63170a2915", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.15, "x": 0.03, "y": 0.96 }, "kind": "source-note", "text": "Source: PGNY FY2021 10-K", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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However, we find that this figure fell far short of reported employee growth, even when looking solely at four major clients. How can this be?", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:11.78+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "269c2352-f06c-4898-9e79-dbebd62e5484", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.9, "x": 0.05, "y": 0.68 }, "kind": "quote", "text": "…many of our clients have continued to expand their workforce as they successfully grow their own businesses. Our existing clients grew in aggregate by approximately 100,000 lives in 2020 despite the significant disruptions caused by the COVID pandemic. Because of our utilization-based model, as our employees grow, we grow too.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:11.78+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8a620f26-cf7b-4548-8d1f-e4c37793f156", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“…many of our clients have continued to expand their workforce as they successfully grow their own businesses. Our existing clients grew in aggregate by approximately 100,000 lives in 2020 despite the significant disruptions caused by the COVID pandemic. Because of our utilization-based model, as our employees grow, we grow too.” — David Schlanger, 2021 JPMorgan Healthcare Conference Transcript", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:08+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ef-12613a2fd454", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.9, "x": 0.05, "y": 0.89 }, "kind": "source-note", "text": "Source: PGNY Q3 2022 earnings call, PGNY Q3 2021 earnings call, PGNY Q3 2020 earnings call, PGNY Q3 2019 earnings call, PGNY 10-Ks for 2019, 2020, and 2021, Bloomberg", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Management also stated on its Q3 earnings call that it expected to start 2023 with 5.4M covered lives. Based on our calculations, we can deduce that 200,000 member lives have vanished. Did PGNY embellish the member additions in the 2022 selling season? We call on management to provide disclosure that aids investors to fully understand the contributors to annual changes in covered lives including churn and changes in covered lives at legacy clients.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:12.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a479ebb0-b1a0-4cd4-9f86-5d3207bfeebd", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Did PGNY embellish the member 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We note your disclosure on page 98 that you have several customers that accounted for at least 10% of total revenue in 2018. Please furnish the information required by Item 101(c)(7)(vii) of Regulation S-K...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.518+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "42715762-4ff4-4d9e-8015-cc707c5bd3c9", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.966, "x": 0.017, "y": 0.46 }, "kind": "paragraph", "text": "PGNY Response to SEC Comment on PGNY IPO Prospectus", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.518+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e1340607-b555-45d1-abf5-dd2b3da7fb7d", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.966, "x": 0.017, "y": 0.285 }, "kind": "paragraph", "text": "Conflicting Commentary on Customer Churn", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.518+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f1c4c0bf-57e5-4fe6-b1f5-5e131f65181e", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.966, "x": 0.017, "y": 0.32 }, "kind": "quote", "text": "\"We have retained substantially all of our clients since inception\" - Excerpt From PGNY 2021 10-K", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.518+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "efb3f1ca-4159-4766-8556-1150f73bef4f", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"We have retained substantially all of our clients since inception\" — Excerpt From PGNY 2021 10-K; \"It would happen, but I can't say how often. Maybe 5% of the time. It was low, but people would switch.\" — Former Lead Fertility Patient Care Advocate at Progyny, Tegus, 10/13/22", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:11+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f1-4308781d1613", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.5, "x": 0.017, "y": 0.82 }, "kind": "source-note", "text": "Source: PGNY 2021 10-K, PGNY response to SEC comment letter dated 9/11/2019, Tegus", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:13.518+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "51db76c7-9d78-4148-a13d-55763edd7d1f", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.966, "x": 0.017, "y": 0.375 }, "kind": "table", "text": "Former Lead Fertility Patient Care Advocate at Progyny, Tegus, 10/13/22: Tegus Client: \"And how often did that happen that people switch providers?\" Former Lead Fertility Patient Care Advocate at Progyny: \"It would happen, but I can't say how often. 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We also assess the impact if Cerner and VMWare drop PGNY after their sales close, as their acquirers are not PGNY clients.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:16.1+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b0442735-83b5-436b-9365-4975e9767b8b", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "We note that there will be other important headwinds to member growth in 2023, including: (1) additional layoffs in 2023, (2) reduced hiring at existing clients, and (3) potential client losses to competitors.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:08+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ef-96e338dc97bf", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.48, "x": 0.51, "y": 0.78 }, "kind": "disclaimer", "text": "We note that there will be other important headwinds to member growth in 2023, including: (1) additional layoffs in 2023, (2) reduced hiring at existing clients, and (3) potential client losses to competitors.", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:16.1+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8e4a417a-0e39-4bf1-b3e7-0a5d37a38bd5", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Potential Lost Revenue: $52M", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:08+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86ef-9bf1dc9257b7", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.96, "x": 0.02, "y": 0.92 }, "kind": "source-note", "text": "Source: Spruce Point Research (1) We adjust Amazon YE 2021 employees to equal the number of members using the PGNY benefit based on our previously discussed estimates. We assume that all announced layoffs at Amazon will come from the PGNY benefit population...", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Using a number of sources, we determined that 207 of those clinics, or approximately 50%, were ultimately owned by private equity firms, and another 22 (or 5%) were owned by a public company.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:15.843+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3865975d-7eba-4eb0-8ae6-fcf90c3691f6", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.85, "x": 0.11, "y": 0.17 }, "kind": "paragraph", "text": "The fertility clinic landscape has changed markedly since PGNY launched its fertility benefit business in 2016. Numerous private equity firms have acquired clinic networks and pursued roll-up strategies, resulting in significantly greater sector concentration.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:15.843+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "aab5bf0b-5ab3-4e66-8f23-2cd6636911b1", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Ready for consolidation: Buyouts eye fragmented fertility clinics — Private Equity News. Fertility Inc.: Inside the big business of babymaking — FORTUNE. This Venture Capital Fund Wants to Get You Pregnant — Institutional Investor. Wall Street greed's latest target: fertility clinics — Take on Wall St.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:16+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f4-2924a841e81b", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.5, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: Spruce Point Research, Private Equity News, Institutional Investor, Fortune, Take on Wall Street", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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It is unclear how it will fare with companies that want an integrated family benefit.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:16.279+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "abc31521-331e-4249-b572-863c9e50e5cc", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"Progyny's biggest con is that it only focuses on infertility. 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With its unique vertically integrated model, Kindbody has put the industry on notice with exceptionally strong client and member growth and its recent Walmart win.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:17.365+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8db0753b-7bd6-434d-b4aa-c4bf00435595", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "In the market for 25 years, WINFertility leads PGNY in clients and lives and has exceptionally strong payer relationships, which differentiates it from other competitors.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f1-cb8d36ca93e5", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.47, "x": 0.51, "y": 0.33 }, "kind": "quote", "text": "If somebody is currently working with one of the Blues as their health plan payer, they generally have a working understanding of WIN, right, because WIN has really grown up servicing a lot of the Blue Cross Blue Shield plans right across the country. 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Maven became the first women's health unicorn by leveraging technology and telehealth to revolutionize care delivery and has demonstrated strong Fortune 500 penetration.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:23.356+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "07785d96-4f7d-4a12-949e-4b231b7e410d", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Carrot is the clear leader in offering fertility benefits internationally, creating an avenue to penetrate existing PGNY clients and compete for their US business.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:11+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f1-54cd0e6d6063", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.48, "x": 0.02, "y": 0.0033 }, "kind": "list", "text": "Founded in 2016, Carrot has differentiated itself by offering a simple, highly flexible, and customizable benefit structure and building the leading international presence. Carrot is unique in offering debit cards loaded by employers to simplify payments. Carrot Rx pricing is ~67% less than national averages. Carrot services over 450 clients in over 120 countries and provides access to over 8,000 clinics, agencies, pharmacies, and legal service partners around the world.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:23.356+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "537f5535-18f2-44e2-a3cd-33f73c5295cf", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.48, "x": 0.02, "y": 0.0068 }, "kind": "list", "text": "Founded in 2014, Maven is a global virtual care provider that focuses on a broad range of women's health issues. 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Different clinics are defined by different fertility treatments and patient demographics (as we discuss below). Moreover, a focus on the performance of PGNY in-network clinics ignores the facts that: (1) PGNY selects clinics for their network based on their outcomes data, and (2) those clinics are NOT exclusive to PGNY.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:18.67+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f6556206-7010-49f7-9868-43f89d9e902a", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.23, "x": 0.53, "y": 0.53 }, "kind": "list", "text": "Some clinics see more than the average number of patients with difficult infertility problems. Some clinics offer ART to most potential patients, even those who have a low probability of success. Others discourage such patients or encourage them to use donor eggs.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:18.67+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "34d26945-6ab0-42ac-b8e8-25f1b619020a", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.23, "x": 0.05, "y": 0.53 }, "kind": "list", "text": "8. Can I use clinic success rates to measure the quality of ART services? Although the quality of ART services can affect the reported outcomes, patient characteristics such as age, race or ethnicity, infertility diagnosis, or existing medical conditions can also contribute to differences in ART success rates.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:18.67+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b49b3e37-c065-43b8-aafc-0f2f73a05db0", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.23, "x": 0.29, "y": 0.53 }, "kind": "list", "text": "Interpretation of Fertility Clinic Success Rates: Many people considering ART will want to use the information presented online in ART Fertility Clinic Success Rates to find the \"best\" clinic. Comparisons between clinics must be made with caution. Many factors contribute to the success of an ART procedure.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:18.67+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dcdbfdc9-6e0b-4c72-ab43-8589596517fb", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.21, "x": 0.77, "y": 0.53 }, "kind": "paragraph", "text": "Given PGNY's client base, its members are skewed toward states like CA, CO, IL, MA, NJ, NY, OH, and TX. All these states have state-mandated fertility insurance coverage. The CDC has found that fewer embryos are transferred, more IVF births occur, and fewer multiples are observed in states with fertility coverage mandates, thus biasing PGNY outcomes data.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:18.67+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "199592ac-2ac0-49fe-a07a-508a039c3306", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.45, "x": 0.05, "y": 0.47 }, "kind": "paragraph", "text": "Excerpts From the CDC’s 2019 Assisted Reproductive Technology, Fertility Clinic and National Summary Report", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:18.67+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4a48b0f8-31ef-45cf-abdd-9b99d6dde2d5", "parentComponentId": null }, { "bbox": { "h": 0.11, "w": 0.92, "x": 0.05, "y": 0.18 }, "kind": "paragraph", "text": "We believe PGNY’s outcomes data should not be relied upon, as it suffers from three fundamental issues of comparability: (1) different clinics, (2) different fertility treatments (driven by different fertility diagnoses and patient motivations), and (3) vastly different patient demographics. These issues, as well as other methodological issues, were largely ignored by the Milliman study assessing PGNY’s outcomes data.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:18.67+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "84532558-5ad0-4358-8160-a96f7b9f1f42", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.6, "x": 0.05, "y": 0.96 }, "kind": "source-note", "text": "Source: CDC 2019 Assisted Reproductive Technology, Fertility Clinic and National Summary Report, CDC website", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Moreover, the PGNY fertility benefit prioritizes IVF and effectively mandates single embryo transfer. Finally, comparing outcomes for patients using the PGNY benefit (often valued at $50K or more, and inclusive of preimplantation genetic testing) to patients using a more limited benefit or self-funding their treatment entirely is not an apples-to-apples comparison.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.253+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "77add60e-7ff1-48fe-b84c-ec9d71cd6232", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Individual fertility treatments and outcomes are strongly dependent upon the fertility diagnosis. Moreover, the PGNY fertility benefit prioritizes IVF and effectively mandates single embryo transfer.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f2-b64eb4592d3b", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.35, "x": 0.63, "y": 0.64 }, "kind": "chart", "text": "Percentage of Embryo Transfers in Which a Single Embryo Was Transferred—United States, 2010-2019", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.253+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "179a898d-97fc-45e6-9550-419d4a6b4598", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Percentage of Single Embryo Transfers: 77.3%", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f2-bd89508d6e58", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.6, "x": 0.02, "y": 0.48 }, "kind": "paragraph", "text": "One of the fundamental tenets (and in fact, a marketed advantage) of the PGNY fertility benefit is that it allows patients to bypass alternative processes such as intrauterine insemination (IUI) and proceed directly to IVF. IUI is less expensive and has a lower success rate than IVF (10-25% depending on age), but it is viewed as an appropriate first treatment for less severe fertility diagnoses. Therefore, PGNY's outcomes data includes \"easy cases\" that could have gotten pregnant through IUI, and non-PGNY patient data is skewed toward more difficult IVF cases, thus lowering expected outcomes.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.253+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5d33c94e-d7c5-43b9-9128-c334183411f1", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.6, "x": 0.02, "y": 0.65 }, "kind": "paragraph", "text": "PGNY pushes single embryo transfer. Therefore, PGNY's higher single embryo transfer rate and resultant lower multiples birth rate is a business decision more than a health outcome. Regardless, SART and the CDC both recommend single embryo transfer, and CDC data (right) clearly indicates this is becoming the standard of care, which will reduce the difference between PGNY and non-PGNY outcomes in the future.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.253+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7ba9a8cb-33df-4b24-8f35-a1346585c474", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.96, "x": 0.02, "y": 0.34 }, "kind": "paragraph", "text": "Even Milliman acknowledges that fertility diagnoses impact outcomes: \"Other factors that may contribute to differences in fertility outcomes include infertility diagnosis, which may include diminished ovarian reserve, endometriosis, male factor, uterine factor, tubal factor, ovulatory dysfunction, or unexplained infertility\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.253+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "91cbae78-7e15-48a4-8446-ec38e10a7699", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.6, "x": 0.02, "y": 0.83 }, "kind": "paragraph", "text": "IVF is very expensive. However, non-PGNY member data includes self-pay patients that, due to the financial burden, pursue alternative treatment protocols and/or go without valuable ancillary services and treatments that can improve outcomes. We believe comparing these two data sets is incorrect.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.253+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e9b086da-9917-4315-b95e-853b2f091a32", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Other factors that may contribute to differences in fertility outcomes include infertility diagnosis, which may include diminished ovarian reserve, endometriosis, male factor, uterine factor, tubal factor, ovulatory dysfunction, or unexplained infertility — Milliman Report", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f2-bba655deec0e", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.6, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: Milliman Report, CDC 2019 Assisted Reproductive Technology, Fertility Clinic and National Summary Report", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Most of these companies are located in major metropolitan areas where quality healthcare is more accessible, and the employee demographics at these companies do not mirror the general workforce.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f1-f4ebf786a2ee", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Median Compensation: $259,657", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f1-fc513cba5e2a", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.96, "x": 0.02, "y": 0.0060999999999999995 }, "kind": "paragraph", "text": "We believe Google, Microsoft, Amazon, and Meta Platforms have all been 10% customers of PGNY since 2018, and in 2021 PGNY's top two customers accounted for 34% of revenue in 2021, suggesting these clients contribute disproportionately to total lives. However, we find that the demographic mix and income levels of these employees are not representative of the general US workforce. It should surprise no one that multiple studies have found that healthcare outcomes, including those related to fertility, in the US are impacted by race and income.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:23.402+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "30e1bd63-716f-47f9-bb50-cbdad3805883", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.2, "y": 0.0018 }, "kind": "paragraph", "text": "PGNY's client base is skewed toward large technology companies and other knowledge workers. Most of these companies are located in major metropolitan areas where quality healthcare is more accessible, and the employee demographics at these companies do not mirror the general workforce. Moreover, employees at these companies, as well as the employees within PGNY clients most likely to pursue a premium benefit, are certain to have dramatically higher incomes than that of the general population. Income inequality is a major driver of healthcare outcomes.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:23.402+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "41896ce9-2f3d-4954-b345-5666686c7054", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "A 2019 study titled “Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017” found that income was the biggest predictor of differences in health outcomes and that health inequality has actually worsened over the past 25 years.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f1-faceb2c626b7", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.96, "x": 0.02, "y": 0.009300000000000001 }, "kind": "source-note", "text": "Source: Alphabet diversity report and proxy, Microsoft diversity report and proxy, Amazon diversity report, Meta Platforms diversity report and proxy, BLS 2020 US Workforce Composition, BLS Q3 2022 Weekly Earnings Report, Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017, Infertility, Inequality, and How Lack of Insurance Coverage Compromises Reproductive Autonomy", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f2-a3570aa57735", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.78, "x": 0.11, "y": 0.17 }, "kind": "paragraph", "text": "As discussed, PGNY frequently compares its results to national data from earlier periods. 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Trends in key metrics were much better for national averages than PGNY over the period of available comparable data.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:24.137+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a3808034-bfcf-48c3-b1c1-1220f7fa0ec1", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.83 }, "kind": "paragraph", "text": "We compare 2018 to 2019/2020 available data. In contrast to Schlanger's and Anevski's statements, national averages improved (often dramatically) in 4 of 5 metrics, while PGNY performance deteriorated in 4 of 5 metrics. Even giving them the benefit of looking at 2020 data where available, PGNY's scale of improvement lagged national averages.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:24.137+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cda1fc4b-44a4-4c93-8763-298e4f1cd196", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.32 }, "kind": "quote", "text": "First, our outcomes continued to significantly outperform the national averages as they have done each year over the past five years. And second, our outcomes have continued to improve each year while the national averages have stayed largely the same over those five years.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:24.137+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "30d94c34-e441-4e4e-9f7e-80f79c2fa9b8", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"First, our outcomes continued to significantly outperform the national averages as they have done each year over the past five years. And second, our outcomes have continued to improve each year while the national averages have stayed largely the same over those five years.\" — Then-CEO David Schlanger on PGNY Q2 2021 Earnings Call; \"...the national averages haven't been improving...\" — CEO Peter Anevski at 2023 JPMorgan Conference, 1/10/23", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f2-9fa9711032f0", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.5, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: PGNY Q2 2021 earnings call transcript, PGNY 10-Ks for 2019, 2020, and 2021, PGNY website", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Moreover, PGNY’s actuary, Milliman, highlighted issues with the Company’s potential under-reporting of miscarriages..", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.534+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8bb5ade1-dd50-4f41-a3f8-419e4dbd9f11", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Miscarriage Rate: 13.9%", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f2-7016-81d6-0b948d4ece21", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.66, "x": 0.17, "y": 0.65 }, "kind": "paragraph", "text": "Progyny’s current IVF live birth rate is calculated by subtracting the IVF miscarriage rate from the IVF pregnancy rate, while the national benchmarks are based on actual reported live birth rates. In addition to clinical documentation of a miscarriage, if a member received a subsequent ART treatment, Progyny assumes the member’s prior IVF cycle did not result in a live birth. Progyny’s live birth rate calculation may be impacted by miscarriage data and may be overstated if miscarriages are under-reported. This is particularly important for IVF cycles that occurred in the fourth quarter of 2021, as Progyny data would only capture miscarriages through March 28, 2022. However, the chance of having a miscarriage after 13 weeks is 1.3% and unlikely to impact the miscarriage rate significantly.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.534+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "066ecd20-9976-46ee-9627-3cb75348c1f5", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.6, "x": 0.35, "y": 0.83 }, "kind": "paragraph", "text": "A miscarriage, or “spontaneous abortion,” refers to the loss of a pregnancy before 20 weeks and occurs in 15 to 20 percent of all pregnancies. Most miscarriages occur during the first trimester but can also occur later on in the pregnancy.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.534+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "53574518-d66e-474d-89d4-6cc8727666ac", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.66, "x": 0.17, "y": 0.6 }, "kind": "paragraph", "text": "Excerpt From Milliman Report On Issues With PGNY’s Live Birth And Miscarriage Calculations", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:19.534+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b8a273d9-7524-4c27-b516-8b836cd6bb51", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Progyny’s live birth rate calculation may be impacted by miscarriage data and may be overstated if miscarriages are under-reported. — Milliman Report", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f2-7016-81d6-0633f8267958", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.5, "x": 0.05, "y": 0.97 }, "kind": "source-note", "text": "Source: PGNY 10-Ks for 2019, 2020, and 2021, PGNY website, Milliman Report, PGNY website", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Includes a sarcastic callout at the bottom regarding PGNY.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 90, "componentCount": 9, "textChars": 2988, "nDataPoints": 12, "notes": "Uses red flag icon to denote warning/risk. Includes a sarcastic callout at the bottom regarding PGNY.", "elementsJson": [ "headline_text", "callout_box", "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:31:25.9+00", "seconds": 9.911, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-4fdf89a4b224/75", "deck": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224", "deckAnchor": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224#slide-75", "deckJson": "/decks/019dd923-622c-750b-8b99-4fdf89a4b224.json" }, "components": [ { "bbox": { "h": 0.15, "w": 0.9, "x": 0.05, "y": 0.0017 }, "kind": "callout", "text": "A recent study of IVF clinic success rate reporting found that clinics only adhered to Society for Assisted Reproductive Technology advertising guidelines between 10.5% and 68.4% of the time, and another study found that clinics were often slow to address violations and/or repeat offenders of other guidelines.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:25.9+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5171ce87-fb6d-4f6e-8c2f-66ab77abf468", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.45, "x": 0.02, "y": 0.0088 }, "kind": "callout", "text": "Good thing PGNY doesn’t actually operate clinics or they’d be violating SART guidelines...", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:25.9+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e0bd7017-514a-4c91-9b43-878968183cfe", "parentComponentId": null }, { "bbox": { "h": 0.4, "w": 0.45, "x": 0.52, "y": 0.0040999999999999995 }, "kind": "paragraph", "text": "One hundred sixty-one of 383 SART member clinics were evaluated in 2019 by the SART AC members. In 2019, 44 (27%) of the 161 clinics reviewed had at least one website violation that was not resolved within the two-week grace period (Table 2). All these clinics eventually resolved their initial violations within a six-month period from the initial citation. One clinic did not renew its SART membership in 2020 and therefore only 43 clinics were reevaluated in 2020 by the AC. On rereview, 10 (23%) of the 43 clinics were noted to have violations in either the same or different categories as in the previous review. Eight (80%) of these 10 clinics that were out of compliance had a violation in the same category found in their previous review (Table 2). However, no violations were exactly the same as those during the first time period, even if they were in the same category. Six (60%) of the 10 clinics with a repeat violation had a violation in at least one new category.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:25.9+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0f78771d-ba72-4e9b-9516-dd3ee7b28873", "parentComponentId": null }, { "bbox": { "h": 0.4, "w": 0.45, "x": 0.02, "y": 0.0039 }, "kind": "paragraph", "text": "All 361 IVF clinics listed on the SART website were evaluated between February 2019 and August 2019. Table 2 displays the percentage of websites that adhered to the core SART guidelines for advertising. Overall, adherence to each specific SART guideline for reporting IVF clinic success rate ranged from 10.5% to 68.4%. Supplemental success rate reporting, which is not encouraged by SART, was found on 114 of the 361 (31.6%) websites. Of these 114 IVF clinics that advertised supplemental success rates, only 10.5% were compliant with the SART guideline requiring clinics to report live birth per transfer, retrieval, and cycle. Of these IVF clinics (68.4%) that reported supplemental success rates had a link to their CSR, 53.5% presented current (2016 or beyond) SART data, and 67.5% included the required disclaimer statement. 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We believe that is a mischaracterization, as Smart Cycles simply represent a “service maximum” as opposed to the traditional “dollar maximum”. It is easy to see that the average employer benefit will be insufficient to cover all patients’ needs.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:20.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7400ffaa-59c7-4c89-9017-e0eb7f37a6da", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "The notion that patients cannot exhaust their coverage mid-treatment is simply not accurate.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:14+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f3-1afe0d596c68", "parentComponentId": null }, { "bbox": { "h": 0.4, "w": 0.3, "x": 0.03, "y": 0.53 }, "kind": "image", "text": "Smart Cycle Bundles and Values", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Infographic", "slug": "infographic", "status": "active", "canonId": "019de52c-fe26-750c-9d7d-9f34e21324e8", "version": 1, "description": null }, "framework": null }, "subkind": "infographic", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:20.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "91f54b65-08c3-4a91-b3c3-790d63f17151", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.94, "x": 0.03, "y": 0.48 }, "kind": "paragraph", "text": "The Reality: PGNY's Fertility Benefit Still Has Coverage Maximums That May Not Cover Full Treatment", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:20.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5ca1c6f1-4529-4a7e-880d-4b3e1c4248d4", "parentComponentId": null }, { "bbox": { "h": 0.4, "w": 0.63, "x": 0.34, "y": 0.53 }, "kind": "paragraph", "text": "It is generally acknowledged that, for the 70-80% of women who will successfully get pregnant through IVF, it will require an average of just over 2 IVF cycles to achieve that result. In addition, reviewing PGNY client coverage amounts, most employers cover 2 to 3 PGNY Smart Cycles. Therefore, given the Smart Cycle allocations for ancillary services and alternative protocols, it is clearly possible that a patient might not be able to complete the average required 2 IVF cycles. In addition, reviewing disclosures from former PGNY patient advocates, one of their primary roles is to explain how to maximize the PGNY benefit given their individual treatment requirements, which can include encouraging patients to pay for certain expenses out-of-pocket in order to preserve Smart Cycle credit. 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We provide all individuals with access to comprehensive coverage. 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However, this figure represents the costs resulting from ALL pre-term births in the US.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:20.047+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "060308a9-a711-4a3d-8705-7c17e042c026", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.9, "x": 0.05, "y": 0.96 }, "kind": "source-note", "text": "Source: CDC 2019 Assisted Reproductive Technology, Fertility Clinic and National Summary Report, CDC National Vital Statistics Reports, Volume 70 Number 2, Births: Final Data For 2019", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The science clearly suggests that there are logical (and for the patient, financial) arguments for using IUI before IVF.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:26.753+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f7034225-773d-44c2-a892-3eccc5982b8e", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "PGNY's presentation of its treatment protocol suggests it is the right course for all patients, ignoring that highly variant fertility issues and diagnoses require a highly individualized approach to reproductive health.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:19+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f5-88eace344269", "parentComponentId": null }, { "bbox": { "h": 0.58, "w": 0.47, "x": 0.03, "y": 0.33 }, "kind": "list", "text": "The PGNY approach to fertility suggests that more intensive treatments yield better outcomes. However, the question of whether IUI or IVF is a preferred primary treatment is widely debated. Fertility treatments should be driven by the precise diagnosis rather than a corporate policy based on financial incentives. For example, IVF, and specifically intracytoplasmic sperm injection (ICSI), may be appropriate when the issues are low sperm count or motility, problems with the fallopian tubes, advanced age. However, for other cases, IUI is much less costly and invasive, has fewer health risks for women, requires milder hormonal stimulation, and does not create supernumerary frozen embryos. In fact, the 2020 ASRM guidelines note that IVF is ‘substantially more invasive and more costly’ than other treatments and state that ‘current evidence does not support IVF as a first-line therapy for unexplained infertility’; usually ‘the best initial therapy is a course (typically 3 or 4 cycles) of ovarian stimulation [...] and intrauterine insemination (OS-IUI)’. Moreover, PGNY and others often frame IUI as presenting a potentially decisive timing delay, yet we note that three cycles of IUI would take just three months, which is immaterial for most patients.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:26.753+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5f1cfd13-8f56-402c-8e93-e39744be7a84", "parentComponentId": null }, { "bbox": { "h": 0.4, "w": 0.45, "x": 0.52, "y": 0.51 }, "kind": "list", "text": "IUI is generally about one-tenth the cost and one-third as effective as IVF. Success rates for both procedures are most heavily impacted by patient age, fertility diagnosis, ovarian reserve, stimulation protocol, presence of male factors, use of donor eggs, and other health conditions. IUI costs and outcomes will be higher/better when accompanied by stimulation medicines. Costs of both procedures are impacted by the clinic and location. 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Assuming they all involved PGT at $5,000 per cycle, that represents $142 million of revenue, or about 40% of PGNY's medical revenue that year. Therefore, it is obvious why PGNY would want to encourage PGT as a standard practice.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.811+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5e0b0eda-95ad-4625-ac88-3e0336a2652a", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "To better understand the materiality of this issue, PGNY completed 28,413 ART cycles in 2021. Assuming they all involved PGT at $5,000 per cycle, that represents $142 million of revenue, or about 40% of PGNY’s medical revenue that year.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:15+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f3-9eb2fa8facbf", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.96, "x": 0.02, "y": 0.57 }, "kind": "list", "text": "PGT-A analyzes cells from embryos to test whether they have the correct number of chromosomes (i.e. are euploid) and thus are likely to be viable if implanted\nPGNY markets PGT-A as a technology that prevents miscarriage and thus enables single embryo transfer\nHowever, PGT-A is highly contentious because the evidence for its efficacy is limited while its costs are high (an additional $3000–12,000 per cycle), and thereby present a significant means of increasing clinic revenue (Theobald et al., 2020, FertilityIQ, 2020a)\nIn the UK, the fertility regulator [Human Fertilisation and Embryology Authority (HFEA)] gives PGT-A a red (negative) rating, stating 'there is no evidence that this add-on is effective and safe' and that there is a 'risk of misdiagnosing a healthy embryo' as abnormal. HFEA also claims that PGT-A 'can sometimes cause damage to the embryo and prevent it from developing once it has been transferred into the womb' (HFEA., 2018, HFEA, 2020).\nASRM states that 'there is insufficient evidence to recommend the routine use of blastocyst biopsy with aneuploidy testing in all infertile patients' and that 'large, prospective, well-controlled studies are needed to determine not only the effectiveness, but also the safety and potential risks of these technologies' (Penzias et al., 2018).", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.811+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "21f0d675-621e-451e-b908-275a7bf05153", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "revenue: $142 million", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:15+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f3-a5a665a02fd1", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Preimplantation genetic testing (PGT) is effectively a standard feature of the PGNY treatment protocol and typically costs around $5,000. While the logic of PGNY's marketing pitch surrounding PGT seems reasonable (leverage advanced, and more expensive, technology to implant better embryos for better fertility outcomes), the reality is far more murky. The efficacy of PGT has been called into question, and the inherent financial conflicts of interest for benefit providers and clinics has not been lost on the scientific community. For this reason, industry bodies still officially characterize some genetic tests as \"experimental\", and many other providers view PGT as only appropriate in limited circumstances.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.811+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dd7892e7-d6cc-4dc3-a479-31caf2ecb642", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "‘there is no evidence that this add-on is effective and safe’ and that there is a ‘risk of misdiagnosing a healthy embryo’ as abnormal. HFEA also claims that PGT-A ‘can sometimes cause damage to the embryo and prevent it from developing once it has been transferred into the womb’ — HFEA., 2018, HFEA, 2020.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:15+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f3-a03d3afa41b5", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.96, "x": 0.02, "y": 0.95 }, "kind": "source-note", "text": "Source: Disrupting the biological clock: Fertility benefits, egg freezing and proactive fertility management, Lucy van de Wiel, Reproductive Biomedicine & Society Online, Volume 14, March 2022, Pages 239-250", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.811+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a200a8aa-25a1-414a-ba5f-9f4e2f2c072b", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.65, "x": 0.31, "y": 0.05 }, "kind": "title", "text": "The Value of A Core Element of The PGNY Treatment Protocol (And Source of Revenue), Preimplant Genetic Testing, Has Been Called Into Question", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.811+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9e82b32b-50a9-4b3f-87df-44ed0bfdefb7", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.96, "x": 0.02, "y": 0.5 }, "kind": "title", "text": "The Science Behind PGTI Is Less Clear, Calling PGNY's Claims And Standard Treatment Protocol Into Question", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Subtitle", "slug": "subtitle", "status": "active", "canonId": "019de52c-fb09-739d-900c-815b0d9ac526", "version": 1, "description": null }, "framework": null }, "subkind": "subtitle", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.811+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e47046fc-d6ba-4ab5-81de-51f8d602a87b", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 100, "arc": { "name": "Overcoming the Monster", "slug": "overcoming-monster", "status": "active", "bestFor": "Competitive positioning, rallying teams", "canonId": "019dd956-6339-76ac-9cbf-4b377c3aa89e", "version": 1, "bodyDocId": "019df22a-2356-73eb-8061-d8c81dc0aa49", "structure": "The Monster -> The Call -> The Struggle -> The Victory -> The New Order", "description": null, "familyLabel": null }, "from": 61, "name": "Resolution", "beatId": "470ad4dd-317c-46c8-baea-551e7894c3b9", "matchId": "58e6ea24-2d1d-42d0-a666-d4b5fc7b7a5d", "beatType": { "name": "Resolution", "slug": "mountain-resolution", "status": "active", "canonId": "019dd9b8-1ac2-777f-9a8f-ac543fee86f7", "version": 1, "description": null }, "evidence": "The document concludes with a detailed analysis of PGNY's valuation and downside risk.", "position": 4, "isPrimaryArc": true, "parentBeatType": { "name": "Resolution", "slug": "resolution", "status": "active", "canonId": "019dd9b8-045d-703b-8dd7-e92aba3ba91b", "version": 1, "description": "How the deck ends. 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We believe PGNY is capitalizing on patients’ (often reasonable) assumption that the increasing use of new technologies must improve health outcomes. Once again, the actual science does not fully support their claim.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:21.713+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f76e5a88-9f57-4a37-ba28-c2a0eeed08d6", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "We believe PGNY's intimation that “Sarah” suffered a miscarriage due to the lack of PGT is marketing fluff. We believe PGNY is capitalizing on patients' (often reasonable) assumption that the increasing use of new technologies must improve health outcomes. Once again, the actual science does not fully support their claim.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:15+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f3-bc21b7abd07a", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.9, "x": 0.05, "y": 0.36 }, "kind": "list", "text": "Recall in PGNY's investor presentation excerpted on page 86, Sarah's story suggests she suffers a miscarriage without genetic screening and a full-term pregnancy (after fewer cycles) after PGT-A. However, the effect of PGT on miscarriage rates is contentious; some recent studies, including multi-center randomized controlled trials, show a reduced risk of miscarriage (Verpoest et al., 2018, Scriven, 2020), while others found that it did not affect miscarriage rates (Munné et al., 2019, Murphy et al., 2019, Sato et al., 2019), or that miscarriages were rare even following the implantation of embryos classified as ‘abnormal’ (Patrizio et al., 2019). Similarly, the reduction of implantation cycles has also been questioned; a recent systematic review of 26 studies on PGT-A confirms that the add-on should, in theory, be able to enhance clinical outcomes on a per-transfer basis, but finds that the ‘current available literature is sparse or of insufficient quality’ and concludes that the routine use of PGT-A ‘with the aim of improving clinical outcomes is not supported by substantial evidence’ (Toft et al., 2020). In fact, ASRM notes that PGT-A may actually decrease the birth rate per cycle as a result of the embryo’s culturing conditions and cell biopsy, which could adversely affect the embryo, or due to the risk of unnecessarily discarding embryos that are classified as ‘abnormal’ (Penzias et al., 2018). For example, Patrizio et al. (2019) found that the transfers of such ‘abnormal embryos’ nevertheless resulted in ‘robust pregnancy and live birth chances with low miscarriage rates’ and raised concerns about PGT-A leading to the disposal of ‘many normal embryos with excellent pregnancy potential’ (also see Mochizuki and Gleicher, 2020). 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The diagnostic tool has been controversial for decades, since no rigorous studies have conclusively proven the test improves the odds of having a baby... 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However, research suggests that PGNY's intensified approach to fertility does not necessarily reduce all prematurity. Admittedly, a move from multiple to single embryo transfer will limit the number of multiples and their associated risk of preterm births. However, even among elective single embryo transfer (eSET) cycles, IVF pregnancies have a greater risk of preterm birth compared with matched singleton births conceived without reproductive technologies. A recent meta-analysis concludes that 'moving towards eSET as the primary transfer paradigm during IVF will likely not succeed in reducing the elevated risk of preterm delivery seen in IVF singletons' (Fechner et al., 2015, Goisis et al., 2019). 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We believe PGNY needs the clinics more than they need PGNY and that short, 1-year clinic contracts only increase clinic network negotiating leverage, which we believe may pressure PGNY margins going forward.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.227+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a4ee55af-d745-43d2-b6b6-188f6ceb1fa0", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "We believe PGNY needs the clinics more than they need PGNY and that short, 1-year clinic contracts only increase clinic network negotiating leverage, which we believe may pressure PGNY margins going forward.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:16+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f4-7699ce3d3771", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.48, "x": 0.02, "y": 0.66 }, "kind": "list", "text": "Clinic / PGNY Economic Splits: Private-equity owned clinic networks have clearly gained negotiating leverage versus PGNY. PGNY still accounts for a small fraction of most clinics' business, making them less strategic. PGNY must legally sustain a clinic network able to service its new clients, placing the onus on PGNY to ensure capacity.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.227+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "06d195c2-1ed5-4d79-9894-443d6ec0eee0", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.48, "x": 0.52, "y": 0.35 }, "kind": "list", "text": "Clinic Demand: PGNY was widely acknowledged to be a richer payer when the Company launched its fertility benefit; with new entrants undercutting PGNY on price, PGNY may become a less attractive source of business. The large number of high-growth competitors presents other options for clinics seeking growth.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.227+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ac7c1ae6-3187-46fa-950a-63e0e36d0e6b", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.48, "x": 0.52, "y": 0.66 }, "kind": "list", "text": "Clinic Contract Issues: The PGNY network is inherently unstable, as client contracts are typically three years, yet clinic contracts are only one year. PGNY clinic relationships are not exclusive, so PGNY has no ability to secure capacity or differentiate its offering.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:22.227+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b55b6d69-2ad2-4b75-b964-ba1ee377f586", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.48, "x": 0.02, "y": 0.35 }, "kind": "list", "text": "Clinic Supply / Capacity: The fertility clinic landscape is generally considered to be supply constrained, with insufficient new endocrinologists graduating from schools. We believe constrained supply is one explanation for clinics with issues remaining in-network. The best clinics are the ones who need PGNY the least. 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Insiders have reduced their stake from 52% prior to the IPO to 14% as of the 2021 proxy filed in April 2022. If insiders are selling at such a rapid clip, why are investors buying?", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:31:21.08+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ec7afdb9-8a65-4ecd-abed-49ce52713707", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Total Executive and Director Ownership %: 14%", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:34:16+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-2b61-7647-86f4-c11e7ad268a8", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.38, "x": 0.02, "y": 0.95 }, "kind": "source-note", "text": "Sources: PGNY IPO Prospectus, 2019 Proxy, 2020 Proxy, 2021 Proxy", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The consensus estimate projects 41% upside to PGNY's share price. However, there are reasons to be skeptical of the sell-side's bullish stance based on slowing or even negative growth from its largest two customers (~25% of FY22E revenue). 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